Requesting authorisation for a deprivation of liberty
Deprivation of Liberty forms
To apply for authorisation of a deprivation of liberty download the appropriate form below and send by fax only to 01296 383338.
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Form 4 - Request for a standard authorisation Word doc
Form 1 - Notification of urgent authorisation Word doc
Form 2 - Notification of extension of urgent authorisation Word doc
Form 19 - Request for a review of a standard authorisation Word doc
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| No. | Question | If answered no | If answered yes |
|---|---|---|---|
| 1 | Does the relevant person lack capacity to consent to the measures you wish to take? | No application can be made | Application may be required |
| 2 | Can he/she receive care through less restrictive but still effective alternatives? | Application may be required | Application can not be made |
| 3 | Is the person 18 years of age or older (or going to turn 18 within 28 days)? | No application can be made | Application may be required |
| 4 | Is the relevant person detained under the Mental Health Act? | Application is required | Application can not be made |
| 5 | Has the person made an advance decision to refuse relevant medical treatment? | Application may be required | Application can not be made |
| 6 | Is the relevant person currently residing in a hospital providing treatment for mental illness and do they object to the proposed care or treatment? | Application may be required | Application can not be made |
| 7 | Is there someone holding a power of attorney or a Deputy appointed by the court of protection who is indicating that they would oppose this application? | Application is required | Application may not be made |
| 8 | Should the authorisation for DoLS begin immediately? | Apply for a standard authorisation | Grant urgent authorisation |
For more information call 01296 382195 or email dols@buckscc.gov.uk
