Fillable Form 3: Assessment of capacity (Cabinet Office)

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Form 3: Assessment of capacity (Cabinet Office)

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1
COP
3
12.17
Court of Protection
Assessment of capacity
For office use only
Date received
Case no.
Full name of person to whom the application relates
(this is the name of the person who lacks, or is alleged to lack, capacity)
Please read first
• If you are applying to start proceedings with the
court you must file this form with your COP1
application form. The assessment must contain
current information.
• You must complete Part A of this form.
• You then need to provide the form with Part A
completed to the practitioner who will complete
Part B. The practitioner will return the form to
you or your solicitor for filing with the court.
• The practitioner may be a registered:
– medical practitioner, for example the GP of
the person to whom the application relates;
– psychiatrist
– approved mental health professional
– social worker
– psychologist
– nurse, or
– occupational therapist
who has examined and assessed the capacity of
the person to whom the application relates.
In some circumstances it might be appropriate
for a registered therapist, such as a speech
therapist or occupational therapist, to complete
the form.
• When the form has been completed, its contents
will be confidential to the court and those
authorised by the court to see it, such as parties
to the proceedings.
• Please continue on a separate sheet of paper
if you need more space to answer a question.
Write your name, the name and date of birth of
the person to whom the application relates, and
number of the question you are answering on
each separate sheet.
• There are additional guidance notes at the end
of this form.
• If you need help completing this form please
check the website,
www.gov.uk/court-of-protection, for further
guidance or information, or contact Court Enquiry
Service on 0300 456 4600 or
courtofprotectionenquiries@hmcts.gsi.gov.uk
• Court of Protection staff cannot give legal
advice. If you need legal advice please contact
a solicitor.
• This form has been prepared in consultation
with the British Medical Association, the
Royal College of Physicians, Royal College of
Psychiatrists and the Department of Health.
© Crown Copyright 2017
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2
Part A - To be completed by the applicant
Section 1 - Your details (the applicant)
1.1 Your details
Mr. Mrs. Miss Ms. Other
First name
Middle name(s)
Last name
1.2
Address
(including
postcode)
Telephone no.
Daytime
Evening
Mobile
E-mail addr
ess
1.3 Is a solicitor representing you?
Yes No
If Yes, please give the solicitor’s details.
Name
Address
(including
postcode)
Telephone no. Fax no.
DX no.
E-mail address
1.4 To which address should the practitioner return the form when they have completed Section 2?
Your address
Solicitor’s address
Other address (please provide details)
3
Section 2 - The person to whom the application relates (the person to be assessed by
the practitioner)
2.1
Mr. Mrs. Miss Ms. Other
First name
Middle name(s)
Last name
Address
(including
postcode)
Telephone no.
Date of birth Male Female
Section 3 - About the application
3.1 Please state the matter you are asking the court to decide. (see note 1)
3.2 What order are you asking the court to make?
3.3 How would the order benefit the person to whom the application relates?
3.4 What is your relationship or connection to the person to whom the application relates?
4
Section 4 - Further information
Please provide any further information about the circumstances of the person to whom the application
relates that would be useful to the practitioner in assessing his or her capacity to make any decision(s) that
is the subject of your application. (see note 2)
Now read note 3 about what you need to do next.
5
Part B - To be completed by the practitioner
Section 5 - Your details (the practitioner)
5.1
Mr. Mrs. Miss Ms.
Dr.
Other
First name
Middle name(s)
Last name
Address
(including
postcode)
Telephone no.
E-mail address
5.2 Nature of your professional relationship with the person to whom the application relates
(For example, social worker or general practitioner (GP))
5.3 Please state your professional qualifications and practial experience with particular reference to making
assessments of capacity in accordance with the Mental Capacity Act 2005 and associated Code of
Practice.
6
If there is information that you do not wish to provide in this form because of its
sensitive nature you can provide the information directly to the court.
6.1 Are you providing any sensitive information separately to the court?
Yes No
Please provide it in writing to:
Court of Protection
PO Box 70185
First Avenue House
42-49 High Holborn
London WC1A 9JA
DX 160013
Kingsway 7
Please include your name and contact details, and the name, address and
date of birth of the person to whom the application relates on any information
you provide separately to the court.
Section 7 - Assessment of capacity
7.1 The person to whom the application relates has the following impairment of, or disturbance in the
functioning of, the mind or brain. Where this impairment or disturbance arises out of a specific diagnosis,
please set out the diagnosis or diagnoses here: (see note 4)
This has lasted since:
As a result, the person is unable to make a decision for themselves in relation to the following
matter(s) in question:
7
7.2 The person to whom the application relates is unable to make a decision in relation to the relevant matter
because: (see note 5)
he or she is unable to understand the following relevant information (please give details);
and/or
he or she is unable to retain the following relevant information (please give details);
and/or
he or she is unable to use or weigh the following relevant information as part of the
process of making the decision(s) (please give details);
and/or
is unable to communicate his or her decision(s) by any means at all (please give details).
8
7.3 My opinion is based on the following evidence of a lack of capacity:
7.4 Please answer either (a) or (b).
(a) I have acted as a practitioner for the person to whom the application
relates since and last assessed
him or her on
(b) I assessed the person to whom the application
relates on
following a referral from:
9
7.5 Has the person to whom this application relates made you aware of any views they
have in relation to the relevant matter?
Yes No
If Yes, please give details.
