Get Mi Dhs-1643 2021-2025

The MI DHS-1643 form is essential for obtaining informed consent for psychotropic medication for children in foster care and juvenile justice. This guide offers a detailed, step-by-step approach to filling out the form online, ensuring clarity and support throughout the process.

Follow the steps to successfully complete the MI DHS-1643 form.

1. Click the ‘Get Form’ button to access the MI DHS-1643 form and open it in the designated editor.
2. Begin by filling out Section A, which requires identifying information. This section should be completed by child welfare staff and includes fields such as the child's name, date of birth, Medicaid ID number, MiSACWIS person ID number, legal status, current placement date, placement type, authorized consenters, and their relationships to the child.
3. Move on to Section C, which addresses medication recommendations. This is to be completed by the physician or medical staff. You will indicate the medication name, starting (current) dose, maximum dose, and any medications that have been discontinued. Ensure that the physician's signature and date are included at the end of this section.
4. Fill out Section D, consent, which must be completed by the consenting party listed in Section A. The consent statement includes the medications’ details, a summary of the physician’s discussion with the consent provider, and space for the consenter's signature, printed name, and date.
5. For Section E, youth attestation, if the youth is unable to attest, there is a checkbox for the physician to mark and initial. The youth needs to provide their signature and date if able.
6. Finally, once you have filled in all the required sections, you can save your changes, download, print, or share the MI DHS-1643 form as needed.

Complete the MI DHS-1643 form online today for efficient document processing.