Get Declaration For Mental Health Treatment Form - Idph State Il

Filling out the Declaration For Mental Health Treatment Form is an essential step in expressing your preferences for mental health treatment during a time when you may not be able to make decisions for yourself. This guide provides clear, step-by-step instructions to help you complete this form online with confidence.

Follow the steps to fill out the form accurately.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering your full name and birth date in the designated fields to establish your identity and age. Ensure all information is accurate to avoid complications later.
3. Next, indicate your understanding of the implications of this declaration. Use the space provided to list any symptoms of a diagnosed mental disorder that may affect your capacity to make informed decisions.
4. In the section for psychotropic medications, specify your preferences by checking the appropriate boxes. If you consent to certain medications, list them; if not, also detail the medications you do not consent to, along with any conditions or limitations you wish to impose.
5. Proceed to the electroconvulsive treatment section. Again, indicate your consent status by checking the corresponding box and include any specific conditions or limitations regarding this treatment.
6. In the admission to and retention in a facility section, express your wishes concerning potential admission to a health care facility. Clearly note your consent or objection and any conditions or limitations.
7. If you have a preferred physician to assess your capacity, write their information in the optional physician selection section.
8. Next, appoint an attorney-in-fact by filling in their name, address, and phone number. This person will be authorized to make decisions on your behalf if you become incapable of consenting to treatment.
9. If necessary, appoint an alternate attorney-in-fact by providing their details in the corresponding section.
10. After completing the form, sign and date it, ensuring that your signature is witnessed as required by law. Each witness must also sign and print their name.
11. Finally, save changes to the form, and download, print, or share it as needed. Ensure you keep a copy for your records.

Complete your Declaration For Mental Health Treatment Form online today to ensure your mental health preferences are respected.