( j ^ 7 0 2 C 5G p.-s C*<-C162 T.P.H 25B

BUITEPASIENTE EN/OF ONGEVALLE AFD. • OUTPATIENT AND/OR CASUALTY DEPT.

. HOSPITAAL • HOSPITAL PASlSNT . PATIENT No...........

Nlaarn v^iuit Name in full...

Huisadres Residential address - 0 ^

/ \C 'Z ' Foon ............................. Phone No.

Huwelikstaat Geslag Ras ^Marita! state ................... S e x .......... .1.................................... Race.........~z..r......

Reroep. r - ^ c ^ / Ge^ or1edatum < ^ .O c c u p a t i o n . . . . ...................^? .^? .^~ "D a te of birth... .^^THY...!................

Naam van persoon verantwoordelik vir betaling van rekening Name of person responsible for payment of account....................

Sy/Haar adres • His/Her address................

Naam van werkgewer • Name of employer..

Volgno. Serial No. %

OpgeneemAdmitted

Datum • Date VM.A.M.

NM.P.M.

M

IndelingClassification.

Dr..

......................

j S - B . S V - • K t ^ c i . 4 -Adres van werkgewer • Address of employer........~ r^ r? . ........

^ aam van siekefonds S/F ■‘ \v_ . ame of sick fund................................................................................................ ........................................................ S/F No

’ Jaarlikse gesinsinkomste • Annual family income Uit alle bronne From all sources

Brood winner • Breadwinner.

Vrou • W ife.............................

Ander afhanklikes • Other dependants.................................................................................................. R

<=_ / &Totaal • Total R

*Getal persone in gesin (brooowinner ingesluit)Number of persons in household (including breadwinner)..............

Meld ouderdomme van afhanklikes ^ „ State ages of dependants...........................................................'t/ .S ..

Rede vir afhanklikheid \ / \r r j j is p Reason for dependence...................................................................................

C* (Minderjariges van 16 jaar en ouer wat selfonderhoudend is, moet uitgesluit word)* (Minor children of 16 years and older who are self-supporting must be excluded)

atum van onoelukfoesering j Date of accident/injury

Persoon wat beseerde ingebring het Person who brought in thelnjured

Sy/Haar adres His/Her address

Sy/Haar handtekening en voertuig No. His/Her signature......................................................................................................................................................... and vehicle No.Was beseerde: (i) Onder die invloed van drank?

Underthe influence of liquor?..........................................................................(ii) By sy/haar bewussyn?

Conscious?................................. ...........................

Was injured:

Geteken: Opneminasbeampte Signed: Admittina'officer........

Die aard van die pasient se siekte mag vir rekeningdoeleindes vrygestel word. The nature of the patient’s illness may be disclosed for accounting purposes.

Getuie W itness.

Datum Date......

8GetekenSigned....

KlagteComplaint..

Huidige siekte Present illness

T.P.H. 2E=

SLEG S VIR AFSKEURSTROKIES FOR COUNTERFOILS ONLY

ONDERSOEK/BEHANDELING/VORDERINGEXAMINATION/TREATMENT/PROGRESS

T.P.H 25B

T0? ’

Datum • Date

fo

r ■+

p \

\ — 4 * V ' t r

£ u j > i “ i & t ,

<L-c

r' ->W

W \ ---- c—t)

r ~

V -7 ^A -~ r &

v/vVW - t:V

'Vr-b

W . & _

fo

VOORSKRIF • PRESCRIPTION

J / CP Y r s J “

; REPORT ON EXAMI^ATIONaIN^ A .€ A S £ w©F AL -EGED ASSAULT OR OTHER CRIME

_ I ;?92 -04- 1 oTHIS FORM IS TO BE USED BY ijlS T R lC T ^ l^ C F r ^ v ^ D irA I

INAT

^UTnAFntCAK-POUfiB

DFFICERS AND MEDICAL PRACTITIONERS MAKINGON

- i r I z z s s i s , 1; " d ’ °™

THIS IS TO C E R ^T F Y jhat at the request o f { ') .................................. ^ ...... ............................................................................

...................................Y ir ....... 7 / ..................iiave this (3)..Z (? .^ ]d a y of..................................................1 9 . ! f . ^ ^ t /$ h ^ •........examined at .......Jpf - /7 c^ /( ........................ .. ......................P).......... ................................................................................................................................................... .............................................. the person o fc t .......... ........................................................................................................... and have to report as follows:Sex...... '■.................................... A pparent age..... . „ . . ._ .^ f Z . ._ R ace ...................................................................................

