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How to Complete the Medical Assessment Referral Form with Authority
The Medical Assessment Referral Form is an important document used for referring clients to receive medical assessment for social assistance in South Africa. It is crucial to complete this form accurately and truthfully to ensure that the client’s medical condition is properly assessed and appropriate assistance is provided.
Medical Assessment Referral Form Part A – Client’s Primary Information
- Fill in the client’s personal details, including their identity number, surname, and full names.
- Indicate the client’s gender by checking the appropriate box (Male/Female).
- Provide the form of identification used by the client, such as their ID or any other method of identification used. If other, specify.
- If you are not the client’s regular treating clinician or institution, provide a reason for completing the form, such as obvious disability, and elaborate on the reason.
Medical Assessment Referral Form Part B – Client’s Medical History (To be completed by Treating Clinician/Institution)
- Confirm the client’s name and ID number.
- Provide information on the client’s medical history, including the presenting problem/symptoms, diagnosis, and any complications.
- Indicate whether the client is compliant with treatment and whether they abuse illegal substances by checking the appropriate boxes (Yes/No).
- Describe how the medical condition has changed over the past 3 months, whether it has improved, stabilized, or worsened, and elaborate on the changes.
- State whether the medical condition is preventing the client from meeting the demands of the open labour market, and elaborate on the impact.
Medical Assessment Referral Form Part C – Declaration
- Read and acknowledge the declaration that all information provided in the referral form is true and correct to the best of your knowledge.
- Sign the form with your full names.
- Provide the official stamp of the treating facility or doctor.
- Fill in the date in the format of day/month/year.
Medical Assessment Referral Form Important Notes
- Provide information on the Social Assistance Act 13 of 2004, Section 30, which states that intentionally furnishing false or misleading information is an offence.
- Mention the consequences of conviction, which include a fine or imprisonment for a period not exceeding 15 years or both.
- Remind the referring clinician that SASSA reserves the right to verify their credentials and conduct quality assurance on all completed medical referral forms.
External Sources
- Link to the Social Assistance Act 13 of 2004: [link to the official government website or any other reliable source where the Act can be accessed]
- Link to the SASSA website for further information on medical assessments: [link to the official SASSA website or any other reliable source for additional information on the medical assessment process]
Note: Please note that the external sources provided should be verified for accuracy and updated information. It is recommended to refer to official government websites or reliable sources for the most up-to-date and accurate information.
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