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T O : T H E S U P E R I N T E N D E N TN A T A L S P R U I T H O S P I T A L
C O N S E N T T O S U P P L Y C O N F I D E N T I A L M E D I C AL R E P O R T
N A M E O F P A T I E N T
H O S P I T A L R E F E R E N C E N O
D A T E OF T R E A T M E N T
I, the u n d e r E i g n e d i
do h e r e b y r e q u e s t and a u t h o r i z e y o u to g i v e a m e d i c a l r e p o r t o n the i n j u r i e s s u s t a i n e d and t r e a t m e n t r e c e i v e d by me, and to s u p p l y c o p i e s of all m e d i c a l r e c o r d s , x - r a y s and r e c o r d s of any o t h e r f o r m o f t r e a t m e n t to : -
T H E S T A T E A T T O R N E Y 8 8 8 R O Y A L S T . M A R Y’S B U I L D I N G
8 5 E L O F F S T R E E T P R I V A T E B A G X9 J O H A N N E S B U R G
as a m a t t e r of u r g e n c y .
I h a v e f u l l y c o n s i d e r e d the i m p l i c a t i o n s of m y a c t i o n s and a u t h o r i z e y o u to g i v e all my m e d i c a l r e c o r d s to my legal r e p r e s e n t a t i v e s or a n y p r i v a t e d o c t o r t h e y m a y a d v i s e m e to see,
S I G N E D at this the ^ ' ^ d a y of
A S W I T N E S S E S : -
S .
'J ) js J s ± v ± d i^O F C O N S E N T E E
OR R I G H T H A N D T H U M B
PH 466 IN THE SUPREME COURT OF SOUTH AFRICA (UITUATERSRAND LOCAL DIVISION)
In the matter between t -
MNQANDU, Nombeko
AND
THE MINISTER OF LAW AND ORDER
REPLY TO NOTICE IN TERMS OF RULE 36<4>
BE PLEASED TO TAKE NOTICE that the P l a i n t i f f h e r e b y a t t a c h e s
r e l e v a n t m e d i c a l r e c o r d s as r e q u e s t e d by the D e f e n d a n t .
day of D E C E M B E R 1992.
N fC H O L L S 7~C AMBAN f B i S U D A N OP L A I N T I F F S’ A T T O R N E Y S 2 3 R D FLOOR, K I N E C E N T R E 1 +1 C O M M I S S I O N E R S T R E E T J O H A N N E S B U R G REF : V S / P P / 4 6
A N D TO : S T A T E A T T O R N E YD E F E N D A N T’S A T T O R N E Y S8 T H F L O O R , R O Y A L S T .M A R Y ’S BLD G8 5 E L O F F S T R E E TJ O H A N N E S B U R GM R .B O W E N / 6 6 7 5 / 9 2 /P5
: . R e c e i v e d c o p y h e r e o f on thisthe r^^-V^lay o f /DEC E M B E R 1992.
F O R : D E F E N D A N T’S A T T O R N E Y SU R E U R I
D A T E D at J O H A N N E S B U R G on th i s the
TO : T H E R E G I S T R A R OF THE A B O V E H O N O U R A B L E C O U R T J O H A N N E S B U R G
CASE NO « 95/56575
Plaintiff
Defendant
G P -S 0C-0162T.P.H. 25B
B U ITE P A S IE N TE EN /O F O N G E V A L L E AFD. • O U TP A TIE N T A N D /O R CASUALTY DEPT.
' - ........... ..................HOSPITAAL • HOSPITAL PASl£NT • PATIENT No.....
Naam voluit Name in full... \ \ W i C o
Huisadres Residential address.........”TT
/ /£- 'Z ' Foon ........................ Phone No..
g s s r . ^ M P '0 ...........................& f > . ;
Naam van persoon verantwoordelik vir betaling van rekening Name of person responsible for payment of account......................
Volgno. Serial No. %
OpgeneemAdmitted
Datum • Date VM.A.M.
NM.P.M.
M
Indeling Classification. U p
Dr..
Sy/Haar adres • His/Her address........................................................................
Naam van werkgewer • Name of employer...
Adres van werkgewer • Address of employer....
|a a m van siekefonds Kame of sick fund.......... S/F
S /FN o..'Jaarlikse gesinsinkomste • Annual family income
Uit alle bronne From all sources
Broodwinner • Breadwinner.
Vrou • Wife.
Ander afhanklikes • Other dependants..
