Medical Treatment and the Adults with Incapacity (Scotland) Act 2000

Background The Adults with Incapacity (Scotland) Act (“the Act”) was introduced in 2000 to regulate how we take decisions for those adults (in this context over the age of 16) unable to make decisions of their own. The previous position whereby people were declared “incapax” was generally considered to be out of date and in real need of modernisation. Basically, the rationale behind the changes was to recognise that very few people lack capacity to decide anything at all for themselves. Most people are able to make at least some basic decisions about what happens in their life and indicate their choices. As a result, capacity is no longer an “all or nothing” concept and we now work on a decision specific model of capacity. In basic terms, this means avoiding general assumptions about a person’s ability. Instead, the law requires us to have a clear idea about any decision(s) that need to be made. We then make an assessment of whether or not that person can make the particular decision(s) we have in mind. This is clearly a more person centred approach based on building capacity and allowing people to make their own choices wherever possible. However, it also means that professionals need to look at the way they operate and deliver services to make sure they comply with the law. The general principles The Act is different from previous legislation in that it sets out general principles. These are very important because they need to be considered whenever a decision is made. The general principles basically reflect good practice. However, everyone should be aware they exist and be able to show that any action or decision taken under the Act complies with them. The principles can be also used as a very useful checklist in the decision making process. They are also of great importance in situations where there are a number of ways to proceed. The general principles are: -

1. Benefit

The Act states that: - “There shall be no intervention in the affairs of an adult unless the person responsible for authorising or effecting the intervention is satisfied that the intervention will benefit the adult and that such benefit cannot reasonably be achieved without the intervention”

2. Minimum Intervention

The Act states that: - “Where it is determined that an intervention…is to be made, such intervention shall be the least restrictive option in relation to the freedom of the adult, consistent with the purpose of the intervention”

3. Consultation

The Act states that: - “In determining if an intervention is to be made and, if so, what intervention is to be made, account shall be taken of—

(a) the present and past wishes and feelings of the adult so far as they can be ascertained by any means of communication, whether human or by mechanical aid (whether of an interpretative nature or otherwise) appropriate to the adult;

(b) the views of the nearest relative and the primary carer of the adult, in

so far as it is reasonable and practicable to do so; (c) the views of—

(i) any guardian, continuing attorney or welfare attorney of the adult who has powers relating to the proposed intervention; and (ii) any person whom the sheriff has directed to be consulted, in so far as it is reasonable and practicable to do so

(d) the views of any other person appearing to the person responsible for

authorising or effecting the intervention to have an interest in the welfare of the adult or in the proposed intervention, where these views have been made known to the person responsible, in so far as it is reasonable and practicable to do so”

4. Encouraging the adult to make their own decisions

The Act states that: - “Any guardian, continuing attorney, welfare attorney or manager of an establishment exercising functions under this Act or under any order of the sheriff in relation to an adult shall, in so far as it is reasonable and practicable to do so, encourage the adult to exercise whatever skills he has concerning his property, financial affairs or personal welfare, as the case may be, and to develop new such skills”

Why is the Act relevant to me? The Act is relevant to medical practitioners mainly because it sets out what happens when someone who lacks capacity needs medical treatment. Medical practitioners are expected to know what the law says and follow the prescribed procedures. Medical practitioners are also increasingly asked for opinions about capacity in relation to non medical matters. For example, they might be asked to sign a form certifying a patient cannot make financial decisions or decide where they live. These forms are explained below. What does “capacity” actually mean? Unfortunately there is no definite test for capacity to make a specific decision. This means that medical practitioners and other professionals need to know some basic tools to assess capacity. The Act tells us that someone is “incapable” if they are unable to: -

Act; or Make decisions; or Communicate decisions; or Understand decisions; or Retain a memory of their decisions.

BMA guidance suggests that in order for someone to have capacity they need to be able to: -

Understand the treatment proposed and the purpose and nature of the treatment

Understand the main benefits, risks and any alternatives Understand the consequences of not having the treatment Use the information to make a decision Retain knowledge of the decision.

