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Upon receipt of this form, the Cheshire Advocacy Hub will allocate this referral to an Advocate from Age UK Cheshire or Cheshire Centre for Independent Living.

Reason for Lack of Capacity:

Please choose as appropriate

Decision-maker 

The decision maker is the individual within the Local Authority or the NHS body who has the responsibility for making the decisions on issues of change of accommodation, serious medical treatment, care review or adult protection on behalf of the client who has been assessed as lacking capacity on any stated issue.*

Referrer:

*Issue:

Please choose as appropriate
All the following questions MUST be answered