Instructions for completing Application for a declaration ...€¦ · For more information on QCAT: Call 1300 753 228 or visit QCAT Queensland Civil and Administrative Tribunal Application

For more information on QCAT: Call 1300 753 228 or visit www.qcat.qld.gov.au

QCATQueensland Civil and Administrative Tribunal



Application for a declaration about capacity – Guardianship and Administration Act 2000

BEFORE YOU GO ANY FURTHER... check that you really need to make this application.

The purpose of this form is to ask QCAT to declare that a particular person has the capacity to make decisions in relation to a matter.

The person whose capacity you are seeking to establish could be a guardian, administrator, or the adult him/herself.

• Whocanmakethisapplication?

You can make this application if you are:

• the adult concerned, or

• a guardian, administrator or attorney, or

• anyone else with an interest.

• HowdoIcompletethisform?

You work through the form, answering each question as it comes by ticking the appropriate box or writing on the lines provided. Some of the questions have space for names, addresses, short explanations and other details.

Do not skip any questions unless the instructions tell you to.

The form itself is divided into six parts:

• preliminarydetails(whichhassectionson‘Basicinformationabouttheperson’, ‘Informationabouttheperson’sallegedimpairedcapacity’and‘Priority’)

• informationabouttheguardian/s,administrator/s,andattorney/s

• informationabouttheapplication

• informationaboutanyoneelseconcerned

• person’srequirementsattheQCAThearing

• basicinformationaboutyou,theapplicant.

• WhatelsedoIhavetodotomakethisapplication?

You have several responsibilities. They are:

• toinformtheadultconcernedthatyouhavemadeanapplication,andexplainwhy(unless,ofcourse,youaremakingtheapplicationonyourownbehalf)

• tosupplyatleastonewrittenreportfromahealthprovideroutliningthenatureoftheperson’sallegedimpairedcapacityorabilitytomanagehis/herpersonaland/orfinancialaffairs;or,ifforsomereasonyoucannotsupplyityourself,toexplainwhyyouhaven’tattachedittotheform,and how the tribunal can obtain a copy

• togiveQCATthenamesandcontactdetailsofeveryonewhohasaninterestinyourapplication, even if they disagree with it

Instructionsforcompleting



• WhatelsedoIhavetodotomakethisapplication?

• toattendtheQCAThearing,whereadecisionwillbemadeonyourapplication

• toarrangeforthepersontoattendthehearing

• toadviseQCATifthepersonhassignedanenduringpowerofattorneyoranadvance health directive

• toinformQCATiftheadult’scircumstanceschangeafteryou’vesubmittedtheapplication.

• Whatwillhappenwhenthetribunalreceivestheapplication?

• QCATstaffwillsendyouanacknowledgmentthatyourapplicationhasbeenreceived.

• Theymaycontactyou,andotherswhoareinvolved,todiscusstheapplication.

• Theywillsetadateforthehearing.

• Theywillsendanoticeofthedate,timeandvenueofthehearingtoyou,thepersonandeveryoneelsenamedintheapplicationasinterestedpersons(inthesectioncalled‘Informationaboutanyoneelseconcerned’).

• Whoattendsthehearing?

All the following will be advised of the hearing and can atttend:

• theadult–asthepersonmakingtheapplication

• theapplicant(ifsomeoneotherthantheadult)

• membersoftheadult’sfamily

• anyoftheadult’sprimarycarers

• allcurrentguardians,administratorsandattorneysfortheadult

• theAdultGuardian

• thePublicTrustee

• anyoneelsewhohasaninterestintheadultorisgivenpermissionbyQCATtoattend.

Itisimportantthattheadultattend.ThisisbecauseQCATwillbebetterabletogaugetheirneedsand rights if they can see him/her.

• CanIwithdrawtheapplication?

You can apply to the tribunal to withdraw the application by making an application under form 40 — Application for miscellaneous matters.

Ifyouhaveanyqueriesaboutapplyingtothetribunaltowithdrawyourapplication,youshouldtalktostaffatthetribunal.Phone1300753228.

• WherecanIgoforhelpwiththisapplication?

Ifyouareuncertainaboutanystepsintheprocedureoryouaredoubtfulabouthowtoanswer any of the questions, you should talk to staff at the tribunal.

Instructionsforcompleting(continued)



Application for a declaration about capacity –Guardianship and Administration Act 2000 –page1of20



IMPORTANT

TheprinciplesofnaturaljusticeandproceduralfairnessrequirethatpartiesbeawareofallmaterialuponwhichQCATwillbaseitsdecision.PartiesarethereforeentitledtoaccesstheapplicationandanymaterialprovidedtoQCAT.Inexceptionalcircumstances,suchaswherethereisriskofphysicalharm,violenceorinterferencewithacurrentinvestigation,apersonmaymakearequestforaconfidentialityorder.ThereisnoguaranteeQCATwillmakeaconfidentialityorder.IfQCATordersthatthematerialbekeptconfidentialitislikelytohavelessweightasotherpartieshavenothadtheopportunitytocomment.IfyourequestthisformbekeptconfidentialandyoudonotprovideanyevidenceofexceptionalcircumstancesforthisorQCATdoesnotmakeaconfidentialityorder,QCATwillnotrelyupon the material.

