TX HHS Form 4017. Capacity Assessment Instrument

The TX HHS Form 4017, Capacity Assessment Instrument, is a practical tool designed to assess an individual's capacity to make decisions regarding psychotropic medication. This form helps healthcare professionals determine whether the individual has the necessary cognitive abilities to understand their treatment options and make informed decisions about their care.

This instrument consists of five questions that evaluate the individual's ability to identify target behaviors, medications, route of administration, intended outcomes, and potential risks associated with taking psychotropic medication. The form is typically used in situations where an individual's capacity to make decisions is being evaluated, such as when a patient is considering or receiving treatment for mental health conditions.

Key features of the Form 4017 include:

• Evaluates an individual's capacity to identify and understand their treatment options
• Assesses an individual's ability to make informed decisions about their care
• Used in situations where an individual's decision-making capacity is being evaluated