The Code also tells us that someone will not be considered incapable simply as a result of any one or more of the following reasons: -

Being in community care Having a psychotic illness Having dementia, particularly in the early stages Having difficulties with speech or writing Having an addiction Disagreeing with the treatment or those offering it Having learning difficulties or disabilities Being vulnerable or at risk from him or herself or others Behaving irrationally

Being promiscuous Having a brain injury Having a physical disability Having a history of offending. Having an acquired or progressing neurological condition Declining to accept the practitioner’s advice Rejecting a recommendation for treatment on emotional rather than rational

grounds. How do I assess capacity? There is no set method to assess capacity but the first stage is normally to be clear about the treatment that you are proposing. The decision specific approach requires you to have a specific decision in mind about treatment before capacity can be assessed. The second stage is an assessment of the patient’s ability can make his or her own decision on the treatment. This involves explaining the treatment in simple terms and making a judgement about whether or not the person understands and can make a decision. Although it is fine to take advice be aware that capacity is a matter for the professional judgement of the person proposing the treatment. What should I do if I am not sure about capacity? The Code recommends using a multi disciplinary approach where possible. This might involve consulting other professionals such as a clinical psychologist, neurologist, speech/language therapist or qualified interpreter. Where someone has fluctuating capacity it is good practice to keep certificates for a short period of time. If the persons capacity may return it is also worth considering deferring a decision provided this does not prejudice the patient. What do I need to know about medical treatment and the Act? When someone lacks capacity to make decisions about medical treatment then medical practitioners need to make sure there is a s.47 certificate on file authorising the treatment. This is a statutory requirement and the certificate must follow the set style. A copy is attached to this handout. A certificate is needed for any medical treatment. “Medical treatment” is defined as: -

“Any healthcare procedure designed to promote or maintain the physical or mental health of the adult”.

This is a very wide definition and would cover most interventions although there is still some uncertainty about whether or not a physical examination is covered. Therefore, for the avoidance of doubt it might be better to have a certificate on file before physical examinations take place.

It is also good practice to record any decision not to treat. How do I complete the certificate? An example of a certificate applies to allowing treatment for a medical treatment is attached to this handout. The Certificate sets out the following information: -

1. Details of Registered Medical Practitioner 2. Details of patient

3. Details of who has been consulted

This might be a welfare attorney or guardian. This is discussed later. In situations where there is no welfare attorney or guardian then the nearest relative and primary carer or anyone else appropriate in the circumstances should be consulted.

4. Information about the medical treatment proposed

One certificate can cover more than one treatment. For example, if someone is having surgery we would normally expect a Certificate to also cover all relevant pre and post-operative procedures, care and pain relief. If a new treatment is needed that is not covered by an existing certificate then a new certificate should be completed. It is not possible to simply alter or update an existing certificate. This is because a new assessment of capacity needs to be carried out for the new treatment. The certificate should also say who is authorised to give the treatment if the person needs support or assistance to take medication and how the medication should be taken. For example, in some cases care home staff or family members will be administering medication. If this is the case then it is helpful to also set out how medicine should be taken to avoid inappropriate actions such as tablets being crushed. If someone needs a lot of medical interventions then it is a good idea to refer to a treatment plan and attach this to the certificate. Treatment plans are explained below.

5. The nature of the incapacity

6. Likely duration of incapacity

7. Period of certification

This should generally not exceed 1 year although it can be up to 3 years if the person has a severe and profound learning disability or severe dementia or severe neurological disorder.

How do I take into account the patients views and wishes? There is a legal obligation to take into account the patients views and wishes even when they lack capacity. There are various ways these views can be established although the weight attributed to each will vary depending on the circumstances.

The contents of any advance statement or living will. Remember that in some cases these might constitute an “advance directive” and be a legally binding refusal of treatment. It is necessary to take additional advice in such cases.

Non-verbal communication and behavioural changes including non-compliance.

An independent advocate. Speaking to family, friends and support staff

Who else can sign a certificate? In 2007 the rules changed and now some other professionals can sign a section 47 Certificate. They are

Dental practitioners Ophthalmic opticians Registered nurses.

