The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

LIT Lab Home | About The Explorer | Find & Compare | Explore: California Lists

Here is the text we could read:

JV-220(B)

Physician’s Request to Continue
Medication—Attachment

Case Number:

This form must be completed and signed by the prescribing physician. Read form JV-217-INFO, Guide to Psychotropic
Medication Forms, for more information about the required forms and the application process.

1 Information about the child (name):

Date of birth:

Gender:

Ethnicity:

Current height:

Current weight:

Fill out this form only if both boxes below are checked. If you cannot check both boxes, fill out form JV-220(A).
a.

This is a request to continue the same psychotropic medication and maximum dosage that the child is
currently taking.
This is the same prescribing physician who completed the most recent form JV-220(A).

License number:

Medical specialty of prescribing physician:

Child/adolescent psychiatry

General psychiatry

Family practice/GP

Pediatrics

This request is based on a face-to-face clinical evaluation of the child by:

The prescribing physician on (date):

Other (provide name, professional status, and date of evaluation):

Information about the child was provided to the prescribing physician by (check all that apply):

Caregiver

Teacher

Social worker

Probation officer

Parent

Child
Public health nurse
Records (specify):

Other (specify):

Tribe

Provide to the court your assessment of the child’s overall mental health.

Prescribing physician:
a.
b.
c.

Name:
Address:
Phone numbers:

Other (specify):

Judicial Council of California, www.courts.ca.gov
Revised January 1, 2018, Alternative Mandatory Form
instead of JV-220(A) for renewal under rule 5.640(c)(7)
Welfare and Institutions Code, §§ 369.5, 739.5
California Rules of Court, rule 5.640

Physician’s Request to Continue
Medication—Attachment

JV-220(B), Page 1 of 4

Child’s name:

Case Number:

Describe the child’s response to any current psychotropic medication.

Describe the symptoms not alleviated or ameliorated by other current or past treatment efforts.

Have nonpharmacological treatment alternatives to the proposed medications been tried in the last six months?

Yes

I don’t know.

If yes, describe the treatment and the child’s response. If no, explain why not.

Diagnoses from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

Relevant medical history (describe, specifying significant medical conditions, all current nonpsychotropic
medications, date of last physical examination, and any recent abnormal laboratory results):

Rev. January 1, 2018

Physician’s Request to Continue
Medication—Attachment

JV-220(B), Page 2 of 4

Child’s name:

Case Number:

All essential laboratory tests were performed.

All essential laboratory tests were not performed (explain what laboratory tests were not done and why).

The child was told in an age-appropriate manner about the recommended medications, the anticipated
benefits, the possible side effects, and that a request to the court for permission to begin and/or continue the
medication will be made and that he or she may oppose the request. The child’s response was:
Agreeable

Not agreeable

Briefly describe child’s response:

The child has not been informed of this request, the recommended medications, their anticipated benefits,
and their possible adverse reactions because:
(1)

The child lacks the capacity to provide a response (explain):

(2)

Other (explain):

Mandatory Information Attached: Significant side effects, warnings/contraindications, drug interactions
(including those with continuing psychotropic medication and all nonpsychotropic medication currently taken by
the child), and withdrawal symptoms for each recommended medication are included in the attached material.

The caregiver was informed of the mandatory information, which is attached.

The caregiver’s response was

agreeable

other (explain):

Additional information regarding medication treatment plan and follow-up:

Rev. January 1, 2018

Physician’s Request to Continue
Medication—Attachment

JV-220(B), Page 3 of 4

Case Number:

Child’s name:

Individual therapy:

Therapeutic services, other than medication, in which the child is enrolled in or is recommended to participate
during the next six months (check all that apply; include frequency for therapy on blank line):
a.
c.
d.
e.
f.
h.
i.
j.
k.
l.

Group therapy:
Milieu therapy (explain):
Therapeutic Behavioral Services (TBS):
Therapy for children on the autism spectrum:
Art therapy:
Wraparound services:
American Indian/Alaska Native healing and cultural traditions:
Speech therapy:
In Home Behavioral Services (IHBS):
Other modality (explain):

Cognitive behavioral therapy (CBT):

List all psychotropic medications currently administered that you propose to continue.

Medication name (generic/brand) and
symptoms targeted by each medication’s
anticipated benefit to child

Maximum
total
mg/day

Treatment
duration*
6-month
maximum

Administration schedule
• Initial and target schedule for new medication
• Current schedule for continuing medication
• Provide mg/dose and # of doses/day
• If PRN, provide conditions and parameters for use

Med:

Class:

Targets:

Med:

Class:

Targets:

Med:

Class:

Targets:

Med:

Class:

Targets:

*Authorization to administer the medication is limited to this time frame or six months from the date the order is issued, whichever occurs first.

