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 | File type |
---|---|---|---|---|---|
Abilify, Abilify Maintena, Abilify MyCite, Aristada, Aristada Initio | aripiprazole | 08/2020 | Antidepressant, Antipsychotic, Bipolar, Mood stabilizing | English | Word |
Abilify, Abilify Maintena, Abilify MyCite, Aristada, Aristada Initio | aripiprazole | 08/2020 | Antidepressant, Antipsychotic, Bipolar, Mood stabilizing | English | |
Adderall, Adderall XR | dextroamphetamine and amphetamine | 05/2021 | Central nervous system, Stimulant | English | |
Adderall, Adderall XR | dextroamphetamine and amphetamine | 05/2021 | Central nervous system, Stimulant | English | Word |
Ambien, Ambien CR | zolpidem | 09/2019 | Hypnotic, Sedative | English | Word |
Ambien, Ambien CR | zolpidem | 09/2019 | Hypnotic, Sedative | English | |
Anafranil | clomipramine | 10/2021 | Antidepressant, tricyclic | English | Word |
Anafranil | 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 | 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 | methylphenidate | 09/2024 | Central nervous system, Stimulant | English | Word |
Aricept | donepezil | 05/2020 | Alzheimer's treatment, Dementia | English | Word |
Aricept | donepezil | 05/2020 | Alzheimer's treatment, Dementia | English | |
Aristada | aripiprazole lauroxil | 08/2018 | Antipsychotic | English | |
Aristada | aripiprazole lauroxil | 08/2018 | Antipsychotic | English | Word |
Artane | trihexyphenidyl | 09/2019 | Antidyskinetic | English | |
Artane | trihexyphenidyl | 09/2019 | Antidyskinetic | English | Word |
Atarax | hydroxyzine hydrochloride | 08/2022 | Antianxiety, Antihistamine, Sedative | English | |
Atarax | hydroxyzine hydrochloride | 08/2022 | Antianxiety, Antihistamine, Sedative | English | Word |
Atarax, Vistaril | hydroxyzine | 09/2024 | Antianxiety, Antihistamine, Sedative | English | Word |
Atarax, Vistaril | hydroxyzine | 09/2024 | Antianxiety, Antihistamine, Sedative | English | |
Ativan | lorazepam | 09/2024 | Antianxiety, Anticonvulsant, benzodiazepine | English | |
Ativan | lorazepam | 09/2024 | Antianxiety, Anticonvulsant, benzodiazepine | English | Word |
Austedo, Austedo XR | deutetrabenazine | 09/2024 | Inhibitor, Vesicular monoamine transporter 2 | English | |
Austedo, Austedo XR | deutetrabenazine | 09/2024 | Inhibitor, Vesicular monoamine transporter 2 | English | Word |
Aventyl Pamelor | nortriptyline | 09/2019 | Antidepressant, tricyclic | English | |
Aventyl Pamelor | nortriptyline | 09/2019 | Antidepressant, tricyclic | English | Word |
Belsomra | suvorexant | 08/2018 | Hypnotic, Sedative | English | |
Belsomra | suvorexant | 08/2018 | Hypnotic, Sedative | English | Word |
Benadryl | diphenhydramine hydrochloride | 05/2020 | Antianxiety, Antihistamine, Sedative | English | |
Benadryl | diphenhydramine hydrochloride | 05/2020 | Antianxiety, Antihistamine, Sedative | English | Word |
Blank | Blank | 05/2024 | Not applicable | Spanish | |
Blank | Blank | 05/2024 | Not applicable | Spanish | Word |
Blank | Blank | 05/2024 | Not applicable | English | Word |
Blank | Blank | 05/2024 | Not applicable | English | |
BuSpar | buspirone | 10/2021 | Antianxiety | English | |
Buspar | buspirone | 10/2021 | Antianxiety | English | Word |
Caplyta | lumateperone | 07/2020 | Antipsychotic | English | |
Caplyta | lumateperone | 07/2020 | Antipsychotic | English | Word |
Cardura, Cardura XL | doxazosin | 09/2024 | Adrenergic, Alpha-1, Blocker | English | |
Cardura, Cardura XL | doxazosin | 09/2024 | Adrenergic, Alpha-1, Blocker | English | Word |
Catapres | clonidine | 05/2020 | Adrenergic, Agonist, Alpha, Antihypertensive | English | |
Catapres | clonidine | 05/2020 | Adrenergic, Agonist, Alpha, Antihypertensive | English | Word |
Celexa | citalopram | 10/2021 | Antidepressant, SSRI | English | |
Celexa | citalopram | 10/2021 | Antidepressant, SSRI | English | Word |
Clozaril | clozapine | 08/2018 | Antipsychotic, Atypical | English | Word |
Clozaril | clozapine | 08/2018 | Antipsychotic, Atypical | English | |
Cogentin | benztropine | 10/2018 | Anticholinergic | English | |
Cogentin | benztropine | 10/2018 | Anticholinergic | English | Word |
Compro | prochlorperazine | 09/2019 | Antiemetic, Antipsychotic | English | |
Compro | prochlorperazine | 09/2019 | Antiemetic, Antipsychotic | English | Word |