FormNumber11(version1)Queensland Civil and Administrative Tribunal Act 2009 (section33)

Yes–Whenever this form asks a question about ‘the person’, it means you. Please answer with details about yourself. Go to question 3.

No–Gotoquestion2

1. Areyoumakingthisapplicationonyourownbehalf?

PRELIMINARYDETAILS

QCATmaymakeadeclarationaboutthecapacityofanadult,guardian,administratoror attorney for a matter.

Application for a declaration about capacity – Guardianship and Administration Act 2000

Refer to attached instructions at the front of this applicationpriortofillingoutthisform. Forofficeuseonly

Casenumberandtype:

Adultnumber:

Date:

Registry:

Sentto:




3. Whatistheperson’sname?

PRELIMINARYDETAILS (continued)

4. Whatothernamesisthepersonknownby?

5. Whatsexisthisperson?

6. Howoldistheperson?

7. Whatistheperson’sdateofbirth?

Title Given name/s Surname/Family name

Male Female

Day Month Year

BASICINFORMATIONABOUTTHEPERSON

2. Haveyouinformedthepersonaboutthisapplication?

Yes–Howdidhe/sherespond?Pleasedescribebriefly:

No–Whynot?Pleaseexplainbriefly:




8. Whataretheperson’scurrentcontactdetails? Givedetailsfortheplacewherethepersonisnowlivingorstaying:

Address

Postcode

Telephone ( ) ( )Daytime phone Mobile phone After hours number (if different)

Fax ( )

Email


9. Isthispersonlivingathis/herpermanentaddress?

Yes – gotoquestion10

No – pleasewritetheperson’spermanentaddressandcontactdetailshere:

10. Whattypeofaccommodationisthis?

Address

Postcode


Fax ( )

Email

(hostel, own home, rental property)

BASICINFORMATIONABOUTTHEPERSON(continued)





INFORMATIONABOUTTHEPERSON’SALLEGEDIMPAIREDCAPACITY

12. Whatisthecauseoftheperson’sallegedimpairedcapacity? (tick one or more boxes)

acquired brain injury or cognitive disability (as a result of accident, illness or other causes)

intellectual disability (a condition that has affected the person since birth or early childhood)

psychiatric disability/mental illness (adiagnosedconditionsuchasschizophreniaorbi-polaraffectivedisorder)

dementia (mentalconfusionduetoaconditionsuchasAlzheimer’sdisease,senilityorsomeotherdegenerativedisease)

other (anyotherconditionthatreducestheabilitytomakedecisionsaboutpersonalorfinancialmatters).Givedetails:

BASICINFORMATIONABOUTTHEPERSON(continued)

11. Pleaseidentifytheperson’sculturalbackground




INFORMATIONABOUTTHEPERSON’SALLEGEDIMPAIREDCAPACITY (continued)

13. Haveyouobtainedanyreportsbymedical,psychiatricorotherprofessionalsthatgivedetailsoftheperson’sallegedimpairedcapacity?

No – you will need to obtain such a report and attach it to this form.

Yes – pleasegivethefollowingdetailsaboutthewriterofthereport,andattachthereporttothisform (there is room for details about two reports)

Writeroffirstreport

Name


Address

Postcode


Fax ( )

Email

Professionalcapacity:

Haveyouattachedthisreport?

Yes

No – Please explain why not and howQCATcanobtainacopy:





Writerofsecondreport(if available)

Name


Address

Postcode


Fax ( )

Email

Professionalcapacity:

Haveyouattachedthisreport?

Yes

No – please explain why not and howQCATcanobtainacopy:

INFORMATIONABOUTTHEPERSON’SALLEGEDIMPAIREDCAPACITY (continued)


PRIORITY

14. Isthisapplicationurgent?Thatis,dothemattersdetailedinthisapplicationposeanimmediateproblem?

No

Yes–pleasegivereasons:




INFORMATIONABOUTANYGUARDIANS,ADMINISTRATORSORATTORNEYS

15. Hasthepersongivenanyoneenduringpowerofattorneyforpersonal/financialmattersormadeanadvancehealthdirective?

No

Unsure–pleasegivecontactdetailsofanyonewhomightknow:

Yes–Attachcopiesoftherelevantforms(‘Enduringpowerofattorney’or‘Advancehealthdirective’) ifavailable,andgivethefollowingdetailsabouttheattorney/s:

Attorney 1Name


Address

Postcode


Fax ( )

Email

Relationship to adult

Whatistheattorney’sattitudetothisapplicationlikelytobe?

support

does not support

don’tknow




Attorney 2 (if there is more than one)

