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MED-PASS:  The Fine Art of Document Design

The MED-PASS warehouse will be closed Friday, October 28, due to inventory. Orders received by 3 pm ET on Thursday, October 27, will ship as usual. All other orders will ship on Monday, October 31. We apologize for the delay.

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%

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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
  • Includes an advisory for antipsychotic medications that calls attention to "Increased Mortality in Elderly Patients with Dementia-Related Psychosis"
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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