SOP 508.24-att-1: Anxiolytic Informed Consent Form (M60-01-01H)
Summary
This is an informed consent form used by the Georgia Department of Corrections when prescribing anxiolytic (anti-anxiety) medications to incarcerated individuals. The form documents that the patient has been informed about and consents to anxiolytic medication treatment. Completed forms are retained in the offender's mental health file for 10 years following the end of mental health services or release.
Key Topics
- anxiolytic medications
- anti-anxiety medication
- informed consent
- mental health medication
- medication consent form
- psychiatric medication
- prisoner medication
- GDC mental health
- M60-01-01h form
Full Text
SOP 508.24
Attachment 1H
8/15/22
GEORGIA DEPARTMENT OF CORRECTIONS Facility: _______________________________
MENTAL HEALTH SERVICES Name: ________________________________
Informed Consent for Mental Health Medication GDC#: _______________________________
DOB: ___________________________
Race: ____________ Sex: ____________
Anxiolytic Informed Consent
Form no. M60-01-01h
Retention Schedule: Completed forms shall be placed in the offender’s mental health file (section 5) and a copy will be given to the offender. At the end of the
offender’s need for mental health services and/or sentence, the mental health file shall be placed within the offender’s health record and retained for 10 years.