Totaal • Total RS I M c S b , c - / &
*Getal persone fn gesin (brooowinner ingesluit)Number of persons in household (including breadwinner)
Meld ouderdomme van afhanklikes—. . whw.w .iHmg van omariM^Kb q •---State ages of dependants................................................. . 'T '.S / ^ \ %Rede vir afhanklikheid \ / C cReason for dependence..................................................
m
* rM innfrhrw eS va«n, I 6 )aar en ouer wal selfonderhoudend is, moet uitgesluit word) J Minor cNdren 01 16 Vears and o'der who are self-supporting must be'excluded)
atum van ongelukfoesering Date of accident/injury
Persoon wat beseerde inaebring het Person who brought in theTnjured,Sy/Haar adres His/Her addressSy/Haar handtekening . .His/Her signature en v°ertuig No.. . . . — ..................................................................................... . ........................................................... and vehicle No.was beseerde: (i) Onder die invloed van drank?was injured: Underthe influence of liquor?.....................................
(ii) By sy/haar bewussyn?Conscious?......................
Geteken: Opnemingsbeampte Signed: Admitting'bfficer........
van, (J'e PaS'ent se siekte mag vir rekeningdoeleindes vrygestel word The nature of the patient’s illness may be disclosed for accounting purposes
Getuie W itness.......
DatumDate....
GetekenSigned....
{?•
KlagteComplaint..
Huidige siekte Present illness..
SLE G S VIR AFSKEURSTRO KIES FO R CO UN TER FO ILS ONLY
T.P.H. 2Z£
DatumDate Betalngs • Payments Datum
Date Betalmgs • Payments Betalings • Payments
i
< r - -
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I»1
ili
j
11j
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Rekenings • Accounts
0
-
O N D E R SO EK /B EH A N D ELIN G /V O R D ER IN GE X A M IN A TIO N /TR EA TM EN T/PR O G R E SS
T.P.H. 25B
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- -HbSF.TAi.LHOSriTA1 af: eli'v3
r c.S 6T»t « Pc'. c."it FcS;4i!riDTi~,er a F£.:.ev.'s Nj~bsr Cjcie'com
Aceshce!irg
• J r Cle?££:JC£:Cn f
3 3 5 8 0 : : i__t._,-n 'r: •;•.'!? be-sr"ice"£rE - c-c r-s;.s*!s p' p*esrr:p: n
<r. / r,
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C 'r— ------------------------------------- ------------------------------------
. * i • - * . ' * ..... " r ” " ' • <•? f T > \ r 1€ ~ * - •
...j - - - - - - - _____: .............. ' c f 6 • v 2 e r -1................................................................................. - C - f j ! . _
/ . £ . . £ . 0 . c V .C ^ C.V C-' 6 ' . . . f . r v '•■£ C r u l 0 6 V C O fS*sfV vV £ * C fS '» , f * i c W O T '
r c D * c r c n -e C J c l 7 j r P ' £ £- r- •"C C ? C * .6 . ' 'C ? 0 £ ' 'C ' £- r r f ►" " ’,*£■ r
• • '•~ r CS C ’ K w 'V c £ " c * € *"C* £.6 €\rl Z , *.ri£ p r t S C M 'S T £ v\ ' “C 'C .c '6 : lh £ * . *ir 6 c .pp o * e : r e ' e r .c ;
I 0P:5 “ “ “ ' / r f > y r,
, • ‘ REPORT ON E X A M II^A T IO N A lN ^A ffiA SK W F A ^ -------- ------------------------- ^_ I ; ? ? 2 - 0 4 - 1 oTHIS FORM IS TO BE USED BY DISTRICT SURGFONSAIEDICAL
INATS i n A F n iC A K P 0 U S 6
J 88
EGED A SSA U L T OR OTHER CRIME
OFFICERS AND MEDICAL PRACTITIONERS MAKINGON
“B” should be^submined^in C L ! nf*u< ^ raPe a?^ post-mortem examinations where injuries «re found and form snou,(3 De sut,m,« « 3 ,n cases where a female has been examined in connection with a sexual offence.i • V . f T 'r‘ * • : ,'■*£. "7 "
^ THIS IS TO CER^TIFYthat at the request of <>).................................... ^ .
..... ...........................................................................
..............................y~*...... •;••/••......... ••••■have this 0 . . / £ ^ ay of.......................................... 19 .^“?— at Z f? . h •
examined at ...../ % cZ f( ' ........
P I .......■ .................................................................................................... ....................... ............................. .......... the person ofc f'Z ............* .............................................................................................................and have to report as follows:ex....../— ...... ........... ....... Apparent age.....Z..Z. R a c e ...............................................................................
