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
Corgard nadolol 10/2018 Adrenergic, Beta, Blocker English PDF
Corgard nadolol 10/2018 Adrenergic, Beta, Blocker English Word
Cymbalta duloxetine 10/2019 Antidepressant English PDF
Cymbalta duloxetine 10/2019 Antidepressant English Word
Dalmane flurazepam 09/2024 benzodiazepine, Hypnotic, Sedative English Word
Dalmane flurazepam 09/2024 benzodiazepine, Hypnotic, Sedative English PDF
Daytrana methylphenidate transdermal 05/2021 Central nervous system, Stimulant English PDF
Daytrana methylphenidate transdermal 05/2021 Central nervous system, Stimulant English Word
Depakene valproic acid 09/2024 Anticonvulsant English Word
Depakene valproic acid 09/2024 Anticonvulsant English PDF
Depakote, Depakote DR, Depakote ER, Depakote Sprinkles divalproex sodium 09/2024 Anticonvulsant, Mood stabilizing English PDF
Depakote, Depakote DR, Depakote ER, Depakote Sprinkles divalproex sodium 09/2024 Anticonvulsant, Mood stabilizing English Word
Depo-Provera, Provera medroxyprogesterone acetate 03/2021 Progestin (for non-contraceptive use), Systemic English PDF
Depo-Provera, Provera medroxyprogesterone acetate 03/2021 Progestin (for non-contraceptive use), Systemic English Word
Desyrel trazodone 10/2021 Antidepressant English PDF
Desyrel trazodone 10/2021 Antidepressant English Word
Dexedrine, Zenzedi, ProCentra dextroamphetamine 03/2021 Central nervous system, Stimulant English PDF
Dexedrine, Zenzedi, ProCentra dextroamphetamine 03/2021 Central nervous system, Stimulant English Word
Effexor, Effexor XR venlafaxine hydrochloride 04/2021 Antidepressant English Word
Effexor, Effexor XR venlafaxine hydrochloride 04/2021 Antidepressant English PDF
Elavil amitriptyline 11/2017 Antidepressant, tricyclic English PDF
Elavil amitriptyline 11/2017 Antidepressant, tricyclic English Word
Eskalith, Eskalith CR, Lithobid lithium carbonate 07/2020 Mood stabilizing English PDF
Eskalith, Eskalith CR, Lithobid lithium carbonate 07/2020 Mood stabilizing English Word
Exelon rivastigmine 05/2021 Alzheimer's treatment English PDF
Exelon rivastigmine 05/2021 Alzheimer's treatment English Word
Fanapt iloperidone 10/2019 Antipsychotic, Atypical English PDF
Fanapt iloperidone 10/2019 Antipsychotic, Atypical English Word
Focalin, Focalin XR dexmethylphenidate 04/2021 Central nervous system, Stimulant English PDF
Focalin, Focalin XR dexmethylphenidate 04/2021 Central nervous system, Stimulant English Word
Gabitril tiagabine 05/2021 Anticonvulsant English PDF
Gabitril tiagabine 05/2021 Anticonvulsant English Word
Geodon ziprasidone 05/2024 Antipsychotic, Mood stabilizing English Word
Geodon ziprasidone 05/2024 Antipsychotic, Mood stabilizing English PDF
Halcion triazolam 06/2020 benzodiazepine, Hypnotic, Sedative English Word
Halcion triazolam 06/2020 benzodiazepine, Hypnotic, Sedative English PDF
Haldol haloperidol 07/2020 Antipsychotic, phenothiazine English Word
Haldol haloperidol 07/2020 Antipsychotic, phenothiazine English PDF
Igalmi dexmedetomidine 08/2024 Adrenergic, Agonist, Alpha-2 English Word
Igalmi dexmedetomidine 08/2024 Adrenergic, Agonist, Alpha-2 English PDF
Inderal, Inderal XL, Hemangeol, InnoPran XL propranolol 05/2021 Adrenergic, Beta, Blocker English Word
Inderal, Inderal XL, Hemangeol, InnoPran XL propranolol 05/2021 Adrenergic, Beta, Blocker English PDF
Ingrezza valbenazine 09/2024 Inhibitor, Vesicular monoamine transporter 2 English PDF
Ingrezza valbenazine 09/2024 Inhibitor, Vesicular monoamine transporter 2 English Word
Invega paliperidone 07/2020 Antipsychotic, benzisoxazole English Word
Invega paliperidone 07/2020 Antipsychotic, benzisoxazole English PDF
Invega Sustenna paliperidone 10/2018 Antipsychotic, benzisoxazole English PDF
Invega Sustenna paliperidone 10/2018 Antipsychotic, benzisoxazole English Word
Invega Trinza paliperidone palmitate 05/2016 Antipsychotic, Atypical English Word
Invega Trinza paliperidone palmitate 05/2016 Antipsychotic, Atypical English PDF

Glossary

 
Last revised August 15, 2024