Medication Consent Forms

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The Fresno County Mental Health Plan (FCMHP) requires contracted psychiatrists to obtain Medication Consent when medications are to be prescribed to beneficiaries. The beneficiary, or legal guardian, must sign the Medication Consent form when starting a new medication, and whenever a change in medication class or addition of new class of psychotropics occurs (e.g., addition of antidepressant to medication regime, change from antidepressant to antipsychotic medication.) This form must be made available in the beneficiary's primary language if the beneficiary is monolingual. The consent must be kept in the medical record at all times.

FCMHP will staff review this form during the annual medical record review. A provider’s credentialing status may be affected if provider does not consistently obtain the beneficiary’s consent.

For your convenience, forms have been provided in all three threshold languages of Fresno County (English, Spanish, and Hmong), in both Adobe PDF format (suitable for printing out the form and completing it by hand), and in Microsoft Word Document format (suitable for completing the form electronically and then printing for the signatures.)

Medication Consent Forms (Adobe PDF)

Medication Consent Forms (Microsoft Word)