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
Klonopin clonazepam 09/2024 Antianxiety, Anticonvulsant, benzodiazepine English PDF
Klonopin clonazepam 09/2024 Antianxiety, Anticonvulsant, benzodiazepine English Word
Lamictal, Lamictal XR lamotrigine 05/2021 Anticonvulsant, phenothiazine English PDF
Lamictal, Lamictal XR lamotrigine 05/2021 Anticonvulsant, phenothiazine English Word
Latuda lurasidone 09/2024 Antipsychotic, Mood stabilizing English Word
Latuda lurasidone 09/2024 Antipsychotic, Mood stabilizing English PDF
Lexapro escitalopram 06/2020 Antianxiety, Antidepressant English PDF
Lexapro escitalopram 06/2020 Antianxiety, Antidepressant English Word
Librium chlordiazepoxide 09/2024 Antianxiety, benzodiazepine English Word
Librium chlordiazepoxide 09/2024 Antianxiety, benzodiazepine English PDF
Loxitane loxapine 07/2020 Antipsychotic, dibenzoxazepine English PDF
Loxitane loxapine 07/2020 Antipsychotic, dibenzoxazepine English Word
Ludiomil maprotiline 07/2020 Antidepressant English Word
Ludiomil maprotiline 07/2020 Antidepressant English PDF
Lunesta eszopiclone 06/2020 Hypnotic, Sedative English PDF
Lunesta eszopiclone 06/2020 Hypnotic, Sedative English Word
Luvox, Luvox CR fluvoxamine 10/2019 Antidepressant English PDF
Luvox, Luvox CR fluvoxamine 10/2019 Antidepressant English Word
Lyrica pregabalin 10/2018 Anticonvulsant English Word
Lyrica pregabalin 10/2018 Anticonvulsant English PDF
Mellaril thioridazine 08/2016 Antipsychotic, phenothiazine English Word
Mellaril thioridazine 08/2016 Antipsychotic, phenothiazine English PDF
Minipress prazosin 09/2024 Adrenergic, Alpha, Blocker English Word
Minipress prazosin 09/2024 Adrenergic, Alpha, Blocker English PDF
Moban molindone 05/2024 Antipsychotic, dihydroindolone English Word
Moban molindone 05/2024 Antipsychotic, dihydroindolone English PDF
Namenda, Namenda XR memantine 04/2021 Alzheimer's treatment English PDF
Namenda, Namenda XR memantine 04/2021 Alzheimer's treatment English Word
Nardil phenelzine 09/2024 Inhibitor, MAO English PDF
Nardil phenelzine 09/2024 Inhibitor, MAO English Word
Navane thiothixene 05/2024 Antipsychotic, thioxanthene English PDF
Navane thiothixene 05/2024 Antipsychotic, thioxanthene English Word
Neurontin, Gralise gabapentin 04/2021 Anticonvulsant English PDF
Neurontin, Gralise gabapentin 04/2021 Anticonvulsant English Word
No brand name available phenobarbital 06/2017 Anticonvulsant, Barbiturate, Barbiturate-like English Word
No brand name available melatonin 09/2024 Agent, Central nervous system English PDF
No brand name available phenobarbital 06/2017 Anticonvulsant, Barbiturate, Barbiturate-like English PDF
No brand name available melatonin 09/2024 Agent, Central nervous system English Word
Norpramin desipramine 08/2018 Antidepressant, tricyclic English Word
Norpramin desipramine 08/2018 Antidepressant, tricyclic English PDF
Nuedexta dextromethorphan hydrobromide/quinidine sulfate 03/2017 Antidepressant, Antipsychotic, Bipolar, Mood stabilizing English Word
Nuedexta dextromethorphan hydrobromide/quinidine sulfate 03/2017 Antidepressant, Antipsychotic, Bipolar, Mood stabilizing English PDF
Nuplazid pimavanserin 05/2020 Antipsychotic, Atypical English Word
Nuplazid pimavanserin 05/2020 Antipsychotic, Atypical English PDF
Orap pimozide 05/2024 Antipsychotic English Word
Orap pimozide 05/2024 Antipsychotic English PDF
Parnate tranylcypromine 06/2017 Inhibitor, MAO English PDF
Parnate tranylcypromine 06/2017 Inhibitor, MAO English Word
Paxil, Paxil CR, Pexeva paroxetine hydrochloride 08/2020 Antidepressant, Inhibitor, MAO English PDF
Paxil, Paxil CR, Pexeva paroxetine hydrochloride 08/2020 Antidepressant, Inhibitor, MAO English Word

Glossary

 
Last revised August 15, 2024