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Client Lacks Capacity with
Client has Substantial Difficulty with
Does the client have someone appropriate to consult?
Can the person support the client appropriately through the process?
Client Group
(Please give details on the client group above)
Please provide the following: - GP Name - Practice Address - Telephone Number
(please include anything that may affect potential home visits)
Please provide ALL required information i.e. Name, Position, Agency, Team and Contact
Has the client provided their consent to be contacted by the advocate?
Will you be the decision maker?
Please provide all information listed.
(eg professionals, court appointed deputy, LPA, EPA, carers, family members, close friends etc)