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Mental Capacity Assessment Form

A mental capacity assessment form is used by medical doctors or healthcare professionals to determine whether or not a patient has the mental capacity to make their own healthcare decisions.

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Description:This mental capacity assessment form is used by healthcare professionals to evaluate a patient's ability to make their own healthcare decisions.

A mental capacity assessment form is a tool used by healthcare professionals to determine whether or not a patient has the mental capacity to make their own healthcare decisions. This form is typically used for patients who may have a cognitive impairment or disability that could affect their ability to make informed decisions about their healthcare. The form includes questions and prompts that assess the patient's understanding of their medical condition, the risks and benefits of treatment options, and their ability to communicate their preferences. The results of the assessment can help healthcare professionals determine the appropriate level of support and decision-making assistance that the patient may need. By using this form, healthcare professionals can ensure that patients are receiving the care that is best suited to their individual needs and abilities.

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Full Name*

Date of Birth*

Have you traveled outside of...*

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Covid 19 Supplemental Informed Consent

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Employee Name*

Evaluation Date*

Select date

Department*

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First Name*

Last Name*

Date of Birth*

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