INSTRUCTIONS FOR ACCESS AND USE OF INFORMED CONSENT FOR MEDICATION FORMS (F-24277)
The Psychotropic Medication Review Committee (PMRC) was
a multi-disciplinary group of the Department of Health Services (DHS). Membership
consisted of staff from each state-run facility, a Client Rights Office
representative, a representative serving as the liaison with the
Behavior Intervention Oversight Committee (BIOC), and a representative from the
Division of Quality Assurance (DQA). Consumer input was accessed to ensure
integrated care and treatment.
PMRC was created to support our mission to
provide services of value to its clients. Doing so requires commitment to
seeking out and providing state-of-the-art solutions to caregivers
relating to safe and effective psychopharmacological interventions. Part
of achieving this goal involves providing current medication information
to caregivers, residents, patients, and guardians. To begin to accomplish
these goals, the electronic Informed Consent for Medication F-24277 form was developed.
This form is available from the DHS Internet Reference Center.
The F-24277 form provides uniformity and accuracy on side
effect information of medications that are used for psychotropic purposes. All medication information for this database is updated at
least every two years. Any significant changes that occur between formal
reviews are initiated and incorporated as they arise; e.g., addition of
new medications, new uses for an existing medication, a substantial change
in the risks and benefits, or changes in warnings or side effects related
to a given medication. The "review date" noted indicates when
any revisions were last made.
Questions and/or suggestions for improvement should be
directed to Lois Mulder, (608) 266-8502, DHS Records/Forms Officer, or Christi Bermejo, (608) 267-7144, Client
Rights Specialists, Department of Health Services, Division of Mental
Health and Substance Abuse Services.
Finding the Appropriate Form
Informed consent for medication forms are available as print-on-demand
forms on the DHS Internet site under the Reference Center http://www.dhs.wisconsin.gov/reference.htm.
there you go to the Forms Library and then the DMHSAS forms list.
Under the Forms heading you will find the heading Informed Consents for
Medications - F-24277 Series. There are two indices
available for locating appropriate medication forms. The first index is by
‘Brand Name’ and the second is by ‘Generic Name’ for medications.
Once the appropriate index is selected, in the upper left corner of the
screen, select the Edit menu and from that menu, select ‘Find’. Type
in the medication name in the window and select the find button. This
process will take you to the link for the appropriate form. Left click on
the link and the informed consent form will open ready for use.
If you do not know the exact spelling of the medication, indices are
listed in alphabetic order. You can scroll through an index until you find
the desired medication. Click on the link to open the Informed Consent
Using Appropriate Forms
Accessing and using print-on-demand forms will require that users have
Adobe Acrobat software on their pc or network. Instructions regarding
Adobe requirements can be found at http://www.dhs.state.wi.us/getAdobeReader.htm.
Print-on-demand forms can be completed manually by means of hand writing
or typing forms. Users will need to rely on the field captions when
In Sections 2 (Alternatives) and 3 (Consequences), users will need to
manually place a check in front of all selections that apply.
September 06, 2012