State of the person as regards physical powers and general state of health................
.......................: Z : : : : : Z Z Z : Z 3 E V Z
V ondition o f clothing............— ...... .
^Ri:Rises and abrasions ( if any) («)f . : r H i " - ; . .
W ounds ( if a n y )£ ) ................................
F ractures or dislocations ( if any) (6).._ ..........
A ny o th er injuries («j....... ............................;S tate o f organs o f generation ( if exam ined) (7).. "7 ^ ‘
PlaceD a te / C ^ 7/ U ' / \ o gXtrjrt V m g ro /i , i f u c f l i u / f l / j ^ c e r ..............................i * ...... .JSm.j/....]9 ..../„... or Medical Practitioner
<’) N am « o f official or person a t w hose in stance the ex am ina tion was carried out.H Initials, name and address of district surgeon, medical officer or medical practitioner.• ) D ate and hou r o f con du ctin g th e exam ination .(4) Place where exam ination was carried ou t.
Nam e o f person exam ined.d a te T n d m anner n “ d e x te " ‘ ° f ,h e abras,>o n . w o u n d . o r o ther injury m ust be ex actly described, together w ith its probable exam ination te in g noted * d,SCrepanC>' be,w een ^ !ta tem en t m^ e by th e person and th e conditions ac tu a lly found on
undertaken ? S S f c " ^ ^ ^ “ *“ «*»» is<V) of1,7pVr° ^ ^ 7 io ^ a n d ad?s7osI]\Ta«fdCl0thlI’g “ * * * “ f° T *** '“ eX2mil'ation- “ » *hould be noted here and the manner
<6)
REPORT ON EXAMINATION IN A CASE OF ALLEGED RAPE OR OTHER SEXUAL OFFENCE VERSLAG OOR TC ONDERSOEK VAN TM GEVAL VAN BEWEERDE VERKRAGTING OF ANDER
SEKSUELE OORTREDING
oNaam j
Physical condition...... Ras QuderdomLiggaamlike toestand Sex Life....................... Geestestoestand
M enstruation. ® '//$Menstruasie / Swangerskappe
Assault...........r...................... • - ---- * - • ------- ----- ‘ - -
Injuries: (E xtragenital).........
B reasts......Borste j / — \
Labia majora Groot skaamlippe / /y~y) *Labia m inora.............Klein skaamlippe */ j-J)Vestibule................. /I'.'U/.............V oorhof -----Hymen MaagdevliesVagina: ( 1 , 2 ,3 fingers).....S k ed e (] , 2 ,3 vingers) , . 3F ourchette ......................Lipvlies .Perineum.........................Boudnaat / / /h>\Discharge..................Afskeiding Haemorrhage
C Bloeiing.xamination (easy—painful)
Ondersoek (m ak lik -p y n lik )J J te ru s ....................................Jiaarm oeder oVagina] sm ears.........SkedesmereRem arks-Opm erkings:
OPINION:MENING: J
Signature/Handtekening.....
TO T H E S U P E R 1 NTEUDEI'TiN A T A L S P R U I T H O S P I T A L
C O N S E N T T O S U P P L Y C O N F I D E N TI A L M E D I C AL R E P O R T
do h e r e b y r e q u e s t and a u t h o r i z e y o u to g i v e a m e d i c a l r e p o r t on the i n j u r i e s s u s t a i n e d a n d t r e a t m e n t r e c e i v e d by me, a n d to s u p p l y c o p i e s o f all m e d i c a l r e c o r d s , x - r a y s and r e c o r d s of any o t h e r f o r m of t r e a t m e n t to s -
T H E S T A T E A T T O R N E Y 8 8 8 R O Y A L S T . M A R Y’S B U I L D I N G
8 5 E L O F F S T R E E T P R I V A T E B A G X9 J O H A N N E S B U R G
as a m a t t e r of u r g e n c y .
I h a v e f u l l y c o n s i d e r e d t h e i m p l i c a t i o n s of m y a c t i o n s and a u t h o r i z e y o u to g i v e all m y m e d i c a l r e c o r d s to my legal r e p r e s e n t a t i v e s or a n y p r i v a t e d o c t o r th e y m a y a d v i s e m e to see.
