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MED-PASS:  The Fine Art of Document Design

Our offices will be closed on July 3, 2015 in observance of the Independence Day Holiday. We will resume normal operations
beginning Monday July 6, 2015.  Happy 4th of July from MED-PASS!

Consent for Use of Psychoactive Medication Therapy - 100/pad


Availability: In stock

Price: $10.20
  • Buy 5-9 for $9.50 each and save 7%
  • Buy 10 or more for $8.00 each and save 22%

Updated to include an advisory for antipsychotic medications that calls attention to "Increased Mortality in Elderly Patients with Dementia-Related Psychosis.” 

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Use this 2-side, handwritten form to document consent or refusal of consent for use of psychoactive medication therapy.
  • Side One:
    • Documents the specific condition warranting use of psychoactive medication using convenient checkboxes and narrative space
    • Checkboxes identify beneficial effects expected from use of the medication
    • Lists general psychoactive medication side effects and side effects specific to each medication class
    • Checkboxes identify proposed length of medication use
  • Side Two:
    • Includes Statement of Consent (or Refusal to provide Consent)
    • In Person or Telephone Consent documentation
    • All text to be read by resident or resident representative is in easy to read 12-point type
    • Tailored to also meet specific needs of State of Texas care providers
Size 8-1/2 x 11
Unit Pad of 100
Other Info Handwritten
Hole Punch 5 holes left, 5 holes top

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