S tate o f the person as regards physical powers and general state o f hea lth ................

f .V ondition o f c lo th in g ............^ .....

.uises and abrasions ( if any) (6).

Wounds ( if a n y )£ ) ............................

Fractures or dislocations ( if any) (6)..

Any o ther injuries (6)..............................

S tate o f organs o f generation ( i f exam ined) C)..

l i t V w rjpiT,!^ -Officeror Medical Practitioner

(’) Name o f official or person a t w hose instance the exam ination was carried out.( ) Initials, name and address o f d istric t surgeon, m edical officer or medical practitioner.<3) Date and hour o f conducting the exam ination.(4) Place where exam ination was carried out.<5) Name o f person exam ined.

<6) J ,"every, case the n ?tu re - Position and extent o f th e abrasion, wound, o r other injury m ust be exactly described, together with its probable e x ^ n a t i o n W n g ^ o T e r 0 0 " ’ diSClepanCy * * * '“ " ^ statem ent made by the person and the conditions actually found on

n £ & * r . S c . S f o n ' S T 3 : ^ v a z s & s z z s s s z s : r “ ' * * * * • » « * « * • » — •*» <■

{>> W 0 th e l 2111016 “ Uken f° T SpeCia, exam inalion- i,s na ,ure should be noted here and the manner

VERSLAG OOR *N ONDERSOEK VAN N GEVAL VAN BEWEERDE VERKRAGTING OF ANDERSEKSUELE OORTREDING

N am e. .....fh tv ............... ........ R ace................................................ A k ..... S ' Z - ■

p.*3™ . Ras ^ OuderdomPhysical cond .tion ................ tk&fZZ...................................................... M ental stateLiggaamlike toestand G eestestoestand ............................ .....................................................Sex life ......................................................................................................................Geslagslewe ./ - ^ .............................................................. ................................................ ..............................M e n s t r u a t i o n . . . . y ^ ^ / . f ? / ^ . ^ ^ ^ . ......................................... Pregnancies.......... /Menstruasie / Swangerskappe ..............................................................................

/ ' ............................................................................................................................................................................................... .. .Assault........... /T................................................................Aanranding .....................................................................................................................................................

REPORT ON EXAMINATION IN A CASE OF ALLEGED RAPE OR OTHER SEXUAL OFFENCE

Injuries: (E x tragen ita l).........( ieserings: (Uiteriike geslagsdele)

a !

1/ M l

A/U..........

, 2

breasts ^ Jo rste

Labia m ajo ra........G root skaamlippeLabia m inora.......Klein skaamlippeVestibule............... .V oorhofH ym en................................MaagdevliesVagina: (1 , 2 ,3 fingers) S k e d e ( l , 2 ,3 vingers) , ^F o u rch ette ....................../t./Of..Lipvlies rn—,}Perineum.........................A..’C2)..Boudnaat Sf/h\Discharge...................Afskeiding Haemorrhage

C-Bloeiing -xam ination (easy-painful).

Ondersoek (m ak lik -p y n lik )'U e ru s ....................................

aarmoeder oVagin al sm e a rs .........5<!rrr.Skedesmere

A,

. / <

' N

/ C\/ J 1 \

/ / a V\

\

/ / y v \ N

/ / / 1 I > y \\

/ jK J I \ \, j / \ 1

\ ( f ” A 11

/

\ \ V j J 1\ n . /\ ------------- /

•

Rem arks-O pm erkings:

OPINION:MENING: J

Signature/H andtekening

I

S MAKING

REPORT ON EXAMINATION IN A CASE OF ALLEGED A S S A J& fcS gU S T ttH R C Rl(^1E f \ S I

1992 -04- 0 9THIS FORM IS TO BE USED BY DISTRICT SURGEONS. MEDICAL O FFIC E R ^ AND M ED IC A LPR A C Tm O N EF

THE EXAMINATION T C N A J ^ O r r f c tT

SOUTH AFRICAN POLICE•B” s h i COmpleled “ ; U “ eluding rape and post-mortem examinations where injuries are found and form

shou,d be submitted in cases where a female has been examined in connection with a sexual offenc*.

