Office of Care and Protection
Patients’ Office
ARTICLE 107 CHECKLIST
Patient’s details
□ Full name
□ Present address
□ Previous address(es)
□ Date of birth
□ National Insurance number
□ Marital status
□ Former occupation(s)
□ Confirmation if Patient ever granted Power of Attorney / Enduring Power of
Attorney to anyone, and if so, that person’s details
□ A Medical Certificate [e.g. Form F5] must be attached to the Article 107
Referral Notice
Nearest Relative details
□ Name
□ Address
□ Telephone number
□ Relationship to Patient
□ Has Notice been given to the nearest relative [Article 108(2)]
□ Is the nearest relative willing / suitable to act on behalf of Patient
□ If not, provide details of another relative / friend who is willing to act
Financial details [list all income, assts and property]
□ Bank / Building Society / Post Office accounts (including account name and
address, account number, and present balance)
□ Investments (including name and address of whom investment held with,
reference numbers, and present value)
□ State or occupation pensions / benefits / direct payments (including amount,
frequency of payment, and where it is being paid to)
□ Details of private pensions (including name and address of payer, amount,
frequency of payment, and where it is being paid to)
□ Any interest in a dwelling house [is house secure? Is house insured?]
□ Any interest in any other properties, lands or stock
□ Significant personal effects or other valuable assets
□ Outstanding debts and recurring charges
□ Details of any Solicitor acting on behalf of the Patient or family [or any
Solicitor who has previously acted if no one currently acting]
□ Confirm the whereabouts of the Patient’s title deeds, will, cash and jewellery
Action
□ What action or intervention do you require OCP to take?
□ What urgent action is required by the Court [e.g. freeze bank accounts,
insure or secure premises, protect valuables, arrange a visit to the Patient,
seek a Court direction or Order etc.]
Date:
Signed:
Position / Qualification:
Print name:
Address:
Telephone No:
Email:
Please note
Should difficulties be encountered in attempting to establish any of the above
information the Office can issue an appropriate person [such as a Trust Official] with
Court authority to investigate a Patient’s financial affairs.
9-9-11