N A M E OF P A T I E N T
D A T E O F T R E A T M E N T
H O S P I T A L R E F E R E N C E N O
1, tht u n d e r s i g n e d ,
S I G N E D a
A S W I T N E S S E S
S I G N A T U R E OF C O N S E N T E E O R R I G H T H A N D T H U M B
O.P.-S. 003-0055 / 0 / e © C ' K
SlMD-AFf^XAAWSE P O ^ S S t\ REPORT ON EXAM INATION IN A CASE OF ALLEGED A ^A U I<*st>K > OTHER C UME
THIS FORM IS TO BE USED BY DISTRICT SURGEONS, MEDICAL OFFICTHE EXAMINATION
A A N K L A O K A N T O O f l
ERS AN D K) B l d A i " p k O l T ITIO R S MAKINGeM« £ s s s r (*
SOUTH AFRiCAK POUCS5 jForm “A” should be com pleted in all cases including rape and post-m ortem exanrinatiuns Where MjUHes are'found and form ‘B” should be subm itted in cases where a female has been examined in connection with a sexual offence.
THIS IS TO C^RTTpY that at the request o f ( ') ........................................... ........................................ ..................................(2).................................................................................................... postal address
examined at (4)............. /..Tt.. ^ .........T i . .................... .............................
Sex........ J~7............................ A pparent age.....R ace.........................................State of the person as regards physical powers and general state o f health
■posts
.................... have this ay o f . . . . ^ ^ ^ / ^ r ^ ' . y/ . . . . . .^ . .1 9 ^ Z r . . . .a t .......U+' ............................... the person of
and have to report as follows:
Condition of c lo th ing .
'Bruisesand abrasions (if any) (6) A-y
Wounds (if any) £)
Fractures or dislocations ( if any) (6)..
Any other injuries (6).................................................State of organs o f generation ( if exam ined) (7)..
Microscopical or o ther special exam ination o f stains, etc. (8)..
Remarks
S £ ^ ....................................................................
&isti a I Si&g^Ofi, M&Ilc'til Offtetr or Medical Practitioner
( ') Name o f official or person a t whose instance the exam ination was carried out.(:) Initials, name and postal address o f district surgeon, medical officer or medical practitioner.<3) Date and hour o f conducting th e exam ination.(4) Place where exam ination was carried out.Is) Name o f person exam ined.(6) In every case th e natu re , position and ex ten t o f the abrasion, w ound, o r o th er injury m ust be exactly described, together with its probable
date and m anner o f causation , any apparen t discrepancy between any sta tem en t m ade by the person and the conditions actually found on exam ination being no ted .
I1) In the case o f a female her consen t, o r, if a m inor, the consent o f her lawful guardian, should be first obtained especially if the exam ination is undertaken in connection w ith a charge o f in fanticide or concealm ent o f b irth .
(8) If any vomit or excreta o r p ortion o f clothing or o ther article is taken for special exam ination , its natu re should be noted here and the manner o f its preservation and disposal s ta ted .
. * ’ REPORT ON EXAMINATION IN A CASE OF ALLEGED RAPE OR OTHER SEXUAL OFFENCE» VERSLAG OOR ’N ONDERSOEK VAN N GEVAL VAN BEWEERDE VERKRAGTING OF ANDER
SEKSUELE OORTREDING
* Form RVorm
N am e..... ........................................................................................................... Race............................................... AgeNaam Ras OuderdomPhysical condition.......................................................................................... Mental s ta te ..................................................................Liggaamlike toestand GeestestoestandSex life ....................../2..Q± t !.C.CC....:...........y................................... ...................................................................................................
M e n s t T u a t i o n . . . ^ . f ^ / ^ . Z . . ^ ^ ^ ^ ^ ^ . ! ^ f ^ . f ^ . . T ? . . ^ ^ . . / ^ /^ re g M n c ie s ................................... >..............................Menstruasie Swangerskappe
Assault........Aanranding
i M . .Injuries: (E xtragenital)......................^ j^ ring s: (Uiterlike geslagsdele)
Breasts.................. ................................A K V a ..........m H . ......
Groot skaamlippe /Labia m inora.................Klein skaamlippeVestibule.................... t ..............Voorhof /if If—AH ym en.................. ................................MaagdevliesVagina: ( 1 , 2 ,3 fingers) ...£ Z s....'.Skede (1, 2 ,3 vingers)Fourchette................
...............A / M ...................
£ £ £ ........ir T U k k .....h id *Afskeiding , Y 1
Ha emorrhage............BloeiingExamination (easy-painful)...'( ^ ^ « s o e k (m aklik— pynlik)
i S . T S L f e : ... . < £ 2 .^^ .e d e sm e reRemarks-Opmerkings:
OPINION:MENING:
i
Signature/Handtekening.
