Medical Report for Activation/Deactivation of Lasting Power of Attorney (LPA)

**(A) Patient's Particulars** **Name (in NRIC):** Tan Mei Ling **NRIC/FIN/Passport:** S1958327D **Date of Birth:** 14/03/1951 **LPA Reference No:** LPA-2019-061238 **(B) Doctor's Opinion on Patient's Mental Capacity** **Diagnosis:** Moderate to severe vascular dementia, diagnosed in 2024 following a series of small-vessel ischaemic events. Background of hypertension, dyslipidaemia, and atrial fibrillation on anticoagulation. **(B-1) Personal Welfare Matters** In your opinion, does the patient have mental capacity in respect of personal welfare matters? [ ] Yes [x] No [ ] Patient to be referred to a specialist for assessment If No, in your opinion, is the patient's mental incapacity likely to be permanent? [x] Yes [ ] No [ ] Patient to be referred to a specialist for assessment **Please state the basis of your opinion above in respect of the patient's mental capacity:** The patient has an established impairment of the mind, namely moderate to severe vascular dementia secondary to small-vessel cerebrovascular disease. This impairment renders her unable to make decisions regarding personal welfare matters, including consent to medical treatment and decisions about where she lives. On formal assessment with the Mini-Mental State Examination she scored 11 out of 30, with severe impairment of orientation, recall, and judgment. She was unable to understand the nature of decisions put to her regarding her care arrangements, was unable to retain the information for more than a brief period, and was unable to weigh the foreseeable consequences of accepting or declining care. Communication was preserved, with the patient able to express herself verbally in Mandarin. The incapacity is assessed as likely to be permanent in view of the established cerebrovascular pathology and the absence of any reversible contributors. **(B-2) Property and Affairs Matters** In your opinion, does the patient have mental capacity in respect of property and affairs matters? [ ] Yes [x] No [ ] Patient to be referred to a specialist for assessment If No, in your opinion, is the patient's mental incapacity likely to be permanent? [x] Yes [ ] No [ ] Patient to be referred to a specialist for assessment **Please state the basis of your opinion above in respect of the patient's mental capacity:** The patient has an established impairment of the mind, namely moderate to severe vascular dementia, which renders her unable to make decisions regarding her financial affairs and property. She was unable to identify her primary sources of income, was unable to state the approximate value of her monthly household expenses, and was unable to understand the implications of a third party transacting on her behalf. Information about her financial circumstances put to her in simple language was not retained, and she was unable to weigh the consequences of decisions regarding her property. All practicable steps to support her decision-making had been taken, including assessment in her preferred language with adequate time and simple visual aids, without success. The incapacity is assessed as likely to be permanent. **(C) Doctor's Declaration** I have read and understood the provisions in sections 3, 4 and 5 of the Mental Capacity Act. I believe in the correctness of the opinion set out in this report and I am acting independently of the patient and the patient's next-of-kin. **Name:** Dr Wong Kah Wai **MCR No.:** M12847B **Date:** 03/06/2026 **Signature:** **Name/Clinic Stamp:** *\*This medical report is not to be used for deputyship application. The affidavit and medical report to be filed in support of the application for appointment of a deputy or deputies shall be in Form 61.* *\*\*This medical report alone does not prove that the LPA is valid. This medical report is to be used together with a valid LPA. If you wish to check the validity of any LPA presented to you, please check against the list of Revoked and Suspended LPAs on OPG's website.*