Purpose of Medication Form

Purpose of Medication Form

Purpose of Medication Form

Purpose of Medication Form

The purpose of this form is to clarify if any currently prescribed medication is considered to be a Chemical Restraint as defined by the National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018 and The Disability Services Act 2006. This information may be used to develop a Positive Behaviour Support Plan.

Client Name
Client Name
First
Last

Medication 1

Reason for Medication

Medication 2

Reason for Medication

Medication 3

Reason for Medication

Medication 4

Reason for Medication

Medication 5

Reason for Medication

Medication 6

Reason for Medication