However, their ability to sign certificates is restricted in two main ways: -

1. They must have undergone training on undertaking incapacity assessment; and

2. They can only authorise treatments within their specific area of expertise. This means that registered medical practitioners may still be asked to sign certificates for dental and other treatments. What do I need to know about Treatment Plans? When someone is likely to need multiple medical interventions for one, or a combination of, conditions then a Treatment Plan will often be appropriate. An example is attached to this handout. If you are using a Treatment Plan the Section 47 Certificate can simply make say “see attached treatment plan” under the section on proposed treatments. The Treatment Plan also says if a person can or cannot consent. A patient might understand routine procedures such as a flu jab or cream for a skin condition but not more complicated anti psychotic medication.

It is also possible to refer to “Fundamental Healthcare Procedures” in the Treatment Plan. Those words are taken to include all measures to promote or safeguard nutrition, hydration, hygiene, skin care and integrity, elimination, relief of pain and discomfort, mobility, communication, eyesight, hearing and simple oral hygiene. Are there any restrictions on what I can authorise? Some treatments are called “restricted treatments”. This means they need different or additional authorisation. Additional advice must be sought on the correct procedure if you are considering treatments such as: -

Sterlisation Treatments to reduce sex drive ECT Abortion Treatment that will lead to sterilisation

Treatment under the Mental Health (Care and Treatment)(Scotland) Act 2003 is also excluded from the Act. Finally, a Certificate does not authorise detention or force unless immediately necessary. Where a patient is not compliant consideration should be given to either treatment under Mental Health Legislation, an application for guardianship or the appropriateness of covert medication. In such situations, it is advisable to seek additional professional advice before proceeding. What about new patients? If a new patient has a Certificate on file then it is good practice to meet them to review this. However, the existing certificate remains valid. What should I know about welfare attorneys and welfare guardians? Some patients will have a welfare attorney or guardian appointed to make decisions for them. A welfare attorney is appointed by the patient at a point in time when they have capacity. This is to cover future situations in which they don’t have capacity. This is quite common in patients with dementia. A welfare guardian is appointed by the court for someone who does not have capacity and has not appointed a welfare attorney at a time they had capacity. In either case, you should have a copy of the document on file. Welfare attorneys and guardians normally have the power to make medical decision although it is worth checking the written document to make sure. However, even when there is a welfare attorney or guardian in place it is still necessary to consider the persons capacity to make the decision. If they lack capacity a Section 47 Certificate must be completed. This is because powers to consent to medical treatment are normally very wide and can only be used in situations where the person actually lacks capacity.

Reasonable efforts must always be made to consult welfare attorneys and guardians about medical treatment. What happens if there is disagreement about treatment? There can be difference of opinion about medical treatment. The procedure for resolving these disputes depends on the legal status of the person challenging a decision. If the person challenging a decision on treatment is a welfare guardian or attorney then a second opinion must be obtained from a Mental Welfare Commission Nominated Practitioner (NP). If the NP agreed with the proposed treatment then it can proceed. If the original medical practitioner or the welfare guardian or attorney disagree then an appeal to the Court of Session is possible. If the person challenging a decision is not a welfare guardian or attorney then they must challenge the decision in court. In the meantime, treatment to preserve life or prevent a serious deterioration in a medical condition is possible. Other certificates under the legislation and how to complete them There are other certificates under the legislation that medical practitioners might be asked to complete from time to time. These are: -

1. Powers of attorney

Powers of attorney include a certificate that the person signing understands the document. These can be signed by solicitors and medical practitioners. This certificate is on a prescribed for and a copy is attached to this handout.

A medical practitioner may also be asked to confirm that an individual who has already signed a power of attorney has lost capacity. There is no set form for this.

2. Intromission with funds

The Act allows an individual or organisation to apply to the Office of the Public Guardian to manage an individual’s bank account. The application form includes a certificate that the patient is unable to manage his or her own finances. This certificate is on a prescribed for and a copy is attached to this handout.

