D4 NO REFUSALS REQUIREMENT
The person satisﬁ es the no refusals requirement. This is because:
Place a cross in ONE of the boxes below (A or B) Ø
A They have not made an advance decision or a lasting power of attorney under
the Mental Capacity Act 2005 and no deputy has been appointed by the Court of Protection.
B Any advance decision they have made does not prevent them from being given the
treatment proposed, and any decisions made by a donee of a lasting power of attorney
or deputy do not conﬂ ict with these proposals for their accommodation, treatment and care.
D5 ELIGIBILITY REQUIREMENT (CARE HOME CASES ONLY)
The person satisﬁ es the eligibility requirement because:
Place a cross in the box below to conﬁ rm that the statement made there is correct Ø
A Accommodating them in this care home will not conﬂ ict with any requirement
imposed on them under any of the following provisions of the Mental Health
(a) a community treatment order
(b) a guardianship application or order
(c) sections 2, 3, 4, 35–38, 44, 45A, 47, 48 or 51.
D6 ELIGIBILITY REQUIREMENT (HOSPITAL CASES ONLY)
The person satisﬁ es the eligibility requirement for the following reason:
Place a cross in EITHER Box A OR B Ø
A They are not subject to any relevant provision of the Mental Health Act 1983 and do not
meet the criteria for being detained under section 2 or 3 of the Mental Health Act
B To the extent that they are relevant, the following statements are all true:
(a) The person is not detained in a hospital under one of the following sections
of the Mental Health Act 1983: sections 2, 3, 4, 35–38, 44, 45A, 47, 48 or 51.
(b) If the person is LIABLE to be detained under one of these sections, the purpose for
which the standard authorisation is requested does not consist wholly or partly of
medical treatment for mental disorder in a hospital.
(c) If the person is LIABLE to be detained under one of these sections, accommodating
them in this hospital will not conﬂ ict with a requirement imposed on them in
connection with their liability to detention under the Mental Health Act 1983, for
example as a condition of a leave of absence or conditional discharge from hospital.
1 References in this form to provisions of the Mental Health Act 1983 include provisions of other enactments that have the same effect.
GFSB-Liberty Form 12.indd 6 26/2/09 12:05:31