Deprivation of Liberty Form No 19 2026

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  1. Click ‘Get Form’ to open Deprivation of Liberty Form No 19 in the editor.
  2. In Part A, enter the full name and date of birth (or estimated age) of the person being deprived of their liberty. Ensure accuracy as this information is crucial for identification.
  3. Provide the name and address of the hospital or care home where the individual is located, along with a contact person's details including their name, telephone number, and email.
  4. In Part B, review each qualifying requirement. For each applicable section (B1-B6), place a cross in the relevant box to indicate which requirements are being reviewed.
  5. In Part C, articulate your reasons for believing that one or more requirements are reviewable. This section allows you to provide context and justification for your request.
  6. Finally, sign on behalf of the managing authority, print your name, state your position, and date the form before submitting it through our platform.

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The DoLS assessment makes sure that the care being given to the person with dementia is in the persons best interests. There are six parts to the assessment: age, mental health, mental capacity, best interests, eligibility and no refusals.
Depriving someone of their liberty may be crucial to ensure they receive care and treatment necessary to prevent harm. Deprivation of Liberty Safeguards ensure that any restrictions or limitations on a persons freedom will be monitored and if necessary, challenged.
Deprivation of liberty means taking someones freedom away. A Supreme Court judgement decided that someone is deprived of their liberty if they are both under continuous supervision, and control and not free to leave.
Ben DoLS and Prader-Willi Syndrome Ben has been assessed as lacking capacity to make decisions about the amount and type of food he eats (this is common among people with Prader-Willi syndrome).
2 What are Deprivation of Liberty Safeguards? The Deprivation of Liberty Safeguards (DoLS) procedure is designed to protect your rights if the care or treatment you receive in a hospital or care home means you are, or may become, deprived of your liberty, and you lack mental capacity to consent to those arrangements.
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If all conditions are met, the supervisory body must authorise the deprivation of liberty and inform the person and managing authority in writing. It can be authorised for up to one year. The person does not have to be deprived of their liberty for the duration of the authorisation.
The objective element: is the person confined to a particular restricted place for a non-negligible period of time? The subjective element: does the person refuse to consent or are they unable to consent?

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