G.P.-S. C -005*< * 9 / 9 ^ ?;u u > a f w k a a k s e p o u s i e
<. REPORT ON EXAM INATION IN A CASE OF ALLEGED A S S A J ^ y ^ ^ ^ K H R CRI1992 -04- 0 9
FICER|S AND MTHE EXAMINATION
THIS FORM IS TO BE USED BY DISTRICT SURGEONS, MEDICAL OFFICERS AND MEDICAL PRACTITIONERS MAKINGO M A W W p F n c t
Form “A” should be com pleted in all cases including rape and post-m ortem
T M O K O Z A
SOUTH AFRICAN POLICE
“ B” should be subm itted in cases where a female has been examined in connection w ith a sexual offence.exam inations where injuries are found and form
^ THIS IS TO C E O I F ^ tha t at the request o f ( ') ............................................. ....................................................... ...................................... 1....................................................................................................... .^postal address (2) . &?%... / .........................................................................
.......... ....,have this..................... dav o f..... .................................. J? ....a t.............................................................. ..have this (3) . . / £ _ d a y o f....^ ..u ;> « ........ ................................0 . ....................examined at (4). .y. . . .Srr..4 ' t ^ S . . Jl. .^ T T T .......... .................... ^rr:^r^r^7... ....... '...................................the person of
P)............Jy.v.iSex....... t ...............................’ A pparent age.State o f the person as regards physical powers and general state of health.
................................................................ - ...... ...........................................................and have to report as follows:........... A pparent age....r...... /..<£......:... R ace...........................................................................................................................
Fractures or dislocations ( if any) (6).
Any other injuries (6).State of organs o f generation (if exam ined) (7).
( ') Name o f official or person a t w hose instance the exam ination was carricd out.(2) Initials, name and postal address of district surgeon, medical officer or medical practitioner.t3) Date and hour o f conducting th e exam ination.(4) Place where exam ination was carried out.(5) Name o f person exam ined.(6) In every case th e natu re , position and ex ten t o f the abrasion, w ound, o r o th er in jury m ust be exactly described, together with its probable
date and m anner o f causation , any apparen t discrepancy between any sta tem en t m ade by the person and the conditions actually found on examination being noted .
(7) In the case o f a female h er consen t, or, i f a m inor, th e consent o f her lawful guardian , should be first obtained especially if the examination is undertaken in connection w ith a charge o f infanticide or concealm ent o f b irth .
(8) If any vomit or excreta or po rtio n o f c lothing or o th er article is taken for special exam ination , its natu re should be noted here and the manner o f its preservation and disposal sta ted .
I
REPORT ON EXAMINATION IN A CASE OF ALLEGED RAPE OR OTHER SEXUAL OFFENCE YERSLAG OOR ’N ONDERSOEK VAN ’N GEVAL VAN BEWEERDE VERKRAGTING OF ANDER
SEKSUELE OORTREDING
Form DVorm “
N ajue..........M t A .
Q a L / ........................................
T M sjcL .......
NaamPhysical condition Liggaamlike toestand Sex life ......Ceslagslewe // /M enstruation.........Menstruasie J
Race...............................................RaS /Mental s ta te ..........Geestestoestand
Age Ouderdom
■
Pregnancies.....?.Swangerskappe
A ssault.........Aanranding
Injuries: (E xtragenital).................B ^pings: (Uiterlike geslagsdele)
Breastsf kste
lb
J M i.
& r ) . .J y .............
...........I I S I
Ml
5Dia majora.......Groot skaamlippeLabia m inora.......Klein skaamlippeVestibule...............VoorhofHym en..................MaagdevliesVagina: ( 1 , 2 ,3 fingers).............................Skede ( 1 ,2 ,3 vingers) / L S \ .Fourchette...............................LipvliesPerineum............Boudnaat l. II < /Discharge................Afskeiding / / IHaemorrhage...........All-)—-...BloeiingF j^ in a t io n (easy-painful).C .'^^so ek (m aklik -pynlik )U tm is ............................................l^iarmoeder
inal sm ears....... f.kis.Hedesmerem
Remarks-Opmerkings:
/ ^/ _ \/ j 1 \
// / A \
\\
/ N1 A s \1 r j \ V \< / ii \ ' 1
1fV I j y
//
\ ///« /
•
V \ \
OPINION:MENING:
S ig n a tu r e /H a jid te k e w f l^ T ^ T ^ ^ ^ X ^ .
I
Collection Number: AK2702 Goldstone Commission of Enquiry into PHOLA PARK Records 1992-1993 PUBLISHER: Publisher:-Historical Papers, University of the Witwatersrand Location:-Johannesburg ©2012
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