IMCA and paid relevant person's representative roles in the Mental Capacity Act Deprivation of Liberty Safeguards

Appendix C: Template report for a 39D IMCA closing a case

39D IMCAs are required to provide a report to the supervisory body. This is a suggested template for a report where, after the IMCA has had contact with both the person and their representative:

Notification to the supervisory body of 39D IMCA case closure

Name of relevant person:

Date of 39D IMCA instruction:

Reason for 39D IMCA instruction (as identified on form 30):

IMCAs contact with the relevant person:

Relevant person’s understanding of the authorisation and their rights:

IMCAs contact with the relevant person’s representative:

Relevant person’s representative’s understanding of the authorisation and their rights:

Conclusion:

The IMCA found that neither the person or their representative appeared to wish to exercise their rights for appeal or access to the Court of Protection.

The IMCA is not seeking a review or making an application to the Court of Protection.

The IMCA recommends that the supervisory body makes a further 39D instruction in the following situations:

The IMCA would like to draw the supervisory body’s attention to the following issues regarding the person’s treatment or care:

Signed

Dated