Psychotropic Medication Quarterly Evaluation

Updated 2025
Revised and reviewed for alignment with revisions to Appendix PP, effective April 28, 2025.

This form provides for documentation of quarterly (4) evaluations of psychotropic medications including:

·Drug/dose/frequency; date drug initiated

·Diagnosis

·Symptoms for use of medication

·Episode frequency

·Interventions (effective and ineffective)

·Adverse reactions

·EPS assessment dates and results

·Physician aware of adverse reactions, including date informed

·Plan of Care update

·Date of last dose reduction

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