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Mental Capacity Act 2005
DEPRIVATION OF LIBERTY FORM No. 8
NO REFUSALS ASSESSMENT
PART A — WHY THIS FORM IS BEING COMPLETED
Place a cross in ONE of the boxes below Ø
A1 This form is being completed in relation to a request for a standard authorisation.
A2 This form is being completed in relation to a review of an existing standard
authorisation under Part 8 of Schedule A1 to the Mental Capacity Act 2005.
PART B — BASIC INFORMATION
Name, address and profession of the assessor
Full name of the person being assessed
Name of the hospital or care home in which the
person is, or may become, deprived of their liberty
Name of the PCT or local authority that is the
supervisory body
The present address of the person being
assessed
(Place a cross in the relevant box and, where
applicable, state the address)
Address of the hospital or care home in which the
person is, or may become, deprived of their liberty
(Place a cross in the relevant box and, where
applicable, state the address)
CASE
NUMBER
Name
Address
Profession
Name
Name
Name
As stated on the request for a standard
authorisation
As stated immediately below
Address
As stated on the request for a standard
authorisation
As stated immediately below
Address
GFSB-Liberty Form 8.indd 1 16/2/09 11:49:17
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PART C — RECORD OF THE ASSESSMENT
I have assessed whether the person meets the no refusals requirement.
In carrying out this assessment, I have taken into account any information given to me, and submissions
made, by any of the following:
(a) any relevant person’s representative appointed for the person
(b) any IMCA instructed for the person in relation to their deprivation of liberty.
To the best of my knowledge and belief:
Place a cross in ONE of the boxes below (C1–C4) Ø
C1 THERE IS NO ADVANCE DECISION, LPA OR DEPUTY TO CONSIDER
The person has 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. The
person therefore satis es the no refusals requirement.
C2 THERE IS AN ADVANCE DECISION, LPA OR DEPUTY TO CONSIDER BUT IT
DOES NOT PREVENT THESE ARRANGEMENTS FROM BEING MADE
Any existing advance decision does not prevent the person from being given the
treatment that is proposed. Similarly, any valid decisions made by a donee of a lasting
power of attorney or deputy do not con ict with these proposals for their accommodation,
treatment or care. The person therefore satis es the no refusals requirement.
C3 THE PROPOSED TREATMENT DOES CONFLICT WITH A VALID AND APPLICABLE
ADVANCE DECISION
The person has made a valid and applicable advance decision that prevents them
from receiving some or all of the treatment it is proposed to give them in the hospital
or care home. The person does not therefore meet the no refusals requirement.
C4 THE PROPOSED ARRANGEMENTS DO CONFLICT WITH A VALID AND
APPLICABLE DECISION MADE BY A DONEE OR DEPUTY
Accommodating the person in the hospital or care home, or giving them some
or all of the proposed care or treatment, would con ict with a valid decision
made by a donee or deputy. The person does not therefore meet the no refusals
requirement.
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If you placed a cross in box C2, C3 or C4 explain here why the proposed arrangements in relation to the
standard authorisation either do or do not con ict with the existing advance decision, or a decision made by
a donee or deputy.
Signed
Dated
WHAT TO DO NOW
It is essential that you give a copy of this assessment to the supervisory body as soon as you have
completed it. This is because the supervisory body may not give a standard authorisation unless and until it
has written copies of all the assessments.
If you have placed a cross in box C3 or C4 then the person does not meet the no refusals qualifying
requirement. As a result, a standard authorisation may not be given and all other on-going assessments
should stop. You should immediately notify the supervisory body, and then provide them with a copy of this
assessment as soon as practicable. You must keep a written record of the assessment.
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