Name


Address

Postcode


Fax ( )

Email

Relationship to adult


support

does not support

don’tknow

INFORMATIONABOUTANYGUARDIANS,ADMINISTRATORSORATTORNEYS

15. Hasthepersongivenanyoneenduringpowerofattorneyforpersonal/financialmattersormadeanadvancehealthdirective?(continued)

INFORMATIONABOUTTHEAPPLICATION

16. Whoisthepersonwhosedecision-makingcapacityyouareaskingQCATtodeclare?(please tick one box)

self

an adult

a guardian

an administrator

anattorneyforfinancialmatters

an attorney under an advance health directive

an attorney for personal matters

a statutory health attorney




INFORMATIONABOUTTHEAPPLICATION(continued)

17. Whatmatterdoesthisdeclarationofcapacityconcern? Pleasegivedetailsaboutthematter:

18. Whydoyoubelievethatthepersonnamedinquestion3has/doesnothavethecapacitytomakedecisionsinrelationtothismatter? Pleaseexplainbriefly:

19. Whydoyoubelievethatthisdeclarationofcapacityisnecessary? Pleaseexplainbriefly:




INFORMATIONABOUTANYONEELSECONCERNED

Inthissection,yougivedetailsaboutanyonewithaninterestinthisapplication,eventhosewhoopposeit.Thiswouldbeanyonewithaninterestintheperson,suchas:theperson’sprimarycarer,membersoftheperson’sfamily(e.g.spouse,defactoormarried;children,stepchildren,adoptedchildrenorfoster-childrenwhoare18orover;parents,step-parentsorfosterparents;siblings,step-siblings,adoptedsiblingsandfoster-siblingswhoare18orover),serviceproviders,(e.g.respitecarersandcommunitynurses),andclosefriends.Ifyouareunabletogivean address, you may suggest a way to contact the person.

20. Doesanyoneelsehaveaninterestinthisapplication?

No

Yes–Give details in the spaces below. Iftherearemorethaneightpeople,pleaselistonaseparatesheetofpaper.

Other person 1Name


Address

Postcode


Fax ( )

Email

Relationship to person


support

does not support

don’tknow




Other person 2Name


Address

Postcode


Fax ( )

Email



support

does not support

don’tknow

INFORMATIONABOUTANYONEELSECONCERNED(continued)




Other person 3Name


Address

Postcode


Fax ( )

Email



support

does not support

don’tknow





Other person 4Name


Address

Postcode


Fax ( )

Email



support

does not support

don’tknow





Other person 5Name


Address

Postcode


Fax ( )

Email



support

does not support

don’tknow





Other person 6Name


Address

Postcode


Fax ( )

Email



support

does not support

don’tknow





Other person 7Name


Address

Postcode


Fax ( )

Email



support

does not support

don’tknow





Other person 8Name


Address

Postcode


Fax ( )

Email



support

does not support

don’tknow





PERSON’SREQUIREMENTSATTHETRIBUNALHEARING

This section deals with any requirements that the person may have while attending QCAT hearing.

21. Isaninterpreterrequired?

Yes No

22. Isthepersondeaf?

Yes No

23. Doesthepersonhaveahearingimpairment?

Yes No

24. Doesthepersonhaveimpairedvision?

Yes No

25. Doesthepersonuseamobilityaid?

Yes No

26. Doesthepersonhaveanyotherrequirements?

Yes No

IfYES,pleasespecifylanguage

If YES, what assistance is requested?



IfYES,pleaseexplainbriefly


Note:QCATwillprovidecommunicationassistanceforthepersonwhereverpossible.




BASICINFORMATIONABOUTYOU,THEAPPLICANT

27. Areyoumakingthisapplicationonyourownbehalf?

Yes–goto‘Declarationbytheapplicant’.

No–pleasegiveyournameandcontactdetailshere:

Name


Address

Postcode


Fax ( )

Email





Pleasereadthroughthisapplicationtocheckthatnothinghasbeenoverlookedandthatallthenecessarydocumentsareattached.Thensigntheapplicationbelow.

LODGEMENTDETAILS

Deliverto: Mailto: Faxto: Emailto:

Queensland Civil and Administrative TribunalFloor9,259QueenStreetBrisbaneQld4000 or at any local Magistrates Court

Queensland Civil and Administrative TribunalGPOBox1639BrisbaneQld4001

(07)32219156 [email protected]

Warning

Section216oftheQueensland Civil and Administrative Tribunal Act 2009 makes it an offence for a person to knowingly give the registry documents containing false or misleading information.

Maximumpenaltyforsuchanoffence–$10,000.

SIGNANDDATEHERE

The information in this application is true to the best of my knowledge.

Applicant/ssignhere Date

Documents

Instructions for completing Application for a declaration ...€¦ · For more information on QCAT: Call 1300 753 228 or visit QCAT Queensland Civil and Administrative Tribunal Application