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This medication consent eszopiclone is for a period effective immediately and not to exceed fifteen (15) months from the date of my signature .
The need for eszopiclone and continued use of this medication will be reviewed at least quarterly by the Interdisciplinary Team .
The goal, on behalf of the client, will be to arrive at and maintain the eszopiclone client at the minimum effective dose .
Client – If Presumed Competent to Consent/Parent of Minor/Guardian (POA-HC) eszopiclone generic cost walmart lunesta rare side effects lunesta plus xanax lunesta or trazodone Relationship to Client Guardian (POA-HC) Staff Present at Oral Discussion Client / Parent of Minor / Guardian (POA-HC) Comments As parent/guardian (POA-HC) was not available for signature, he/she was verbally informed of the information in this consent .
eszopiclone Obtained by – PRINT – Staff Name Written Consent Received Obtained from – PRINT – Parent / Guardian (POA-HC) Name .
420(a)(2) DHS adverse side effects of lunesta eszopiclone vs estazolam lunesta hong kong side effects of lunesta 134 . eszopiclone 31(3)(o) DHS 94 . eszopiclone 09 §§ 51 . 03 eszopiclone & 94 . 61(1)(g) & (h) INFORMED CONSENT FOR MEDICATION Dosage and / or Side lunesta side effects high blood pressure does lunesta keep you asleep lunesta tips lunesta Effect information last revised on 08/16/2016 Completion of this form is voluntary . DEPARTMENT OF HEALTH SERVICES eszopiclone Division of Care and Treatment Services F-24277 (09/2016) STATE OF WISCONSIN 42 CFR483 .
If not completed, the medication cannot be administered without a eszopiclone court order unless in an emergency .
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