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
Periactin cyproheptadine 07/2017 Antihistamine English PDF
Periactin cyproheptadine 07/2017 Antihistamine English Word
Pristiq desvenlafaxine 09/2024 Antidepressant English PDF
Pristiq desvenlafaxine 09/2024 Antidepressant English Word
Prolixin fluphenazine 09/2024 Antipsychotic, Derivative, First generation, phenothiazine English PDF
Prolixin fluphenazine 09/2024 Antipsychotic, Derivative, First generation, phenothiazine English Word
Prozac fluoxetine 06/2020 Antidepressant, SSRI English PDF
Prozac fluoxetine 06/2020 Antidepressant, SSRI English Word
Remeron, Remeron SolTab mirtazapine 08/2020 Antidepressant English Word
Remeron, Remeron SolTab mirtazapine 08/2020 Antidepressant English PDF
Restoril temazepam 11/2017 benzodiazepine, Hypnotic, Sedative English PDF
Restoril temazepam 11/2017 benzodiazepine, Hypnotic, Sedative English Word
ReVia naltrexone 06/2017 Antagonist, Opioid English Word
ReVia naltrexone 06/2017 Antagonist, Opioid English PDF
Rexulti brexpiprazole 06/2020 Antipsychotic, Mood stabilizing English Word
Rexulti brexpiprazole 06/2020 Antipsychotic, Mood stabilizing English PDF
Risperdal, Risperdal Consta risperidone 04/2021 Antipsychotic, Mood stabilizing English Word
Risperdal, Risperdal Consta risperidone 04/2021 Antipsychotic, Mood stabilizing English PDF
Rozerem ramelteon 08/2020 Hypnotic, Sedative English Word
Rozerem ramelteon 08/2020 Hypnotic, Sedative English PDF
Saphris, Secuado asenapine 06/2020 Antimanic, Antipsychotic English PDF
Saphris, Secuado asenapine 06/2020 Antimanic, Antipsychotic English Word
Serax oxazepam 09/2024 Antianxiety, benzodiazepine English Word
Serax oxazepam 09/2024 Antianxiety, benzodiazepine English PDF
Seroquel, Seroquel XR quetiapine 06/2020 Antipsychotic, Mood stabilizing English PDF
Seroquel, Seroquel XR quetiapine 06/2020 Antipsychotic, Mood stabilizing English Word
Serzone nefazodone hydrochloride 08/2020 Antidepressant English PDF
Serzone nefazodone hydrochloride 08/2020 Antidepressant English Word
Sinequan doxepin 06/2020 Antianxiety, Antidepressant, Sleep aid, tricyclic English Word
Sinequan doxepin 06/2020 Antianxiety, Antidepressant, Sleep aid, tricyclic English PDF
Sonata zaleplon 09/2024 Hypnotic, Sedative English PDF
Sonata zaleplon 09/2024 Hypnotic, Sedative English Word
Spravato esketamine 09/2024 Antidepressant English PDF
Spravato esketamine 09/2024 Antidepressant English Word
Stelazine trifluoperazine 04/2021 Antipsychotic, phenothiazine English PDF
Stelazine trifluoperazine 04/2021 Antipsychotic, phenothiazine English Word
Strattera atomoxetine 09/2024 Agent, Central nervous system English PDF
Strattera atomoxetine 09/2024 Agent, Central nervous system English Word
Suboxone & Suboxone Film Strips buprenorphine and naloxone sublingual tablet & film 04/2012 Maintenance treatment of opioid dependence English PDF
Suboxone & Suboxone Film Strips buprenorphine and naloxone sublingual tablet & film 04/2012 Maintenance treatment of opioid dependence English Word
Subutex buprenorphine 09/2024 Antagonist, Opioid English PDF
Subutex buprenorphine 09/2024 Antagonist, Opioid English Word
Symbyax olanzapine + fluoxetine 08/2020 Antidepressant, Antipsychotic English Word
Symbyax olanzapine + fluoxetine 08/2020 Antidepressant, Antipsychotic English PDF
Symmetrel amantadine hydrochloride 08/2018 Antidyskinetic English Word
Symmetrel amantadine hydrochloride 08/2018 Antidyskinetic English PDF
Tegretol carbamazepine 08/2018 Anticonvulsant, Mood stabilizing English PDF
Tegretol carbamazepine 08/2018 Anticonvulsant, Mood stabilizing English Word
Tenex, Intuniv XR guanfacine 04/2021 Attention deficit/hyperactivity disorder/ADHD English Word
Tenex, Intuniv XR guanfacine 04/2021 Attention deficit/hyperactivity disorder/ADHD English PDF

Glossary

 
Last revised August 15, 2024