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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
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B4 Following a change in the place where the person is deprived of their liberty, the standard
authorisation has been replaced by a new standard authorisation and has therefore
ceased to have effect.
B5 The Court of Protection or another court has made an order that the standard
authorisation is invalid or that it shall no longer have effect.
B6 The person has died.
B7 The standard authorisation has ceased to be in force for some other reason,
which is that given immediately below.
If you placed a cross next to box B7, state the reason here:
PART C — PROVIDING COPIES OF THIS NOTICE
If you have received a copy of this notice, it is because the supervisory body is required to give notice that a
standard authorisation has ceased to be in force to the following persons:
(a) the managing authority of the relevant hospital or care home
(b) the person who was the subject of the standard authorisation
(c) the relevant person’s representative
(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 notice must be given as soon as practicable after the authorisation ceases to be in force.
Signed
(on behalf of the supervisory body)
Dated
Signature
Print name
Position
Date
GFSB-Liberty Form 23.indd 2 18/2/09 12:43:11
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