Other information about the prescribed medication that you want the court to know (e.g., reasons for prescribing
more than one medication in a class, prescribing outside the approved range, or prescribing medication not approved
for a child of this age):

Date:

Rev. January 1, 2018

Type or print name of prescribing physician

Signature of prescribing physician

Physician’s Request to Continue
Medication—Attachment

JV-220(B), Page 4 of 4

Physician's Request to Continue Medication—Attachment

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 4
Fields(s): 119
Average fields per page: 29
Reading Level: Grade 11
LIST Grouping(s): HE-03-00-00-00, ES-05-00-00-00, HE-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

topmost_subform_page_item_aname_tf was topmostSubform[0].Page1[0].item3aname_tf[0] (0.60 conf)
topmost_subform_page_item_b_tf__1 was topmostSubform[0].Page1[0].item3b_tf[0] (0.40 conf)
topmost_subform_page_item_c_tf__1 was topmostSubform[0].Page1[0].item3c_tf[0] (0.40 conf)
topmost_subform_page_item_dother_tf was topmostSubform[0].Page1[0].item3dother_tf[0] (0.40 conf)
topmost_subform_page_item_alicnumber_tf was topmostSubform[0].Page1[0].item3alicnumber_tf[0] (0.40 conf)
topmost_subform_page_item_tf__1 was topmostSubform[0].Page1[0].item4a_tf[0] (0.40 conf)
topmost_subform_page_item_tf__2 was topmostSubform[0].Page1[0].item5other_tf[0] (0.40 conf)
topmost_subform_page_item_records_tf was topmostSubform[0].Page1[0].item5records_tf[0] (0.40 conf)
topmost_subform_page_item_height_tf was topmostSubform[0].Page1[0].item1height_tf[0] (0.40 conf)
topmost_subform_page_item_gender_tf was topmostSubform[0].Page1[0].item1gender_tf[0] (0.40 conf)
topmost_subform_page_item_weight_tf was topmostSubform[0].Page1[0].item1weight_tf[0] (0.40 conf)
topmost_subform_page_item_ethnicity_tf was topmostSubform[0].Page1[0].item1ethnicity_tf[0] (0.40 conf)
topmost_subform_page_item_dob_tf was topmostSubform[0].Page1[0].item1dob_tf[0] (0.40 conf)
topmost_page_case_number_ft__1 was topmostSubform[0].Page1[0].CaseNumber_ft[0] (0.43 conf)
topmost_subform_item_ft__1 was topmostSubform[0].Page1[0].item1childsname_ft[0] (0.40 conf)
topmost_subform_page_item_b_cb__1 was topmostSubform[0].Page1[0].item2b_cb[0] (0.40 conf)
topmost_subform_page_item_dother_cb was topmostSubform[0].Page1[0].item3dother_cb[0] (0.40 conf)
topmost_subform_page_item_dchildpsy_cb was topmostSubform[0].Page1[0].item3dchildpsy_cb[0] (0.40 conf)
topmost_subform_page_item_dgenpsy_cb was topmostSubform[0].Page1[0].item3dgenpsy_cb[0] (0.40 conf)
topmost_subform_page_item_dfamprac_cb was topmostSubform[0].Page1[0].item3dfamprac_cb[0] (0.40 conf)
topmost_page_item_dpedi_cd was topmostSubform[0].Page1[0].item3dpedi_cd[0] (0.40 conf)
topmost_subform_page_item_child_cb was topmostSubform[0].Page1[0].item5child_cb[0] (0.40 conf)
topmost_subform_page_item_caregiver_cb was topmostSubform[0].Page1[0].item5caregiver_cb[0] (0.40 conf)
topmost_page_item_teacher_cb was topmostSubform[0].Page1[0].item5teacher_cb[0] (0.40 conf)
topmost_subform_page_item_sw_cb was topmostSubform[0].Page1[0].item5sw_cb[0] (0.40 conf)
topmost_page_item_po_cb was topmostSubform[0].Page1[0].item5po_cb[0] (0.40 conf)
topmost_subform_page_item_parent_cb was topmostSubform[0].Page1[0].item5parent_cb[0] (0.40 conf)
