Informed Consent For Psychiatric Medications (Page 2 of 2) in pdf

Procedure for Medication Consent for Voluntary Patients

Purpose

To serve as a legal record of the patient’s agreement to take psychiatric medication as part of

a treatment regimen.

To document that the patient has been offered an explanation of the effects of the medication

offered.

To document that the patient has been offered written information about the medications

being prescribed.

Responsibility for Documentation

The prescriber has the primary responsibility for filling out the form once the patient has

received language-appropriate information about the medication.

A new form must be executed when any new medications are added.

The completed form should be filed permanently in the chart. Medication Information Sheets

do not need to be filed in the chart.

A copy of the consent form should be given to the client for his/her records (see below 3.H.).

Instructions

The patient is to receive both a verbal explanation and the appropriate Medication Information

Sheets before the form is completed.

This form can accommodate up to 6 medications, assuming the patient consents to all.

The medication information is entered into the table.

If the patient consents to medications, check the applicable box.

1. If the patient agrees, then the patient and physician sign and date at the bottom.

2. If the patient cannot or will not sign, the physician fills in the reason, and signs at the

bottom with a witness.

3. The physician documents his/her continued attempts to obtain a signature by initialing and

dating the appropriate line.

4. If the patient is willing to document refusal of medications, this box can be check and the

physician and patient can sign and date at the bottom.

If the patient signs with a mark, a witness is needed.

A patient may withdraw consent at any time by notifying the physician a/o clinician. The

reason for the withdrawal should be documented in the progress notes, and the medication

order should be discontinued.

G. If a medication is being recommended for which there is not current Medication Information

Sheet, document the verbal explanation in the progress note and have the patient sign the

consent form.

The original consent form is to be filed in the client chart. A copy is to be given to the client.

If the client is conserved, the conservator should sign the medication consent and the original

kept in the chart. A copy to be maintained by the conservator.

MHE 702

Distribution: Original in Chart; Copy to Parent or Legal Guardian, Copy to Public Guardian (if conserved)

Rev 3-2015

Informed Consent For Psychiatric Medications Page 2