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

Glossary

 
Last revised August 15, 2024