Psychotropic Medication Informed Consent
Updated 2025
Revised and reviewed for alignment with revisions to Appendix PP, effective April 28, 2025.
Briggs Psychotropic Medication Consent form provides the resident/resident representative with the required information to provide informed consent for the use of psychotropic medications. The form provides for documentation of:
| • | Medical diagnosis for use of psychotropic medication; also specific purpose for use |
| • | Non-pharmacological interventions that have been used and found to be ineffective |
| • | Proposed course/length of duration for the use of the psychotropic medication |
| • | Behaviors exhibited that would benefit from medication |
| • | Consent and acknowledgment of black-box warnings reviewed with the resident/resident representative |
| • | Declination of consent |
Size: 8 ½" x 11"
Print: Black ink
Paper: 2-part carbonless - white and canary
Punching: 5-holes top and side
Packaging: 100/pack