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 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 from the Forms Library.

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 form.

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 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: January 26, 2015