^ THIS IS TO C ER TIFY tha t at the request o f (')

1 .........................

..... ................................................................... have this (» )../C ^ ;„d

exam ined ajt (‘L ......... £ 1 . .

Race.

c

F)......... ..............................................

Sex........rZ............................... A pparent a g e .. . .h .. . . . /^ L „ .; ,

S tate o f the person as regards physical powers and general sta te o f health

................................ ..............................................................................

gtal address ?) ........

day o f ..... ....................................................................................

— ..................................the person of

....... and have to report as follows:

ondition o f clothing.

'B ruises and abrasions ( if an y ) (6).

W ounds ( if any) £)..

F ractures or dislocations ( i f any) (6).

A ny o ther injuries (t)............................

S ta te o f organs o f generation ( i f exam ined) (7).

( ') Name o f official or person a t whose instance the exam ination was carried out.( ) Initials, name and postal address of district surgeon, medical officer or medical practitioner.,5J Date and hour o f conducting the exam ination.(4) Place where exam ination was carried out.<5) Name o f person exam ined.

In every case the na ture , position and extent o f the abrasion, wound, or o ther in jury m ust be exactly described, together w ith its probable d ate and manner o f causation , any apparent discrepancy betw een any statem ent m ade by the person and the conditions actually found on exam ination being no ted .

<7) In the ease o f a female her consent, or, i f a m inor, the conscnt o f her law ful 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 birth.

<8; vomi' or excreta or portion o f clothing or o ther article is taken for spccial exam ination , its nature should be noted here and the mannero f its preservation and disposal stated.

tt

VER5LAG OOR *N ONDERSOEK VAN *N CEV A L VAN BEWEERDE V ERKRACTING OF ANDER SEKSUELE OORTREDING

REPORT ON EXAMINATION IN A CASE OF ALLEGED RAPE OR OTHER SEXUAL OFFENCE

.......... ........................................................................................................ Race................................................

Physical condition ..... ..QaJu.......................... .......... M ental s ta te .........

................................................... G" s,es,oes,“ d0<**lags)ewe 7/ jfM enstruation......... ............................................................................M enstruasie u

A ge. 'Ouderdom

/ f ■

Pregnancies Swangerskappe

Assault.........A anranding

Injuries: (E x tragen ital)...................B a r in g s : (Uiterlike geslagsdele)

A i . .h ..............

W E E .

" M .

B d T iLabia m ajo ra .........G ropt skaamlippeLabia m inora.........Klein skaam lippeV estibule................V oorho fH y m en ....................Maagdevlies ^ Vagina: ( 1 , 2 , 3 fingers).....

r o S ' m 2 ' 3 V' n s m )

S l ...........M L ....B oudnaat / . / / . JD ischarge.................IW.hl.T&r...............A fskeiding At I H aem orrhage..,......../\l.Bloeiing '/?Exam ination (easy-painful)..M soek (m ak lik -p y n lik ) /I ' i g .B j ^ ^ d e rVagtnjil sm ears........(k>..l!f;,Skedesm ere

R em arks-O pm erkings

OPIN IO N :M ENING: J

Signature/H andteki

-

Collection Number: AK2702 Goldstone Commission of Enquiry into PHOLA PARK Records 1992-1993 PUBLISHER: Publisher:-Historical Papers, University of the Witwatersrand Location:-Johannesburg ©2012

LEGAL NOTICES:

Copyright Notice: All materials on the Historical Papers website are protected by South African copyright law and may not be reproduced, distributed, transmitted, displayed, or otherwise published in any format, without the prior written permission of the copyright owner.

Disclaimer and Terms of Use: Provided that you maintain all copyright and other notices contained therein, you may download material (one machine readable copy and one print copy per page) for your personal and/or educational non-commercial use only.

People using these records relating to the archives of Historical Papers, The Library, University of the Witwatersrand, Johannesburg, are reminded that such records sometimes contain material which is uncorroborated, inaccurate, distorted or untrue. While these digital records are true facsimiles of the collection records and the information contained herein is obtained from sources believed to be accurate and reliable, Historical Papers, University of the Witwatersrand has not independently verified their content. Consequently, the University is not responsible for any errors or omissions and excludes any and all liability for any errors in or omissions from the information on the website or any related information on third party websites accessible from this website.

This document is part of a private collection deposited with Historical Papers at The University of the Witwatersrand by the Church of the Province of South Africa.