1
Mental Capacity Act 2005
DEPRIVATION OF LIBERTY FORM No. 23
STANDARD AUTHORISATION HAS CEASED TO BE IN FORCE
PART A — BASIC INFORMATION
Full name of the person to whom the standard
deprivation of liberty authorisation related
Their date of birth (or estimated age if unknown)
Name and address of the relevant hospital or
care home
Name and address of the supervisory body
Person to contact at the supervisory body
PART B — NOTICE THAT THE STANDARD AUTHORISATION HAS CEASED TO BE IN FORCE
The standard authorisation has ceased to be in force, with effect from ,
for the following reason:
Place a cross in the box next to the reason that applies Ø
B1 The managing authority gave notice to the supervisory body that this person had ceased
to meet the eligibility requirement. 28 days have now elapsed since that notice was
given without the suspension having been lifted.
B2 The standard authorisation has expired.
B3 A review of the standard authorisation has been completed (under Part 8 of Schedule A1
to the Mental Capacity Act 2005). The review concluded that the person no longer meets
the requirements for being deprived of their liberty under the Mental Capacity Act 2005.
Name
DOB d d m m y y y y
Est. age Years
Name
Address
Name
Address
Name
Telephone
Email
CASE
NUMBER
ddm
m
yyyy
GFSB-Liberty Form 23.indd 1 18/2/09 12:43:11
