Questions That Must Be Answered

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QUESTIONS THAT MUST BE ANSWERED
WHEN REQUESTING EITHER MEDICAL OR ECT CONSENT
WHEN A PATIENT IS ON A TEMPORARY OR LPS CONSERVATORSHIP
Conservatee’s name
Court Number
QUESTION #1:
What is the condition that requires treatment or
surgery?
QUESTION #2:
What is the recommended course of
treatment?
QUESTION #3:
What is the predictable results if authority to
consent to treatment is denied or delayed by
the court?
QUESTION #4:
What is the predictable or probable results if
the recommended treatment is given?
Rev. 10/05
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