Consent For Voluntary Inpatient Treatment {MH 781}

MH 781 - CONSENT FOR VOLUNTARY INPATIENT TREATMENT. This form is used to authorize mental health treatment for individuals who agree to receive inpatient psychiatric care on a voluntary basis. This form applies to adults age 18 and older, as well as minors age 14 to 17 with their own consent, and children under 14 with consent from a parent or legal guardian. By signing the form, the patient or guardian acknowledges that the proposed treatment plan—including medications, examinations, and any applicable restrictions—has been explained to them, and they confirm understanding of their rights and responsibilities during hospitalization. The form also outlines the requirement for written advance notice (up to 72 hours) if the patient or guardian wishes to withdraw from treatment or discharge the patient before an official discharge. Additionally, the form includes a section where a physician documents the initial evaluation and treatment plan, and both the physician and patient or guardian must sign to indicate agreement. www.FormsWorkflow.com