Follow the steps to complete the IL CFS 431-A form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date of the request at the top of the form. This is crucial for record-keeping and tracking purposes.
3. Fill in the child’s name and indicate their gender by checking the appropriate box. Provide the date of birth and place of placement, such as foster care or residential facility.
4. Input the CFS ID#, current height, and weight of the child. Include details regarding the ethnicity and contact number if applicable.
5. Provide the address of the facility or caregiver and list the prescribing physician’s name along with their contact number and fax number.
6. In the clinical information section, detail any concurrent medical diagnoses and all psychiatric diagnoses that the child has.
7. List the current psychotropic medications the child is taking, including dosage and frequency. Continue for all medications as needed.
8. Document any discontinued psychotropic medications the child has used, along with their dosages and frequency.
9. In the medication request section, select the type of request by checking the appropriate box: new, increase, renewal, resume, or one-time order. If applicable, include the current dosage for increase or renewal requests.
10. Provide details about the medication requested, including the brand name, chemical name, dosage, frequency, duration, and symptom details related to the request.
11. List any tests or procedures required prior to or during monitoring of the requested medication.
12. Document alternative treatments or medications considered or attempted, along with reasons for their rejection.
13. Ensure that you review potential side effects with the child and indicate whether the child objects to the medication if they are 12 years of age or older.
14. Once all fields are completed, you can save changes, download, print, or share the form as needed.

Complete your IL CFS 431-A form online today to facilitate timely medication requests.