CHIEF CIVIL PSYCHIATRIST APPROVED FORM 2B	
	
               DECISION MAKING
           CAPACITY- 
           CHILDREN

Mental Health Act 2013
Section 7

THCI: (PatientId): 	

Family Name:  <<Patient Demographics:Surname>>	

Given Name: <<Patient Demographics:First Name>>	

DOB: <<Patient Demographics:DOB>>  Gender: <<Patient Demographics:Sex>>	

Address: <<Patient Demographics:Full Address>>	

Phone: <<Patient Demographics:Phone (Home)>>  Mob: <<Patient Demographics:Phone (Mobile)>>	

AFFIX STICKER HERE	
RECORD OF DETERMINATION - DECISION MAKING CAPACITY - CHILDREN	
                TREATING MEDICAL PRACTITIONER TO COMPLETE
	The patient or prospective patient is the person who is being assessed for capacity.
	
Patient or prospective patient's name:

<<Patient Demographics:Full Name>>	

Treating medical practitioner's name:

<<Doctor:Name>>	

For the purposes of the Mental Health Act 2013, a child is taken to have the capacity to make a decision about his or her own
assessment or treatment ONLY IF a person or body considering that capacity under the Act is satisfied that the child is sufficiently mature to make the decision, and notwithstanding any impairment of, or disturbance in, the functioning of the child’s mind or brain,the child is able to:
·	Understand information relevant to the
decision, and
·	Retain information relevant to the decision, and
·	Use or weigh information relevant to the decision,and
·	Communicate the decision             (whether by  gesture,                      speech or other means).

A child may be taken to understand information relevant to a decision if it reasonably appears that he or she is able to understand an explanation of the nature and consequences of the decision given in a way that is appropriate to his or her circumstances (whether by words, signs or other means).

A child may be taken to be able to retain information relevant to a decision even if he or she may onlybe able to retain the information briefly.

Information relevant to a decision includes information on the consequences of making the decision one way or the other, deferring the making of the decision, and failing to make the decision.    	
 I am NOT SATISFIED that the patient named above has the capacity to make a decision, under the Mental Health Act 2013, about his or her own: 
               q     Assessment    OR   q Treatment 
Specifically, I confirm that I am: 
q   Not satisfied that the patient named above is sufficiently mature to make the decision
 OR
q   Not satisfied that the patient named above is able to understand information relevant to the decision, and retain information relevant to the decision, and use or weigh information relevant to the decision, and communicate the decision (whether by gesture, speech or other means). 
Reasons for not being satisfied that the patient named above has the capacity to make a decision about his or her own assessment or treatment: 

	

Steps that have been taken to assist the patient named above to make a decision about his or her own assessment or treatment: 

	

Treating medical practitioner's signature:_____________________________________

Date and time of determination: <<Miscellaneous:Date (short)>>   Time:              AM/PM	

COPY TO: q  LOC OTHER:q If record is about the capacity to make a decision about assessment – append to AO                                                            q If record is about the capacity to make a decision about treatment – append to TO