7.6 Do you consider there is a prospect that the person to whom the application relates might regain or
acquire capacity in the future in respect of the decision to which the application relates? (see note 6)
Yes – please state why and give an indication of when this might happen.
No – please state why.
7.7 Are you aware of anyone who holds a different view regarding the capacity of the
person to whom the application relates?
Yes No
If Yes, please give details.
10
7.8 Do you, your family or friends have any interest (financial or otherwise) in any
matter concerning the person to whom the application relates?
If Yes, please give details.
Yes No
7.9 Do you have any general comments or any other recommendations for future care? (see note 7)
Signed
Name Date
Now read note 8 about what you need to do next.
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11
Guidance notes
Note 1
About the application
These questions are repeated on the COP1 application
form. Please copy your answers from the COP1 form
so that the information on both forms is the same.
Note 2
Further information
Please provide any further information about the
circumstances of the person to whom the application
relates that would be relevant in assessing their
capacity. For example, if your application relates to
property and financial affairs, it would be useful for the
practitioner to know the general financial circumstances
of the person concerned. This information will help the
practitioner evaluate the decision-making responsibility
of the person to whom the application relates and may
help to inform the practitioner’s view on whether that
person can make the decision(s) in question.
Note 3
What you need to do next
Please provide this form to the practitioner who will
complete Part B.
The practitioner will return the form to you or your
solicitor when they have completed Part B. You will
then need to file the form with the court together with
the COP1 application form and any other information
the court requires. See notes on the COP1 form for
further information.
Note 4
Assessing capacity
For the purpose of the Mental Capacity Act 2005 a
person lacks capacity if, at the time a decision needs to
be made, he or she is unable to make or communicate
the decision because of an impairment of, or a
disturbance in the functioning of, the mind or brain.
The Act contains a two-stage test of capacity:
1. Is there an impairment of, or disturbance in the
functioning of, the person’s mind or brain?
2. If so, is the impairment or disturbance sufficient
that the person lacks the capacity to make a
decision in relation to the matter in question?
Please refer to Part A of this form where the applicant
has set out details of the application and relevant
information about the circumstances of the person to
whom the application relates. In particular, section 3.1
sets out the matter the applicant is asking the court
to decide.
The assessment of capacity must be based on the
person’s ability to make a decision in relation to the
relevant matter, and not their ability to make decisions
in general. It does not matter therefore if the lack of
capacity is temporary, if the person retains the capacity
to make other decisions, or if the person’s capacity
fluctuates.
Under the Act, a person is regarded as being unable to
make a decision if they cannot:
• understand information about the decision to
be made;
• retain that information;
• use or weigh the information as part of the
decision-making process; or
• communicate the decision (by any means).
A lack of capacity cannot be established merely by
reference to a person’s age or appearance or to a
particular condition or an aspect of behaviour. A person
is not to be treated as being unable to make a decision
merely because they have made an unwise decision.
The test of capacity is not the same as the test for
detention and treatment under the Mental Health Act
1983. Many people covered by the Mental Health Act
have the capacity to make decisions for themselves.
On the other hand, most people who lack capacity to
make decisions will never be affected by the Mental
Health Act.
Practitioners are required to have regard to the Mental
Capacity Act 2005 Code of Practice. The Code of
Practice is available online at www.gov.uk/court-
of-protection Hard copies are available from The
Stationery Office (TSO), for a fee, by:
• phoning 0870 600 5522;
• emailing customerservices@tso.co.uk; or
• ordering online at www.tsoshop.co.uk -
ISBN 9780117037465
For further advice please see (for example):
• Making Decisions: A guide for people who work
in health and social care (2nd edition), Mental
Capacity Implementation Programme, 2007.
• Assessment of Mental Capacity: Guidance
for Doctors and Lawyers (2nd edition), British
Medical Association and Law Society (London:
BMJ Books, 2004)
12
Note 5
Capacity to make the decision in question
Please give your opinion of the nature of the lack of
capacity and the grounds on which this is based.
This requires a diagnosis and a statement giving clear
evidence that the person to whom the application
relates lacks capacity to make the decision(s) relevant
to the application. It is important that the evidence of
lack of capacity shows how this prevents the person
concerned from being able to take decision(s).
Note 6
Prospect of regaining or acquiring capacity
When reaching any decision the court must apply the
principles set out in the Act and in particular must
make a determination that is in the best interests of
the person to whom the application relates. It would
therefore assist the court if you could indicate whether
the person to whom the application relates is likely
to regain or acquire capacity sufficiently to be able to
make decisions in relation to the relevant matter.
Note 7
General comments
The court may make any order it considers appropriate
even if that order is not specified in the application
form. Where possible, the court will make a one-off
decision rather than appointing a deputy with on-going
decision making power. If you think that an order other
than the one being sought by the applicant would
be in the best interests of the person to whom the
application relates, please give details including your
reasons.
Note 8
What you need to do next
Please return the completed form to the applicant
or their solicitor, as specified in section 1.4. You are
advised to keep a copy for your records.
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Completed 15 October 2020

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