CENTRAL OHIO MENTAL HEALTH CENTER
Subject:
Consent for Treatment
Section:
04.05.02.00
Effective Date: 08/01/2005
Approved by: ______________________________
Victoria Hartley, Board President
PURPOSE:
To provide a uniform methodology for obtaining the informed consent for
treatment from individuals and/or their parent or legal guardian being served by
Central Ohio Mental Health Center in compliance with OAC 5122-27-04, 3793:21-06, and other regulatory bodies.
POLICY:
The Center shall obtain written informed consent for treatment from an adult client or legal
guardian, as applicable; and in the instances of children and youth, from a parent or legal
guardian/custodian, as applicable.
I.
General Consent for Treatment Services: Each client and/or parent/legal guardian will
be offered the opportunity to request and consent for mental health and/or alcohol or
other drug (AoD) treatment services in writing prior to receiving a service. This Consent
shall include:
A.
Authorization for the Center to provide mental health services
B.
Authorization for the Center to provide alcohol and/or other drug services
C.
Information on Client Rights and Grievance policies and procedures
D.
Information on the Center’s Privacy Practices
E.
The right to refuse any treatment service or to withdraw consent for treatment at
any time. The risks and benefits of the proposed treatment will be explained.
F.
Information that the client may be referred to another service provider if the
Center is not able to meet the client’s treatment needs.
G.
Consent for the release of individually identifying information to the Mental
Health and Recovery Service Board in the county of residence, ODMH,
ODADAS, and ODJFS in the amount necessary to pay claims or conduct health
oversight activities.
H.
Information that the Center complies with Ohio law regarding the supervision of
clinicians not licensed to practice independently.
II.
Informed Consent for Treatment Services: Each client and or parent/legal guardian
shall receive an explanation of condition(s) for which treatment is being recommended,
the recommended treatment and desirable outcomes of such treatment, the duration of
treatment, the risks and benefits of any proposed treatment, alternative treatment
options, both internal and external to the Center, including the risks and benefits of the
alternative treatment options, and the possible outcome if no treatment is received.
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A.
B.
C.
D.
III.
Medication Informed Consent: Clients receiving medication shall review the conditions
for which s/he is being treated, reasonable available medication options, medication side
effects, risks and benefits, alternative treatment options, and risks of not treating the
disorder with medication.
A.
B.
C.
D.
E.
IV.
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The intake clinician or primary provider shall provide this information to the
client/legal guardian prior to initiating treatment and document consent on the
Informed Consent for Treatment Services form.
The client/legal guardian shall indicate which treatment services are accepted
and which services are declined on the Informed Consent for Treatment Service
form.
Informed consent shall be obtained when changes in treatment are
recommended and reviewed with the client/legal guardian. The client/legal
guardian’s signature on the Individual Service Plan (ISP) will serve as informed
consent on an on-going basis.
The intake clinician or primary provider shall document on an Individual Service
Note (ISN) each time informed consent is obtained and the client/legal
guardian’s response.
The prescribing physician and/or nurse shall provide this information to the
client/legal guardian and complete the Adult Medication Informed Consent form
or Child/Adolescent Medication Informed Consent form prior to initiating any
medication.
The client/legal guardian shall indicate whether the medication(s)
recommendation is accepted or declined on the Medication Informed Consent
form.
The Medication Informed Consent form shall be completed any time a new
medication is being initiated.
The prescribing physician and/or nurse may review the risks and benefits of a
medication with a client/legal guardian over the phone and obtain verbal consent
that the client fully understands the risks and benefits of the medication. The
prescribing physician and/or nurse shall document the client/legal guardian’s
agreement on the appropriate Medication Informed Consent form. The
Client/legal guardian will be asked to sign the Medication Consent form at the
next scheduled office visit.
The prescribing physician and/or nurse shall document on an ISN each time
medication informed consent is obtained and the client/legal guardian’s
response.
Crisis Intervention: A client initiating services, as the result of a crisis will be provided
with an opportunity to provide written consent for mental health and/or AoD services at
the time of service.
A.
The Emergency Service Clinician treating the client will review the Consent for
Treatment form with the client and explain his/her rights. The Emergency
Service Clinician shall document a refusal to consent to services on the Consent
for Treatment form and in the Crisis Assessment form.
B.
The client will be provided with the crisis intervention service, appropriate
treatment plan, and linkage with the appropriate level of care to ensure the
safety of the individual, others, and community regardless of his/her willingness
to consent to treatment.
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C.
Clients requesting on-going treatment services beyond the crisis intervention will
review the Consent for Treatment and Informed Consent for Treatment Services
with the primary provider and be offered the opportunity to provide written
consent for services.
V.
Treating Minors: Minors age fourteen years of age or older may request and be
provided with mental health services, except for the use of medication, for a limited time
without the Consent for Treatment form signed by the minor’s parent or legal guardian
(ORC 5122.04).
A.
Services shall be limited to six sessions or 30 days, whichever comes first. After
the sixth session or thirty days of services, the primary provider shall terminate
the services or, with the consent of the minor notify the parent/legal guardian to
obtain consent to provide further outpatient services.
B.
The primary provider shall review the information stated in Sections I and II of
this policy and obtain written consent from the minor client.
C.
The primary provider shall document on an Individual Service Note (ISN) when
informed consent is obtained and the minor’s response.
D.
The minor’s parent/legal guardian shall not be informed of the services without
the minor’s consent unless the mental health provider determines there is a
compelling need for disclosure based on the substantial probability of harm to
the minor or other persons, and the minor is notified of the providers intent to
inform the minor’s parent/legal guardian.
VI.
Refusal to Consent to Treatment: In accordance with OAC 5122:2-1-02, an individual
has the right to refuse treatment. The Intake Clinician, Primary Provider, and/or
emergency service clinician shall ensure that the client and/or parent/legal guardian
understands the implication and potential consequences of refusing and/or withdrawing
consent for treatment.
A.
In the event of a refusal of proposed treatment or withdrawal from treatment, the
primary provider will assist the client and/or parent/legal guardian to identify
and/or develop alternative approaches to assist the client in receiving needed
services.
B.
The provider will explain any complications or potential consequences of refusing
/ withdrawing treatment.
C.
The client will be asked to indicate s/he is declining and/or withdrawing from
services on the appropriate Consent for Treatment form.
D.
The Primary provider shall document on an Individual Service Note (ISN) each
attempt to obtain informed consent and the client/legal guardian’s response.
VII.
Documentation of consent for treatment, refusal to consent, or withdrawal of consent
shall be kept in the integrated client record (ICR) and filed according to the Center’s
Integrated Client Record Management System (05.05.02.01).
RESPONSIBILITY:
The Executive Director is responsible for the communication and implementation of this policy
and any subsequent procedures that are applicable.
Revision:
07/28/2005
01/22/2004
Approved:
12/23/1992
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