DHS-1643, Psychotropic Medication Informed Consent, For Children in Foster Care and or Juvenile Just-2025

1. Click ‘Get Form’ to open the DHS-1643 in the editor.
2. Begin with SECTION A, where Child Welfare staff will input identifying information such as the child's name, date of birth, Medicaid ID, and legal status. Ensure all fields are accurately filled out.
3. Move to SECTION B for health information. Here, medical providers should enter details like physician name and appointment date. This section is crucial for establishing a medical context.
4. In SECTION C, document medication recommendations. Input the medication name, starting dose, and maximum dose. The physician must also provide their signature and date to validate this section.
5. Proceed to SECTION D for consent. The authorized consenter must sign and print their name, confirming they understand the treatment plan discussed by the physician.
6. Finally, if applicable, complete SECTION E for youth attestation. The youth should sign and date this section after discussing medications with their physician.

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