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The Mental Capacity Act 2005
The Care Act 2014
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Express Power of Attorney
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Important Questions
Your Title
(the person granting the Power of Attorney known as the Donor)
Select one...
Mr
Mrs
Miss
Ms
Dr
Rev
Your Full Name
(the person granting the Power of Attorney known as the Donor)
Your Address
(the person granting the Power of Attorney known as the Donor)
Your Date of Birth
(the person granting the Power of Attorney known as the Donor)
Title, Full Name, Date of Birth and Address of your Attorney(s)
Title, Full Name, Date of Birth and Address of your Reserve Attorney
(OPTIONAL)
Title, full name and address of your Certificate Provider
(an adult who has known the Donor
for over 2 years and considers they have Mental Capacity)
Should your Attorneys act Jointly and Severally, so that if one Attorney is not available the other Attorney can still make decisions ?
Select one...
Only one Attorney is being appointed
Yes (most popular option for multiple Attorneys)
No
When should your Attorney(s) be able to represent you ?
Select one...
Immediately (most popular & practical option).
Only after the Attorney can provide medical evidence proving the Donor has lost Mental Capacity.
Should your Attorney(s) to be able to make decisions about life sustaining treatment ?
Select one...
Yes (most popular option).
No.
What things do you enjoy and where do they enjoy doing these activities ?
What things are important to your identity ?
Do you have particular religious beliefs and if so what are these ?
What things do you dislike or frighten you ?
What should people know about your routine, preferences and any care needs you have ?
What are your food & drink preferences ?
Where do you want to live and receive care ?
Who should be involved in decisions about your care ?
What medical conditions affect you and what medication do you take ?
How do you express you are feeling unwell and what type of treatment would you prefer ?
Are there any other things about your future care you want to express
(OPTIONAL)
?
Do you, your Attorney(s) and the Certificate Provider agree to our
Terms & Conditions
?
Select one...
Yes
No
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