Form Mpc 800 - Clinician'S Affidavit As To Competency And Treatment Page 3

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15. The proposed antipsychotic medication treatment plan is as follows:
MEDICATION
DOSAGE AND DOSE RANGE
As currently listed in Q. 12
Alternative Antipsychotic Medication:
MEDICATION
DOSAGE AND DOSE RANGE
16. The Respondent
is currently exhibiting the following side effects from the antipsychotic medication:
is not currently exhibiting any side effects from the antipsychotic medication.
17. The potential side effects of the proposed course of treatment are as follows:
18. The results I expect from use of this medication with the Respondent include the following:
19. Long term planning for the Respondent includes the following:
20. Describe in detail the plan for reduction of the administration of antipsychotic medications:
MPC 800 (6/17/11)
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