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Deprivation of Liberty Form No 4 free printable template

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Between care homes and hospitals (80%/20%), and between authorizations ... from the new safeguards both those whose applications are authorized and ... MCA and DOES, are available from www.kent.gov.uk/mentalcapacityact.
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How to fill out Deprivation of Liberty Form No. 4

01
Gather the necessary personal information of the individual affected.
02
Identify the circumstances that may lead to deprivation of liberty.
03
Complete each section of the form accurately, providing clear and concise information.
04
Ensure that any necessary supporting documentation is attached.
05
Review the form for completeness and correctness.
06
Submit the form to the relevant authority for approval.

Who needs Deprivation of Liberty Form No. 4?

01
Individuals who are subjected to restrictions on their liberty due to care or treatment.
02
Care providers or facilities implementing restrictions on residents or patients.
03
Legal representatives involved in the care or treatment decisions of individuals.
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The Deprivation of Liberty Safeguards (DoLS) can only apply to people who are in a care home or hospital. This includes where there are plans to move a person to a care home or hospital where they may be deprived of their liberty. The care home or hospital is called the managing authority in the DoLS.
For example, a care home or staff in a hospital may stop the person from walking around at night or leaving the building, or give them medications that may affect their behaviour. Sometimes, taking away a person's freedom in this way is defined in law as a 'deprivation of liberty'.
The Deprivation of Liberty Safeguards (DoLS) procedure is designed to protect your rights if the care or treatment you receive in a hospital or care home means you are, or may become, deprived of your liberty, and you lack mental capacity to consent to those arrangements.
DoLS form 2 - Further authorisation request. THE PURPOSE OF THE AUTHORISATION is to enable the following care and / or treatment to be given: Describe the care / treatment the person is receiving on a day-to-day basis. This will include details of personal care, support, supervision, help with mobility and medication.
A deprivation of liberty is where your liberty is taken away from you - that is, you are not free to leave and you are under continuous supervision and control. The Mental Capacity Act says that the law allows this only in very specific situations.
Asking whether the following statements apply to the person will help you to think about whether this is a deprivation of liberty: The person is under continuous supervision and control. The person is not free to leave. The person lacks capacity to consent to their care arrangements.

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Deprivation of Liberty Form No. 4 is a legal document used to formally request authorization for the deprivation of a person's liberty under specific circumstances, typically related to mental health or care situations.
Individuals or professionals involved in the care and treatment of a person who may be deprived of their liberty, such as healthcare providers, social workers, or legal guardians, are required to file Deprivation of Liberty Form No. 4.
To fill out Deprivation of Liberty Form No. 4, one must provide detailed information regarding the individual concerned, the reasons for deprivation of liberty, the legal basis for the request, and any supporting documentation that justifies the application.
The purpose of Deprivation of Liberty Form No. 4 is to ensure that any deprivation of a person's liberty is legally justified and subject to oversight, protecting the rights of individuals under care.
Information that must be reported on Deprivation of Liberty Form No. 4 includes the personal details of the individual affected, the circumstances of their care, the rationale for deprivation of liberty, the duration of the proposed deprivation, and details of any assessments or consultations conducted.
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