B1 The person is aged 18 or over.
B2 The person is suffering from mental disorder.
B3 The purpose of accommodating the person here is to give them care or treatment.
B4 The person lacks capacity to make their own decision about whether to be accommodated
here for the purpose of being given the proposed care or treatment.
B5 The person has not, as far as the managing authority is aware, made a valid advance
decision that prevents them from being given any proposed treatment.
B6 Accommodating the person here, and giving them the proposed care or treatment, does
not, as far as the managing authority is aware, conﬂ ict with a valid decision made by a
donee of a lasting power of attorney or deputy appointed by the Court of Protection under
the Mental Capacity Act 2005.
B7 Even though the circumstances amount to depriving the person of their liberty, it is in
their best interests to be accommodated here so that they may be given the proposed
care or treatment.
B8 This is necessary in order to prevent harm to them, and is a proportionate response to the
harm they are likely to suffer if they are not so deprived of liberty, and the seriousness
of that harm.
B9 The need for the person to be deprived of their liberty here is so urgent that it is appropriate
for that deprivation to begin immediately.
B10 The person concerned is not, as far as the managing authority is aware, subject to an
application or order under the Mental Health Act 1983
or, if they are, that order or
application does not prevent an urgent authorisation being given.
PART C — DETAILS OF THIS URGENT AUTHORISATION
This urgent authorisation permits the managing authority to deprive the person of their liberty here, but only
for the purpose of enabling them to be given the care or treatment speciﬁ ed below in section C2 of this form.
C1 THE DURATION OF THIS URGENT AUTHORISATION
This urgent authorisation comes into force immediately.
It is to be in force for a period of: DAYS
The maximum period allowed is seven days.
Enter number of days in the box above ×
This urgent authorisation will expire at the end of the day on:
Enter date in boxes above ×
Important note: the day on which the urgent authorisation is given counts as the ﬁ rst of the days.
For example, if an urgent authorisation is given for seven days at 11.30pm on Monday, it will expire
at the end of the day on the following Sunday.
1 References in this form to provisions of the Mental Health Act 1983 include provisions of other enactments that have the same effect.
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