3. Residents finances

The Act allows managers of registered establishment to manage funds for residents. This requires a certificate that the individual is unable to manage

his or her own funds. This certificate is on a prescribed for and a copy is attached to this handout.

4. Intervention /Guardianship Applications

Medical practitioners can be asked to sign forms certifying that an individual lacks the ability to make specific decisions set out in an application for an intervention or guardianship order. This certificate is on a prescribed for and a copy is attached to this handout. A medical practitioner might also be asked to sign a form to recall a power of attorney or guardianship application. Again. this certificate is on a prescribed for and a copy is attached to this handout.

Section 47 Certificate

SCHEDULE Regulation 2 Certificate of Incapacity for the purposes of Section 47(1) of the Adults with Incapacity (Scotland) Act 2000 I .......................................................................(name) of..………........................................................................(address) * am the medical practitioner primarily responsible for the medical treatment of; or * am a person who is * a dental practitioner / an ophthalmic optician / a registered nurse and who satisfies such requirements as are prescribed by the Adults with Incapacity (Requirements for Signing Medical Treatment Certificates) (Scotland) Regulations 2007 and who is primarily responsible for medical treatment of the kind in question of .........................................................................(name) of ..................................................................... (address) ............../ ........./ ......... (date of birth) for whom the *guardian/welfare attorney/person appointed by intervention order/nearest relative/carer is ........................................................................................................................................................ I have examined the patient named above on ............/ ........ /......... (Date). I am of the opinion that *he/she is incapable within the meaning of the Adults with Incapacity (Scotland) Act 2000 (“the 2000 Act”) in relation to a decision about the following medical treatment:– .......................................................................................................................................................... .......................................................................................................................................................... because of (nature of incapacity) ....................................................................................................... .......................................................................................................................................................... ........................................................................................................................................................... This incapacity is likely to continue for ................. months. *I therefore consider it appropriate for the authority conferred by section 47(2) of the 2000 Act to subsist from ………………………………………..…………. / ..…. / …… (date of examination) until ……./……./……., being a period which does not exceed one year from the *date of the examination on which this certificate is based/ date of revocation of the certificate issued previously by me; or *I am of the opinion that (a) *he/she is suffering from *a severe or profound learning disability/ dementia/a severe neurological disorder; and (b) *what he/she is suffering from is unlikely to improve within the meaning of the Adults with Incapacity (Conditions and Circumstances Applicable to Three Year Medical Certificates) (Scotland) Regulations 2007/ and therefore consider it appropriate for the authority conferred by section 47(2) of the 2000 Act to subsist until .............. /.................../ .......... being a period which does not exceed three years from the *date of the examination on which this certificate is based / date of revocation of the certificate issued previously by me. The authority conferred by section 47(2) of the 2000 Act shall subsist for the period specified above or until such earlier date as this certificate is revoked. In assessing the capacity of the patient, I have observed the principles set out in section 1 of the 2000 Act. Signed .................................................................... Date ........................................................................

*delete as appropriate

Treatment plan for patients

Treatment plan for patients receiving ongoing treatment under the terms of Part 5 of the Adults with Incapacity (Scotland) Act 2000. Name of patient………………………………. Date of birth……/……/…… Address……………………………………………………………………….. …………………………………………………………………………………. I have examined the patient named above on………./………./………(Date) and consider that he/she needs to undergo procedures to safeguard or promote physical or mental health in relation to the treatment plan below. I have assessed his/her capacity to consent to treatment in relation to each area of intervention. Disorder/intervention (See note A)

Capacity C = capable I = incapable

I have consulted the following people over this treatment Plan and over the patient’s capacity (see note C): Name……………………………………………. Designation…………………………….. Address……………………………………………………………………………………….

Name……………………………………………. Designation…………………………….. Address……………………………………………………………………………………….

Signed…………………………………………………………

Notes on completion of treatment plan This plan is intended to guide healthcare professionals who are caring for patients who have multiple and complex needs. It should be attached to a certificate of incapacity and retained in the patient's multidisciplinary case record.

