Please clarify relationship and Address frequency of contact. This will help the DOLS Service determine whether to appoint an IMCA. The BIA will also need this Telephone information, so they can consult with this person. Anyone named by the person as Name someone to be consulted about their welfare. Address Is there an Advanced Decision made by the person?. Do you have a copy? Telephone Anyone engaged in caring for the Name person or interested in their welfare. Address Telephone Any Lasting Power of Attorney Name granted by the person. Address Please clarify whether it is for Finance or Welfare or both. Telephone Do you have a copy of the LPA? Any Personal Welfare Deputy Name appointed for the person by the Court of Protection Address Do you have a copy of the appointing the Deputy? Telephone Any IMCA instructed in Name accordance with sections 37 to Address 39D of the Mental Capacity Act 2005 e.g. an IMCA appointed for Telephone serious medical treatment or a move to residential care, or a paid RPR WHETHER IT IS NECESSARY FOR AN INDEPENDENT MENTAL CAPACITY ADVOCATE (IMCA) TO BE INSTRUCTED Place a cross in EITHER box below
Please clarify relationship and frequency of contact. This will help the DOLS Service determine whether to appoint an IMCA. The BIA will also need this information, so they can consult with this person. Address Telephone Anyone named by the person as someone to be consulted about their welfare. Is there an Advanced Decision made by the person?. Do you have a copy? Name Address Telephone Anyone engaged in caring for the person or interested in their welfare. Name Address Telephone Any Lasting Power of Attorney granted by the person. Please clarify whether it is for Finance or Welfare or both. Do you have a copy of the LPA? Name Address Telephone Any Personal Welfare Deputy appointed for the person by the Court of Protection Do you have a copy of the appointing the Deputy? Name Address Telephone Any IMCA instructed in accordance with sections 37 to 39D of the Mental Capacity Act 2005 e.g. an IMCA appointed for serious medical treatment or a move to residential care, or a paid RPR Name Address Telephone WHETHER IT IS NECESSARY FOR AN INDEPENDENT MENTAL CAPACITY ADVOCATE (IMCA) TO BE INSTRUCTED Place a cross in EITHER box below