Are there any recent life events that may contribute to the person’s capacity? Please specify: Has the person recently taken any form of medication that is likely to impact on their capacity? Please specify: Have relevant health and social care professionals, families and carers been consulted regarding this person’s capacity? Please specify: Assessment of Capacity: Stage 1 Diagnosis: – Does the patient have an impairment of, or disturbance in, the functioning of the mind or □ □ Yes No □ □ □ If yes, is the impairment: Temporary Fluctuating Permanent If temporary/fluctuating, can the decision wait capacity returns? If not please provide details: Stage 2 Functioning: – If yes to the above question, is the patient able to: □ □ Understand the information relevant to the decision? Yes No Evidence include the actions taken to enhance capacity: – AND: □ □ Retain that information? Yes No Please provide details/further information if appropriate/necessary: AND: □ □ Use or weigh that information as part of the process of making the decision? Yes No
Are there any recent life events that may contribute to the person’s capacity? Please specify: Has the person recently taken any form of medication that is likely to impact on their capacity? Please specify: Have relevant health and social care professionals, families and carers been consulted regarding this person’s capacity? Please specify: Assessment of Capacity: Stage 1 – Diagnosis: Does the patient have an impairment of, or disturbance in, the functioning of the mind or □ Yes □ No If yes, is the impairment: □ Temporary □ Fluctuating □ Permanent If temporary/fluctuating, can the decision wait capacity returns? If not please provide details: Stage 2 – Functioning: If yes to the above question, is the patient able to: Understand the information relevant to the decision? □ Yes □ No Evidence – include the actions taken to enhance capacity: AND: Retain that information? □ Yes □ No Please provide details/further information if appropriate/necessary: AND: Use or weigh that information as part of the process of making the decision? □ Yes □ No
Dysphagia-Nutrition-Hydration-Bundle-editable-Word-doc.docx