Request for a Standard Urgent Authorisation

This form has been adapted for use by the Eastern Region from the ADASS/DoH DoLS Forms.
 
Please note before completing this form:

In 1.13 of the DoLS' Code of Practice:-
 
"Depriving someone who lacks the capacity to consent to the arrangements made for their care or treatment of their liberty is a serious matter and the decision to do so should not be taken lightly."
 
As such, please ensure that the information that you provide for this request in the section "Purpose of the standard authorisation" must be person centred with details as to how the restrictions of the person's care regime amount to a deprivation of the person's liberty. Please also provide documentary evidence that the person is unable to give valid consent to their placement in the care home or hospital as the DoLS only applies to those assessed as lacking capacity in this regard.

You will be required to create a portal account, or log in to an existing account, in order to complete and submit the form.

* The red star/asterisk symbol indicates that the question is mandatory and must be answered in order to continue.

The form will take 15-30 minutes to complete depending on the amount of information you need to provide. Please be aware that for security reasons your session will timeout after 30 minutes of inactivity.

Please save your form regularly using the 'Save for Later' button at the bottom of the screen. The form will then be available for 90 days in your list of My Saved Forms.

Once you have submitted the form you will be able to see a copy of it in My Submitted Forms (at the top of the screen). This will be available for 90 days. After 90 days the form will no longer be visible. We recommend that you print or save a copy locally. To do this select the one you want, from My Submitted Forms, and open it. Then you can print or save it.

There may be times that we ask you for more information. We will not progress this referral until you re-submit the form with the extra information.

You will receive an email asking for further information. You can click on the link in the email or go to My Submitted Forms section of the portal. The Forms requesting more information section will be at the top.

The missing information details will be under Comments, including the name of the referred adult. Open the form by clicking on the link on the left under Form. You can update most of the questions (except name, Date of Birth and address) and re-submit it.