Submission Instructions for Standing Medications

The first page asks who is submitting the form, whether it is the physician’s office, the prescribing physician, or staff in an outpatient office, treatment facility, or from an inpatient hospital. If necessary, the page also allows for the selection of “other,” such as when requests submitted by caseworkers. First name, last name, email, and phone number of the submitter are required. Providing an extension is not required but allows the research staff direct access to needed clinical information which will expedite the request for consent. If an email is not available include your preferred fax number to assure you receive the consent sent.

The first name, last name, DOB, placement type, and name of placement are required. If available, please include the youth’s DCFS ID. ID must be 8 characters and cannot end in 00.

The first name, last name, specialty, and phone number are required information in case we need to reach out with questions.  Always only add ATTENDING physicians and FELLOWS to the consent, never Residents.

*If provider has never submitted a consent to DCFS before, adding an NPI number in the “Other” box helps us add the correct provider to our system without needing to call the submitter to clarify the physician’s identity.

1. Select the request type. Indicate if the request is for a one-time emergency medication notification. For standing medication consent request, you would select “No”.
2. ALL psychiatric diagnoses are needed, including those that are not associated with the medications currently being requested. The diagnosis drop down is searchable by either a key word or by the DSM-5TR, ICD 10 codes. If your diagnosis is not listed, pick “Other”, and a new box will appear where you can add that diagnosis.
3. Including medical diagnoses (if present) and any medications used to treat medical conditions is helpful for our consultants to get a full clinical picture.
4. Include over the counter medications for the same reason. Melatonin is to be treated as psychotropic and put in the psychotropic medication section. Diphenhydramine (Benadryl), another over the counter medication (OTC) medication, should be put in the psychotropic medication section if it is being used to treat anxiety and/or a sleep disturbance.
5. Height, weight, and the date they were taken are required. Include the most recent height and weight (consultants prefer the height and weight measurements to be no more than 6 months old).
   1. This is especially important when youth is taking a stimulant or antipsychotic medication, or if the BMI is in an unhealthy range. If the youth is under 10% or over 90% BMI, a weight related plan is required.

Indicate all current medications here. Only include medications that the youth is actively taking, not those being requested to be started. If the youth is not taking any current medications, you should mark “No”. To add a current medication, you would select the “Add” button. A new window will open requiring the medication name, the dosages, and the times each dosage is given. Four time slots are provided: AM, Noon, PM, and HS. If the dosage is administered at a time outside of the time slots, you can put it in the “Other Dosage and Time Given” box. This box should also be used for psychotropic medications given every other day or monthly.

1. At the bottom of the window, you can indicate whether this medication will be discontinued. A discontinuation reason is required. You can select from the options provided and describe the reason further in the box below it.
   • If time is needed to wean the youth off the mediation, the tapering schedule can be included in the box below that.
     • This schedule is forwarded to YouthCare and can make a difference in the ability to continue to pick up medications after DCFS is informed the medication will be discontinued. It will also signal to DCFS that though there is no active consent, youth is still in compliance.
2. Once you have done all of this, click “Submit” and the medication information will be displayed on the form. Add each medication the youth is currently taking.

The medication(s) being requested should be indicated in this section. Like the previous page, you will add medications by clicking the “Add” button. A new window will appear. You will select the type of request whether it is a new medication, the renewal of a previous request, an increase of a previous request, or if the youth is new to DCFS care and needs active medications brought into compliance with DCFS Rule 325.

Below the type of request, you are asked to indicate if the youth has been taking medication without consent or has been on a higher dosage than the youth had been consent for. If you click “Yes”, you will get a few more boxes asking for the provider who started/increased the medication and the date the medication change was started.

1. Medication name is required.
2. The medication form is required if it is not a pill form. If you choose “Solution”, you will be asked to provide the concentration of the solution. All dosage values are assumed to be mg. If a different unit of measurement is being used, it must be converted to mg.
3. Medication duration: the maximum amount of time a medication can be requested is 180 days. This is the standard amount of time a consent is approved for if not given a modified duration by the consultant. If you want a shortened duration, it must be indicated.
4. The desired start date for the medication can also be indicated in the box below. Desired start date must be in the future. This section is only necessary if the start date is AFTER the date the consent is being submitted.
5. The time and dosage the medication will be given are required. If outside of the provided time slots, you can put the time and dosage in the “Other Dosage and Time Given” box.
6. The max daily range is required. The range is the maximum daily dosage keeping potential increases in mind. If you have no range you would like to request, you can just put the dosage (or sum of all the dosages) in this box.
7. Next, the page asks for symptoms and related information. It’s important to note that the symptom section is NOT for a diagnosis. Instead of putting ADHD, you can put the symptoms inattentive and hyperactive, for example. Instead of PTSD, you can put the symptoms hyperarousal and flashbacks, for example.
   1. Confirm if the youth’s symptoms are current or partially improved. If you pick “Yes” you are required to put the current symptoms in the indicated “current” box. If you pick “No” you are required to put the controlled symptoms in the indicated “controlled with medication” box.
   2. “Current” means that the symptoms are still prevalent or only partially improved while the youth is taking the medication.
   3. “Controlled with medication” means that the youth is functioning well, and symptoms are negligible while taking the medication.
8. The additional rationale section is for Provider’s explanations for why they are prescribing the medication. This will not always be necessary, but when it is, it will save a lot of time for processing.
   1. This section exists for situations where two medications of the same class are being prescribed at once (e.g. Clonidine and Guanfacine, or Abilify and Seroquel), if a non- first line medication is being used (e.g. Bupropion or Atomoxetine for ADHD), or if there is any information the provider would like the consultant to know about med choice (e.g. if they want to contest a prior denial of medication).
9.  Lab work: Labs are required when a youth is taking an antipsychotic, a mood stabilizer, or if labs are requested by a consultant. If labs are not needed, you can select “N/A.” If labs are needed but you do not have them available, you can select “No.”
   1. If you do select “No” a new box appears that can be used for multiple purposes: 1. Providing the date of the most recent labs, 2. Providing the estimated date that labs will be submitted, or 3. Providing the date that the most recent labs were requested.
10. Once you have done all of this, click “Submit” and the medication information will be displayed on the form.

Add as many medications as needed.  The bottom of the page allows you to attach any test results.

Requests any additional information that may be needed for the consent. You are asked to confirm if the medications have been reviewed with the youth. You are asked whether the youth objects to the medication. The third box asks if there is any additional information relevant to the request that has not been captured elsewhere.  At the bottom of this page, you can include any non-test result attachments, like progress notes, scales, court orders etc..

The last page requests a CAPTCHA prompt to prove you are human before allowing submission of the consent request. A copy of the completed consent request form will be sent to the email you provided on page 1 for your records and as confirmation of your submission.