A. Under the Act, you can only intervene if it will benefit the patient. Your intervention must be the least restrictive in relation to the patient's freedom in order to achieve the required benefit. You must take the patient's views into account and you must consult other relevant people, where reasonable and practical.

Include all present or foreseeable disorders and/or interventions for physical and mental disorders not included in "Fundamental Healthcare Procedures" (see note B). You should consider the patient's capacity to consent to each intervention. Under the Act, the patient is incapable if he/she is incapable of acting, or making decisions, or communicating decisions, or understanding decisions, or retaining the memory of decisions. Exclude all interventions that would ordinarily need the signed consent of the patient. Interventions of this sort need a separate certificate of incapacity. For example, if you write "coronary heart disease and hypertension" on the plan, this authorises you to prevent disease with aspirin, or treat disease with anti-hypertensive drugs, but not operate to bypass blocked arteries. You may not include on this form any treatment regulated under section 48 of the Act. Please consult the regulations and separate guidance issued on these treatments.

B. Fundamental healthcare procedures include all measures to promote or safeguard the following: nutrition, hydration, hygiene, skin care and integrity, elimination, relief of pain and discomfort, mobility, communication, eyesight, hearing and simple oral hygiene.

C. The Act requires you to take the views of others into account when deciding

on an intervention. You should discuss this plan with professional carers and relatives of the patient. Any person with an interest in the welfare of the patient may appeal a treatment decision to the Sheriff. If the patient has a Welfare Attorney or Guardian with the authority to consent to treatment, you must consult this person where reasonable and practical. You can find out if your patient has a Welfare Attorney or Guardian by contacting the Public Guardian on 01324 678300. If this person disagrees with any element of your plan, you must obtain a second opinion from a Nominated Practitioner appointed by the Mental Welfare Commission for Scotland, tel. 0131 222 6111.

You may find that you need to treat a condition that is not specified in your treatment plan. If this is a short lived condition, a separate certificate in relation to it might suffice. If it is a condition that is likely to need ongoing intervention, you should consider rewriting the treatment plan. This treatment plan is only valid for the period specified in the certificate of incapacity.

Power of Attorney Certificate

SCHEDULE 1 Regulation 2

CERTIFICATE UNDER SECTIONS 15(3)(c) AND/OR 16(3)(c) OF THE ADULTS WITH INCAPACITY (SCOTLAND) ACT 2000 TO BE INCORPORATED IN A

DOCUMENT GRANTING A POWER OF ATTORNEY

1. This certificate is incorporated in the document subscribed by

Insert name of granter

2. On

Insert date subscribed

3. That confers a

Tick appropriate box – tick one box only Continuing power of attorney (i.e. confers property or financial powers

only) Welfare power of attorney (i.e. confers welfare powers only)

Combined power of attorney (i.e. confers both property or financial

and welfare powers)

4. Appointing as Attorney(s)

Insert name(s) of Attorney(s)

5. Declaration of Certifier

Note: any person signing this certificate should not be the person to whom this power of attorney has been granted.

I certify that

1 I interviewed the granter immediately before he/she subscribed this power of attorney;

2 I am satisfied that, at the time this power of attorney was granted,

the granter understood its nature and extent; and

I have satisfied myself of this: Please tick appropriate box. (Both may apply but one must

apply)

(a) because of my own knowledge of the granter;

and/or

(b) because I have consulted the following person who has

knowledge of the granter on the matter

Insert name, address and relationship with granter, of

person consulted

3 I have no reason to believe the granter was acting under undue

influence or that any other factor vitiates the granting of this power of attorney.

Signed: .......................................................... Date………………………………

Print name: ....................................................

Profession: ....................................................

Address: ........................................................

.......................................................................

.......................................................................

Intromission with funds certificate

Certificate of incapacity to accompany an application to the Public Guardian under section 24C, 24D or 25

I (full name)

of

(professional address) in my capacity as

(1)

have examined the following patient on

(date),

(patient’s name)

of

(address) / / (date of birth)

I am of the opinion that he/she is incapable in relation to decisions about, or incapable of acting to safeguard or promote his/her interests in, his/her funds.

