Informed Consent for Medications F-24277 Series: Psychotropic Medications

In Wisconsin, people receiving health care have a right to participate in the planning of their treatment.

Informed consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a treatment. The patient must be competent to make a voluntary decision about the treatment.

Written informed consent is required for the use of psychotropic medications. If written informed consent is not given, the psychotropic medication cannot be administered without a court order unless in an emergency.

For the convenience of health care providers and to comply with requirements listed in Wis. Stat. § 50.08, informed consent forms for many psychotropic medications are provided below in both Adobe PDF (suitable for printing and completing by hand) and Microsoft Word (suitable for completing electronically and printing for signatures).

These forms are reviewed regularly and updated as needed.

Forms listed with a "Blank" medication name are the base form available in English and Spanish versions. Complete a blank form if no prefilled version exists for the prescribed psychotropic medication.

The Client Rights Office accepts questions about these forms and suggestions for improvements.


The list below can be narrowed down by the medication name (brand or generic), file type, and medication category. 

Medication brand name Sort descending Medication generic name Last revised Medication category Language
Abilify, Abilify Maintena, Abilify MyCite, Aristada, Aristada Initio (PDF) aripiprazole 08/2020 Antidepressant, Antipsychotic, Bipolar, Mood stabilizing English
Abilify, Abilify Maintena, Abilify MyCite, Aristada, Aristada Initio (Word) aripiprazole 08/2020 Antidepressant, Antipsychotic, Bipolar, Mood stabilizing English
Adderall, Adderall XR (Word) dextroamphetamine and amphetamine 05/2021 Central nervous system, Stimulant English
Adderall, Adderall XR (PDF) dextroamphetamine and amphetamine 05/2021 Central nervous system, Stimulant English
Ambien, Ambien CR (PDF) zolpidem 09/2019 Hypnotic, Sedative English
Ambien, Ambien CR (Word) zolpidem 09/2019 Hypnotic, Sedative English
Anafranil (PDF) clomipramine 10/2021 Antidepressant, tricyclic English
Anafranil (Word) clomipramine 10/2021 Antidepressant, tricyclic English
Aptensio XR, Concerta, Contempla XR-ODT,Jornay PM, Metadate CD, Metadate ER, Methylin, Quillichew ER, Quillivant XR, Relexxii, Ritalin, Ritalin LA (Word) methylphenidate 09/2024 Central nervous system, Stimulant English
Aptensio XR, Concerta, Contempla XR-ODT,Jornay PM, Metadate CD, Metadate ER, Methylin, Quillichew ER, Quillivant XR, Relexxii, Ritalin, Ritalin LA (PDF) methylphenidate 09/2024 Central nervous system, Stimulant English
Aricept (PDF) donepezil 05/2020 Alzheimer's treatment, Dementia English
Aricept (Word) donepezil 05/2020 Alzheimer's treatment, Dementia English
Aristada (PDF) aripiprazole lauroxil 08/2018 Antipsychotic English
Aristada (Word) aripiprazole lauroxil 08/2018 Antipsychotic English
Artane (Word) trihexyphenidyl 09/2019 Antidyskinetic English
Artane (PDF) trihexyphenidyl 09/2019 Antidyskinetic English
Atarax (Word) hydroxyzine hydrochloride 08/2022 Antianxiety, Antihistamine, Sedative English
Atarax (PDF) hydroxyzine hydrochloride 08/2022 Antianxiety, Antihistamine, Sedative English
Atarax, Vistaril (Word) hydroxyzine 09/2024 Antianxiety, Antihistamine, Sedative English
Atarax, Vistaril (PDF) hydroxyzine 09/2024 Antianxiety, Antihistamine, Sedative English
Ativan (Word) lorazepam 09/2024 Antianxiety, Anticonvulsant, benzodiazepine English
Ativan (PDF) lorazepam 09/2024 Antianxiety, Anticonvulsant, benzodiazepine English
Austedo, Austedo XR (PDF) deutetrabenazine 09/2024 Inhibitor, Vesicular monoamine transporter 2 English
Austedo, Austedo XR (Word) deutetrabenazine 09/2024 Inhibitor, Vesicular monoamine transporter 2 English
Aventyl Pamelor (Word) nortriptyline 09/2019 Antidepressant, tricyclic English
Aventyl Pamelor (PDF) nortriptyline 09/2019 Antidepressant, tricyclic English
Belsomra (PDF) suvorexant 08/2018 Hypnotic, Sedative English
Belsomra (Word) suvorexant 08/2018 Hypnotic, Sedative English
Benadryl (Word) diphenhydramine hydrochloride 05/2020 Antianxiety, Antihistamine, Sedative English
Benadryl (PDF) diphenhydramine hydrochloride 05/2020 Antianxiety, Antihistamine, Sedative English
Blank (PDF) Blank 05/2024 Not applicable Spanish
Blank (Word) Blank 05/2024 Not applicable Spanish
Blank (PDF) Blank 05/2024 Not applicable English
Blank (Word) Blank 05/2024 Not applicable English
Buspar (Word) buspirone 10/2021 Antianxiety English
BuSpar (PDF) buspirone 10/2021 Antianxiety English
Caplyta (PDF) lumateperone 07/2020 Antipsychotic English
Caplyta (Word) lumateperone 07/2020 Antipsychotic English
Cardura, Cardura XL (PDF) doxazosin 09/2024 Adrenergic, Alpha-1, Blocker English
Cardura, Cardura XL (Word) doxazosin 09/2024 Adrenergic, Alpha-1, Blocker English
Catapres (Word) clonidine 05/2020 Adrenergic, Agonist, Alpha, Antihypertensive English
Catapres (PDF) clonidine 05/2020 Adrenergic, Agonist, Alpha, Antihypertensive English
Celexa (PDF) citalopram 10/2021 Antidepressant, SSRI English
Celexa (Word) citalopram 10/2021 Antidepressant, SSRI English
Clozaril (PDF) clozapine 08/2018 Antipsychotic, Atypical English
Clozaril (Word) clozapine 08/2018 Antipsychotic, Atypical English
Cobenfy (Word) xanomeline/trospium chloride 11/2024 Anticholinergic, Antipsychotic English
Cobenfy (PDF) xanomeline/trospium chloride 11/2024 Anticholinergic, Antipsychotic English
Cogentin (PDF) benztropine 10/2018 Anticholinergic English
Cogentin (Word) benztropine 10/2018 Anticholinergic English

Glossary

 
Last revised August 15, 2024