PART D — WHETHER THERE APPEARS TO BE AN UNAUTHORISED DEPRIVATION OF LIBERTY
Place a cross in either box D1 or D2 below Ø
D1 The best interests assessment report included a statement that it appeared to the assessor
that this person is, or is likely to be, subject to an unauthorised deprivation of liberty
D2 The best interests assessment report included a statement that it appeared to the assessor
that this person is not, or is not likely to be, subject to an unauthorised deprivation of liberty
PART E — PROVIDING COPIES OF THIS DECISION
As soon as practicable, the supervisory body must give a copy of this decision notice to the following:
(a) the managing authority of the hospital or care home
(b) the person in respect of whom the deprivation of liberty authorisation was requested
(c) any IMCA instructed for the person under section 39A of the Mental Capacity Act 2005 in relation to the
request for a standard authorisation
(d) every person named by the best interests assessor in their report as an interested person whom they
have consulted in carrying out their assessment.
This form is also your notice that any urgent authorisation previously in force now ceases to have effect. As
a result, there is now no authority to deprive this person of their liberty under the Mental Capacity Act 2005.
PART F — PROVIDING COPIES OF THE ASSESSMENTS
Copies of all the assessments in relation to the above person have been attached to this decision notice.
They will be sent as soon as practicable to all of the persons listed in paragraphs (a) to (c) of Part E above.
Unless they also fall within paragraphs (a) to (c) of Part E above, interested persons consulted by the best
interests assessor are entitled to receive a copy of this notice but not copies of the assessments.
(on behalf of the supervisory body)
NOTE TO THE MANAGING AUTHORITY OF THE HOSPITAL OR CARE HOME
Because your request has been refused on this occasion, you are not required to make a new request for
a standard authorisation unless it appears to you that there is a change in the person’s circumstances as a
result of which the supervisory body is likely to give a standard authorisation.
GFSB-Liberty Form 13.indd 3 16/2/09 12:27:43
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