To request a Deprivation of Liberty (DoLS) standard authorisation or urgent authorisation, further standard authorisation, or request a review, please complete the relevant form below:
- DoLS - Form 1 - Standard Request And Urgent Authorisation (DOC)
- DoLS - Form 2 - Further Standard Authorisation Request (DOC)
- DoLS - Form 10 - Review Request (DOC)
Please send the completed form to us by:
- Fax: 01483 517830
- Email: firstname.lastname@example.org
- GCSX: email@example.com
If sending requests by email you need to be aware of, and take responsibility for, any data protection responsibilities that you may have as a care home or organisation.
For more information on how to complete these forms please refer to the ADASS guidance (PDF).
Notification to the Coroner
With a death occurring on or after 3rd April 2017 any person subject to a DoL (i.e. a deprivation of liberty formally authorised under the MCA 2005) is no longer 'in state detention' for the purposes of the 2009 Act.
When that person dies the death should be treated as with any other death outside the context of state detention; it need only be reported to the coroner where one or more of the other requisite conditions are met.
Supreme Court Judgement regarding Deprivation of Liberty
In March 2014 the Supreme Court handed down a judgement concerning 'Deprivation of Liberty' which concerns the criteria for judging whether the living arrangements made for a mentally incapacitated person amount to a deprivation of liberty. If they do, the deprivation must be authorised by a court or by the Deprivation of Liberty Safeguards (DoLS) procedures in the Mental Capacity Act 2005, and subject to regular independent checks.
The Department of Health (DoH) and the Care Quality Commission (CQC) have issued information and guidance relevant to all support and care providers who work with people who may lack mental capacity. Managing authorities (e.g. care homes and hospitals), care providers and commissioners should familiarise themselves with these.
Further advice and information for providers
Please note that the DoLS processes and provisions have not changed as a result the Supreme Court judgement (see above). Managing authorities should continue to apply to Surrey County Council in the usual way if they consider it necessary to deprive a person of their liberty in order to provide the accommodation, care, treatment or support assessed as necessary under the Mental Capacity Act.
Surrey County Council (the supervisory body for DoLS in Surrey), is not able to give legal advice to Managing Authorities (e.g. care homes or hospitals) or other providers. Neither can we advise, in the absence of a formal request for a DoLS authorisation, whether a person's particular circumstances amount to a deprivation of liberty.
It is important that managing authorities do not make speculative applications for DoLS as a result of this judgement, and residents / patients are not subjected to unnecessary or avoidable assessments, which can be unsettling for them and their families.
If a DoLS request is made solely because of the factors referred to in the Supreme Court Judgement (i.e. the person is not subject to new or additional restrictions) we would ask managing authorities to considering making a Standard Authorisation request unless they believe that the criteria for an Urgent Authorisation are met.
Applications for DoLS must only be made as a result of an MCA compliant and properly recorded, best interest decision for that person. Managing Authorities are reminded of their responsibilities and the guidance outlined in the DoLS Code of Practice (PDF).
For further information contact the Surrey County Council DoLS Team
Files available to download
- DOLS Guidance 2015 (477.6 KB)
Deprivation of Liberty guidance 2015
- DOLS - Form 1 - Standard Request And Urgent Authorisation (127.7 KB)
First DOLS Application Form
- DOLS - Form 2 - Further Standard Authorisation Request (99.7 KB)
DOLS Renewal Request Form
- DOLS - Form 10 - Review Request (100.6 KB)
For when circumstances or conditions have changed
- Deprivation of Liberty Safeguards: A guide for hospitals and care homes OPG-608 (1.1 MB)
Useful information for managing authorities
- Deprivation of Liberty Safeguards: A guide for relevant person's representatives OPG-609 (1.2 MB)
Useful information for RPR role