Instructions for Access and Use of Informed Consent for Medication Forms


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 Forms Library. 

The F-24277 form provides uniformity and accuracy regarding side effects 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 or a review of the information was completed.

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 Specialist, Department of Health Services, Division of Care and Treatment Services.

Finding the Appropriate Form

Informed consent for medication forms are available as fillable or print-on-demand forms on the DHS Forms Library. If you do not know the exact spelling of the medication, you can sort the list by the brand or generic name and scroll through until you find the desired medication

Under the Forms Library you can find the Informed Consents for Medications - F-24277 Series. The list can be sorted by brand name or generic name, and there is a Word version and a PDF available. Click on the link to open the Informed Consent form.

Using Appropriate Forms

Accessing and using PDF forms will require that users have Adobe Acrobat software on their pc or network. 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 entering information.

In Sections 2 (Alternatives) and 3 (Consequences), users will need to manually place a check in front of all selections that apply.

Last Revised: July 3, 2018