topmost_subform_page_item_records_cb was topmostSubform[0].Page1[0].item5records_cb[0] (0.40 conf)
topmost_subform_page_item_cb__1 was topmostSubform[0].Page1[0].item5other_cb[0] (0.40 conf)
topmost_subform_page_item_b_tf__2 was topmostSubform[0].Page1[0].item4b_tf[0] (0.40 conf)
topmost_subform_page_item_cb__2 was topmostSubform[0].Page1[0].item4a_cb[0] (0.40 conf)
topmost_subform_page_item_b_cb__2 was topmostSubform[0].Page1[0].item4b_cb[0] (0.40 conf)
topmost_subform_page_item_tf__3 was topmostSubform[0].Page1[0].item6_tf[0] (0.40 conf)
topmost_subform_page_item_pubnurse_cb was topmostSubform[0].Page1[0].item5pubnurse_cb[0] (0.40 conf)
topmost_subform_page_item_tribe_cb was topmostSubform[0].Page1[0].item5tribe_cb[0] (0.40 conf)
topmost_subform_page_item_cb__3 was topmostSubform[0].Page1[0].item2a_cb[0] (0.40 conf)
topmost_subform_item_ft__2 was topmostSubform[0].Page2[0].item1childsname_ft[0] (0.40 conf)
topmost_page_case_number_ft__2 was topmostSubform[0].Page2[0].CaseNumber_ft[0] (0.43 conf)
topmost_subform_page_item_tf__4 was topmostSubform[0].Page2[0].item7a_tf[0] (0.40 conf)
topmost_subform_page_item_tf__5 was topmostSubform[0].Page2[0].item10_tf[0] (0.40 conf)
topmost_subform_page_item_cb__4 was topmostSubform[0].Page2[0].item8a_cb[0] (0.40 conf)
topmost_subform_page_item_cb__5 was topmostSubform[0].Page2[0].item8a_cb[1] (0.40 conf)
topmost_subform_page_item_b_tf__3 was topmostSubform[0].Page2[0].item8b_tf[0] (0.40 conf)
topmost_subform_page_item_b_tf__4 was topmostSubform[0].Page2[0].item7b_tf[0] (0.40 conf)
topmost_subform_page_item_tf__6 was topmostSubform[0].Page2[0].item9_tf[0] (0.40 conf)
topmost_subform_page_item_cb__6 was topmostSubform[0].Page2[0].item8a_cb[2] (0.40 conf)
topmost_subform_item_ft__3 was topmostSubform[0].Page3[0].item1childsname_ft[0] (0.40 conf)
topmost_page_case_number_ft__3 was topmostSubform[0].Page3[0].CaseNumber_ft[0] (0.43 conf)
topmost_subform_page_item_b_tf__5 was topmostSubform[0].Page3[0].item12b2_tf[0] (0.40 conf)
topmost_subform_page_item_cb__7 was topmostSubform[0].Page3[0].item12a_cb[0] (0.40 conf)
topmost_subform_page_item_aagreeable_cb__1 was topmostSubform[0].Page3[0].item12aagreeable_cb[0] (0.40 conf)
topmost_subform_page_item_b_cb__3 was topmostSubform[0].Page3[0].item12b_cb[0] (0.40 conf)
topmost_subform_page_item_b_tf__6 was topmostSubform[0].Page3[0].item12b1_tf[0] (0.40 conf)
topmost_subform_page_item_b_cb__4 was topmostSubform[0].Page3[0].item12b1_cb[0] (0.40 conf)
topmost_subform_page_item_b_cb__5 was topmostSubform[0].Page3[0].item12b2_cb[0] (0.40 conf)
topmost_subform_page_item_anotagreeable_cb was topmostSubform[0].Page3[0].item12anotagreeable_cb[0] (0.40 conf)
topmost_subform_page_item_ab_cb__1 was topmostSubform[0].Page3[0].item11ab_cb[0] (0.40 conf)
topmost_subform_page_item_ab_cb__2 was topmostSubform[0].Page3[0].item11ab_cb[1] (0.40 conf)
topmost_subform_page_item_b_tf__7 was topmostSubform[0].Page3[0].item11b_tf[0] (0.40 conf)
topmost_subform_page_item_tf__7 was topmostSubform[0].Page3[0].item12a_tf[0] (0.40 conf)
topmost_subform_page_item_tf__8 was topmostSubform[0].Page3[0].item14_tf[0] (0.40 conf)
topmost_subform_page_item_cb__8 was topmostSubform[0].Page3[0].item18a_cb[0] (0.40 conf)
