TX HHS Form 4017. Capacity Assessment Instrument

The TX HHS Form 4017, Capacity Assessment Instrument, is a tool used to assess an individual's capacity to make decisions regarding the use of psychotropic medications. This form helps healthcare professionals determine whether an individual has the necessary understanding and decision-making abilities to manage their medication regimen effectively.

This instrument consists of five questions that evaluate the individual's ability to identify target behaviors, medications, route of administration, intended outcome, and potential risks associated with taking psychotropic medications. The form is designed for use in situations where an individual's capacity to make informed decisions about their medication treatment plan needs to be assessed.

The Capacity Assessment Instrument (Form 4017) should be used when healthcare professionals need to determine the decision-making capacity of an individual regarding psychotropic medications, as required by Senate Bill 236, effective June 1, 1994. This form is a valuable tool for healthcare providers working with patients who require psychotropic medication management.