Form Mpc 800 - Clinician'S Affidavit As To Competency And Treatment (Page 4 of 5) in pdf

Form Mpc 800 - Clinician'S Affidavit As To Competency And Treatment Page 4

SUBSTITUTED JUDGMENT FACTORS

PROGNOSIS WITHOUT TREATMENT

It is my opinion that if the proposed treatment is not provided to the Respondent, it is likely Respondent will continue to

21.

deteriorate or will have to remain as an inpatient for an undetermined length of time.

22. It is my opinion that the proposed treatment is essential to ameliorate the clinically diagnosed condition from which this

patient currently suffers.

PROGNOSIS WITH TREATMENT

23. The prognosis with treatment is

fair

guarded

good.

With treatment it is expected that the Respondent will continue to

make progress

remain stable,

with the prospect of (check all that apply):

increasing levels of independence;

the ability to remain in the community;

eventual discharge from the hospital to a community setting; or

other:

RISKS AND BENEFITS OF PROPOSED TREATMENT

24. The risks and benefits of the proposed medications and treatment have been described in previous affidavits which I have

reviewed. The risks and benefits of any proposed new medications are:

PATIENT'S RELIGIOUS CONVICTIONS

25. The Respondent's religion is

. The Respondent's decision with regard to treatment as

proposed in this affidavit

is not affected by Respondent's religious beliefs or convictions.

is affected by Respondent's religious beliefs or convictions as follows:

IMPACT ON PATIENT'S FAMILY

26. The Respondent has:

family who are involved and supportive of the Respondent's treatment, and cooperative with facility staff.

Any unnecessary or prolonged hospitalization would be a burden on the Respondent's family.

family who are involved in, but not supportive of the Respondent's treatment, for the following reasons:

MPC 800 (6/17/11)

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Form Mpc 800 - Clinician'S Affidavit As To Competency And Treatment Page 4