Mental Capacity Act Forms | Department of Health

The legal framework for Deprivation of Liberty provided by the Act is supported by a set of Forms. Most of the Forms are statutory but all are recommended to be used. These Forms support Phase One of the implementation and commencement of the Act only.

Details

Forms 1-2 and 4-16 are statutory Forms which must be used when undertaking certain functions under the Act therefore the content of the Forms cannot be amended.

Forms 3 and 17-21 are not statutory Forms. However, their contents are statutory so it is highly recommended that they are used.

Form 22 is for guidance only.

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Documents

MCA(NI) 2016 - Form 1 – Statement of incapacity (Statutory Form)
Word (53 KB)

MCA(NI) 2016 - Form 2 – Best interests determination statement (Statutory Form)
Word (51 KB)

MCA(NI) 2016 - Form 3 – Consultation with nominated person (Non-Statutory Form)
Word (48 KB)

MCA(NI) 2016 - Form 4 - Care plan (Statutory Form)
Word (47 KB)

MCA(NI) 2016 - Form 5 – Application for trust panel authorisation (Statutory Form)
Word (50 KB)

MCA(NI) 2016 - Form 6 – Medical report (Statutory Form)
Word (52 KB)

MCA(NI) 2016 - Form 7 – Statement that the person lacks capacity whether an application should be made to the Review Tribunal (Statutory Form)
Word (49 KB)

MCA(NI) 2016 - Form 8 – Short-term detention authorisation for examination or examination followed by treatment or care (Statutory Form)
Word (55 KB)

MCA(NI) 2016 - Form 9 – Consultation with approved social worker (Statutory Form)
Word (49 KB)

MCA(NI) 2016 - Form 10 – Short-term detention admission exception certificate (Statutory Form)
Word (48 KB)

MCA(NI) 2016 - Form 11 – Short-term detention admission report (Statutory Form)
Word (51 KB)

MCA(NI) 2016 - Form 12 – Short-term detention further admission report (Statutory Form)
Word (52 KB)

MCA(NI) 2016 - Form 13 – Short-term detention further report (Statutory Form)
Word (52 KB)

MCA(NI) 2016 - Form 14 – Extension authorisation (extension by report) (Statutory Form)
Word (54 KB)

MCA(NI) 2016 - Form 15 – Responsible person statement (Statutory Form)
Word (50 KB)

MCA(NI) 2016 - Form 16 – Application for trust panel extension authorisation (Statutory Form)
Word (50 KB)

MCA(NI) 2016 - Form 17 – Notification of application for trust panel authorisation and trust panel extension authorisation (Non-Statutory Form)
Word (45 KB)

MCA(NI) 2016 - Form 18 – Notification of trust panel decision (Non-Statutory Form)
Word (47 KB)

MCA(NI) 2016 - Form 19 – Notification of short-term detention (Non-Statutory Form)
Word (45 KB)

MCA(NI) 2016 - Form 20 – Notification of an extension (Non-Statutory Form)
Word (47 KB)

MCA(NI) 2016 - Form 21 – Discharge from detention (Non-Statutory Form)
Word (45 KB)

MCA(NI) 2016 - Form 22 – Appointment, revocation, making of a declaration or revoking a declaration in relation to nominated person (Guidance)
Word (51 KB)

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