I am of the opinion that the patient named above is incapable in terms of section 27B of the Act because of:

mental disorder(2) and/or

inability to communicate because of physical disability(3)

Brief description of mental disorder/inability to communicate

(signed) (date)

(1) the person signing the certificate must be a medical practitioner; insert as appropriate, eg GP, specialist in mental disorder

(2) mental disorder has the meaning given to it in section 328 of the Mental Health (Care and Treatment) (Scotland) Act 2003, namely that it means any mental

illness; personality disorder or leaning disability however caused or manifested, but an adult is not mentally disordered by reason only of sexual orientation; sexual deviancy; transsexualism; transvestism; dependence on, or use of, alcohol or drugs; behaviour that causes, or is likely to cause, harassment, alarm or distress to any other person; or acting as no prudent person would act.

(3) one of these must be deleted unless both apply

Management of Residents Finances

SCHEDULE 1

Adults with Incapacity (Scotland) Act 2000 ("the Act") Certificate of incapacity in relation to decisions as to, or safeguarding interest in, resident's affairs. I

(full name of medical practitioner) of

(professional address) have examined

(resident's name),

/

/

(resident's date of birth), of

(authorised establishment where resident lives) on

/

/

(date) in my capacity as

*. I am of the opinion that he/she is incapable in relation to: - decisions as to** - safeguarding his/her interests in ** any of the affairs referred to in section 39 of the Act. This is because of: - mental disorder** - inability to communicate because of physical disability**

(brief description of nature of mental disorder/inability to communicate). I am not related to the resident or to any of the managers of the authorised establishment in which he/she resides, nor do I have any direct or indirect financial interest in the authorised establishment. In assessing the capacity of the resident, I have given effect to the principles set out in section 1 of the Act.

(signature of medical practitioner)

(printed name)

____________________ Date

Note: In accordance with section 37(7) of the Act, this certificate shall expire on ………………………………. (three years after date of signature), but it shall be reviewed before that date where it appears that there has been any change in the condition or circumstances of the resident named in this certificate bearing on that resident's incapacity. * the person signing the certificate must be a medical practitioner; insert as appropriate eg GP, specialist in mental disorder. ** one of these must be deleted unless both apply.

Application for Guardianship/Intervention Order/Renewal of Guardianship

SCHEDULE 2 Regulation 3

(As amended)

Report of incapacity to accompany

application for guardianship application for renewal of guardianship application for intervention order

AWI[1]Adults with Incapacity (Scotland) Act

2000Section 57(3)(a) and 60(3)(a)

Note: fill in Part A1 where the adult is examined in Scotland and Part A2 where the adult is examined outwith Scotland. PART A1 DETAILS OF REPORT WRITER AND ADULT FOR

EXAMINATIONS IN SCOTLAND

I (name) being a medical practitioner with the following professional address: (state full postal

address for contact)

Telephone E-mail [complete the following box if applicable(1); otherwise, delete]

and being approved by the

Health Board/ by the State Hospital’s Board for Scotland (please delete one)

for the purposes of section 22 of the Mental Health (Care and Treatment) (Scotland) Act 2003 as having special experience in the diagnosis and treatment of mental disorder, hereby confirm that I examined and assessed the following adult (“the adult”)

delete the two which do not apply (1) Where the incapacity is by reason of mental disorder, one of the medical practitioners must be approved for the purposes of section 22

of the 2003 Act as having special experience in the diagnosis and treatment of mental disorder (section 57(6B) of the Act).

Name Residing at

(state full postal address)

Date of birth

On (give date of examination and assessment)

OR PART A2 DETAILS OF REPORT WRITER AND ADULT FOR

EXAMINATIONS OUTWITH SCOTLAND

I (name) being a medical practitioner with the following professional address: (state full postal

address for contact)

Telephone E-mail having the following qualification and special experience in relation to the treatment of mental disorder:

and having consulted the Mental Welfare Commission(2) about this report

(please tick box)

hereby confirm that I examined and assessed the following adult (“the adult”)

Name Residing at

(state full postal address)

Date of birth

On (give date of examination and assessment)

At (insert place and address of assessment)

PART B PURPOSE OF EXAMINATION AND ASSESSMENT The examination and assessment was in connection with a proposed application for (tick whichever applies) A guardianship order/renewal of guardianship order/an intervention order

a) with power over personal welfare

b) with power over property and/or financial affairs

c) with power over personal welfare, property and/or financial affairs.

