For the purposes of section 44(2)(c) of the Act, the following information is the prescribed information:

(a) the name and address of each of the following persons:

(i) the applicant;

(ii) the person in respect of whom the application is made;

(iii) the registered practitioner who recommended the treatment that is proposed;

(iv) the registered practitioner who intends to carry out the treatment;

(v) a person responsible for the person in respect of whom the application is made;

(vi) any other person who is concerned for the welfare of the person in respect of whom the application is made;

(vii) a health care professional who has diagnosed the disability of the person in respect of whom the application is made;

(b) the telephone number and email address of each person referred to in paragraph (a) , if known;

(c) details of –

(i) the medical or dental condition requiring treatment; and

(ii) the proposed treatment; and

(iii) the date, time and place of the proposed treatment, if known;

(d) the views of the person, in respect of whom the application is made, on the proposed treatment;

(e) a report from a registered practitioner giving details of –

(i) the disability of the person in respect of whom the application is made; and

(ii) how the disability affects the capacity of that person to give a consent to the proposed treatment; and

(iii) whether the person concerned is, or is likely to become, capable of consenting to the treatment; and

(iv) the condition and proposed treatment of the person in respect of whom the application is made; and

(v) the risks to that person of carrying out the treatment; and

(vi) the risks to that person of failure to carry out the treatment; and

(vii) whether the proposed treatment can be postponed on the ground that better treatment may become available; and

(viii) any alternative treatment available to that person.