Skip to main content
Department of Health Department of Health An Roinn Sláinte Männystrie O Pouste

Main navigation

  • Home
  • Topics
  • Publications
  • Consultations
  • Contact

Translation help

Translate this page

Select a language

  • Arabic — عربي
  • Chinese (Simplified) — 中文简体
  • Chinese (Traditional) — 中文繁體
  • Dutch — Nederlands
  • Filipino — Filipino
  • French — Français
  • German — Deutsch
  • Hungarian — Magyar
  • Irish — Gaeilge
  • Italian — Italiano
  • Latvian — Latviešu
  • Lithuanian — Lietuvių kalba
  • Polish — Polski
  • Portuguese — Português
  • Romanian — Română
  • Russian — Русский
  • Slovak — Slovenčina
  • Spanish — Español
  • Ukrainian — Українська
  • Mental Capacity Act Forms

    Date published: 9 September 2019

    Last updated: 26 July 2022

    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.

    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.

    Back to Homepage

    Documents

    • MCA(NI) 2016 - Form 1 – Statement of incapacity (Statutory Form) Microsoft Word (53 KB)
    • MCA(NI) 2016 - Form 2 – Best interests determination statement (Statutory Form) Microsoft Word (51 KB)
    • MCA(NI) 2016 - Form 3 – Consultation with nominated person (Non-Statutory Form) Microsoft Word (48 KB)
    • MCA(NI) 2016 - Form 4 - Care plan (Statutory Form) Microsoft Word (47 KB)
    • MCA(NI) 2016 - Form 5 – Application for trust panel authorisation (Statutory Form) Microsoft Word (50 KB)
    • MCA(NI) 2016 - Form 6 – Medical report (Statutory Form) Microsoft 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) Microsoft Word (49 KB)
    • MCA(NI) 2016 - Form 8 – Short-term detention authorisation for examination or examination followed by treatment or care (Statutory Form) Microsoft Word (55 KB)
    • MCA(NI) 2016 - Form 9 – Consultation with approved social worker (Statutory Form) Microsoft Word (49 KB)
    • MCA(NI) 2016 - Form 10 – Short-term detention admission exception certificate (Statutory Form) Microsoft Word (48 KB)
    • MCA(NI) 2016 - Form 11 – Short-term detention admission report (Statutory Form) Microsoft Word (51 KB)
    • MCA(NI) 2016 - Form 12 – Short-term detention further admission report (Statutory Form) Microsoft Word (52 KB)
    • MCA(NI) 2016 - Form 13 – Short-term detention further report (Statutory Form) Microsoft Word (52 KB)
    • MCA(NI) 2016 - Form 14 – Extension authorisation (extension by report) (Statutory Form) Microsoft Word (54 KB)
    • MCA(NI) 2016 - Form 15 – Responsible person statement (Statutory Form) Microsoft Word (50 KB)
    • MCA(NI) 2016 - Form 16 – Application for trust panel extension authorisation (Statutory Form) Microsoft Word (50 KB)
    • MCA(NI) 2016 - Form 17 – Notification of application for trust panel authorisation and trust panel extension authorisation (Non-Statutory Form) Microsoft Word (45 KB)
    • MCA(NI) 2016 - Form 18 – Notification of trust panel decision (Non-Statutory Form) Microsoft Word (47 KB)
    • MCA(NI) 2016 - Form 19 – Notification of short-term detention (Non-Statutory Form) Microsoft Word (45 KB)
    • MCA(NI) 2016 - Form 20 – Notification of an extension (Non-Statutory Form) Microsoft Word (47 KB)
    • MCA(NI) 2016 - Form 21 – Discharge from detention (Non-Statutory Form) Microsoft Word (45 KB)
    • MCA(NI) 2016 - Form 22 – Appointment, revocation, making of a declaration or revoking a declaration in relation to nominated person (Guidance) Microsoft Word (51 KB)

    Help viewing documents

    Share this page Share on Facebook (external link opens in a new window / tab) Share on X (external link opens in a new window / tab) Share by email (external link opens in a new window / tab)

    Department footer links

    • Crown copyright
    • Terms and Conditions
    • Privacy
    • Cookies
    • Accessibility
    • The Northern Ireland Executive
    • The Executive Office
    • Department of Agriculture, Environment and Rural Affairs
    • Department for Communities
    • Department for Education
    • Department for the Economy
    • Department of Finance
    • Department for Infrastructure
    • Department for Health
    • Department of Justice
    • nidirect.gov.uk — the official government website for Northern Ireland citizens