Name of applicant or person requesting report

Name(s) of person or persons nominated in application (if known)

PART C FINDINGS OF EXAMINATION AND ASSESSMENT

(2) Postal address: The Mental Welfare Commission, Floor K, Argyle House, 3 Lady Lawson Street, Edinburgh, EH3 9SH. Telephone:

0131 222 6111. Website: www.mwcscot.org.uk delete the two which do not apply

On the basis of my examination and assessment I am of the opinion that the adult named in Part A has (tick box for whichever of the following applies and add comments on nature

a) Mental disorder3

Nature

And /or

b) Inability to communicate because of physical disability

Nature

3 Mental disorder has the meaning given to it in section 328 of the Mental Health (Care and Treatment) (Scotland) Act 2003, namely that it

means any mental illness; personality disorder or learning disability however caused or manifested, but an adult is not mentally disordered by reason only of sexual orientation; sexual deviancy; transsexualism; transvestism; dependence on, or use of, alcohol or drugs; behaviour that causes, or is likely to cause, harassment, alarm or distress to any other person; or acting as no prudent person would act.

I am of the opinion that the condition mentioned in Part C has impaired the capacity of the adult named in Part A to make decisions about or to act to safeguard or promote his/her interests in his/her property, financial affairs or personal welfare in relation to the matters covered in the proposed application. The reason for my opinion is given below.

Please indicate the findings of your examination and assessment, so far as they relate to the adult’s capacity in relation to the matters which are the subject of the application.

Please indicate the likely duration of the incapacity

Please indicate the extent to which you have been able to communicate with the adult,

Please indicate the extent to which you have been able to consult the nearest relative, primary carer, named person and anyone else having an interest in, or knowledge of, the adult.

PART D

DECLARATION OF INTEREST

Delete (a) or (b)

(a) I am not related to the adult

(b) I am related to the adult being his /her (state relationship)

AND

Delete (c) or (d)

(c) I have no pecuniary interest

in the appointment of a guardian or guardians*

in the renewal of guardianship*

in the intervention order sought*

(d) I have a pecuniary interest

in the appointment of a guardian or guardians*

in the renewal of guardianship*

in the intervention order sought The nature and extent of that interest is

Signed4

Date

delete the two which do not apply. 4 Please note that the application and accompanying reports will be served on interested parties.

Recall of powers of Attorney or Guardian

Report of capacity to accompany applications to the Office of the Public Guardian under section 73(1) of the Act for recall of powers of a guardian relating to property and financial affairs.

PART A DETAILS OF REPORT WRITER AND ADULT

I (name) being a medical practitioner with the following professional address:

(state full postal address for contact)

Telephone

E-mail

hereby confirm that I examined and assessed the following adult (“the adult”)

Name

Residing at

(state full postal address)

Date of birth

On (give date of examination and assessment)

PART B DETAILS OF APPLICATION

Name of applicant or person requesting report

Date of application (if known)

PART C FINDINGS OF EXAMINATION AND ASSESSMENT

On the basis of my examination and assessment I am of the opinion that the adult named in Part A is no longer incapable in relation to decisions about, or of acting to safeguard or promote his/her interests in his/her financial and property affairs in relation to the matters covered in the guardianship order. The reason for my opinion is given below.

Please indicate the findings of your examination and assessment, so far as they relate to the adult’s capacity in relation to the matters which are the subject of the guardianship order.

Please indicate the extent to which you have been able to communicate with the adult,

Please indicate the extent to which you have been able to consult the nearest relative, primary carer, and anyone else having an interest in, or knowledge of, the adult.

Signed

Date