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 | |
Periactin | cyproheptadine | 07/2017 | Antihistamine | English | Word |
Pristiq | desvenlafaxine | 09/2024 | Antidepressant | English | |
Pristiq | desvenlafaxine | 09/2024 | Antidepressant | English | Word |
Prolixin | fluphenazine | 09/2024 | Antipsychotic, Derivative, First generation, phenothiazine | English | |
Prolixin | fluphenazine | 09/2024 | Antipsychotic, Derivative, First generation, phenothiazine | English | Word |
Prozac | fluoxetine | 06/2020 | Antidepressant, SSRI | English | |
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 | |
Restoril | temazepam | 11/2017 | benzodiazepine, Hypnotic, Sedative | English | |
Restoril | temazepam | 11/2017 | benzodiazepine, Hypnotic, Sedative | English | Word |
ReVia | naltrexone | 06/2017 | Antagonist, Opioid | English | Word |
ReVia | naltrexone | 06/2017 | Antagonist, Opioid | English | |
Rexulti | brexpiprazole | 06/2020 | Antipsychotic, Mood stabilizing | English | Word |
Rexulti | brexpiprazole | 06/2020 | Antipsychotic, Mood stabilizing | English | |
Risperdal, Risperdal Consta | risperidone | 04/2021 | Antipsychotic, Mood stabilizing | English | Word |
Risperdal, Risperdal Consta | risperidone | 04/2021 | Antipsychotic, Mood stabilizing | English | |
Rozerem | ramelteon | 08/2020 | Hypnotic, Sedative | English | Word |
Rozerem | ramelteon | 08/2020 | Hypnotic, Sedative | English | |
Saphris, Secuado | asenapine | 06/2020 | Antimanic, Antipsychotic | English | |
Saphris, Secuado | asenapine | 06/2020 | Antimanic, Antipsychotic | English | Word |
Serax | oxazepam | 09/2024 | Antianxiety, benzodiazepine | English | Word |
Serax | oxazepam | 09/2024 | Antianxiety, benzodiazepine | English | |
Seroquel, Seroquel XR | quetiapine | 06/2020 | Antipsychotic, Mood stabilizing | English | |
Seroquel, Seroquel XR | quetiapine | 06/2020 | Antipsychotic, Mood stabilizing | English | Word |
Serzone | nefazodone hydrochloride | 08/2020 | Antidepressant | English | |
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 | |
Sonata | zaleplon | 09/2024 | Hypnotic, Sedative | English | |
Sonata | zaleplon | 09/2024 | Hypnotic, Sedative | English | Word |
Spravato | esketamine | 09/2024 | Antidepressant | English | |
Spravato | esketamine | 09/2024 | Antidepressant | English | Word |
Stelazine | trifluoperazine | 04/2021 | Antipsychotic, phenothiazine | English | |
Stelazine | trifluoperazine | 04/2021 | Antipsychotic, phenothiazine | English | Word |
Strattera | atomoxetine | 09/2024 | Agent, Central nervous system | English | |
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 | |
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 | |
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 | |
Symmetrel | amantadine hydrochloride | 08/2018 | Antidyskinetic | English | Word |
Symmetrel | amantadine hydrochloride | 08/2018 | Antidyskinetic | English | |
Tegretol | carbamazepine | 08/2018 | Anticonvulsant, Mood stabilizing | English | |
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 |