topmost_subform_page_item_aagreeable_cb__2 was topmostSubform[0].Page3[0].item18aagreeable_cb[0] (0.40 conf)
topmost_subform_page_item_aother_cb was topmostSubform[0].Page3[0].item18aother_cb[0] (0.40 conf)
topmost_subform_page_item_c_tf__2 was topmostSubform[0].Page3[0].item13c_tf[0] (0.40 conf)
topmost_subform_page_item_cb__9 was topmostSubform[0].Page3[0].item18a_cb[1] (0.40 conf)
topmost_subform_item_ft__4 was topmostSubform[0].Page4[0].item1childsname_ft[0] (0.40 conf)
topmost_page_case_number_ft__4 was topmostSubform[0].Page4[0].CaseNumber_ft[0] (0.43 conf)
topmost_subform_page__1 was topmostSubform[0].Page4[0].T94[0] (0.38 conf)
topmost_subform_page__2 was topmostSubform[0].Page4[0].T95[0] (0.38 conf)
topmost_subform_page_fill_text__1 was topmostSubform[0].Page4[0].FillText178[0] (0.44 conf)
topmost_subform_page_fill_text__2 was topmostSubform[0].Page4[0].FillText177[0] (0.44 conf)
topmost_subform_page_fill_text__3 was topmostSubform[0].Page4[0].FillText177a[0] (0.44 conf)
topmost_subform_page_fill_text__4 was topmostSubform[0].Page4[0].FillText174[0] (0.44 conf)
topmost_subform_page_fill_text__5 was topmostSubform[0].Page4[0].FillText173[0] (0.44 conf)
topmost_subform_page_fill_text_n was topmostSubform[0].Page4[0].FillText177n[0] (0.44 conf)
topmost_subform_page_fill_text__6 was topmostSubform[0].Page4[0].FillText170[0] (0.44 conf)
topmost_subform_page_fill_text__7 was topmostSubform[0].Page4[0].FillText169[0] (0.44 conf)
topmost_page_fill_text_c was topmostSubform[0].Page4[0].FillText177c[0] (0.44 conf)
topmost_subform_page_fill_text__8 was topmostSubform[0].Page4[0].FillText166[0] (0.44 conf)
topmost_subform_page_fill_text__9 was topmostSubform[0].Page4[0].FillText165[0] (0.44 conf)
topmost_subform_page_fill_text__10 was topmostSubform[0].Page4[0].FillText177d[0] (0.44 conf)
topmost_subform_page__3 was topmostSubform[0].Page4[0].T95[1] (0.38 conf)
topmost_subform_page__4 was topmostSubform[0].Page4[0].T94[1] (0.38 conf)
topmost_subform_page__5 was topmostSubform[0].Page4[0].T95[2] (0.38 conf)
topmost_subform_page__6 was topmostSubform[0].Page4[0].T94[2] (0.38 conf)
topmost_subform_page__7 was topmostSubform[0].Page4[0].T95[3] (0.38 conf)
topmost_subform_page__8 was topmostSubform[0].Page4[0].T94[3] (0.38 conf)
topmost_subform_page__9 was topmostSubform[0].Page4[0].T6[0] (0.38 conf)
topmost_subform_page_fill_text__11 was topmostSubform[0].Page4[0].FillText136[0] (0.44 conf)
topmost_subform_page_item_tf__9 was topmostSubform[0].Page4[0].item15a_tf[0] (0.40 conf)
topmost_subform_page_item_b_tf__8 was topmostSubform[0].Page4[0].item15b_tf[0] (0.40 conf)
topmost_subform_page_item_c_tf__3 was topmostSubform[0].Page4[0].item15c_tf[0] (0.40 conf)
topmost_subform_page_item_cb__10 was topmostSubform[0].Page4[0].item15a_cb[0] (0.40 conf)
topmost_subform_page_item_c_cb was topmostSubform[0].Page4[0].item15c_cb[0] (0.40 conf)
topmost_subform_page_item_b_cb__6 was topmostSubform[0].Page4[0].item15b_cb[0] (0.40 conf)
topmost_subform_page_item_tf__10 was topmostSubform[0].Page4[0].item15d_tf[0] (0.40 conf)
topmost_subform_page_item_cb__11 was topmostSubform[0].Page4[0].item15d_cb[0] (0.40 conf)
topmost_subform_page_item_g_tf was topmostSubform[0].Page4[0].item15g_tf[0] (0.33 conf)
topmost_subform_page_item_g_cb was topmostSubform[0].Page4[0].item15g_cb[0] (0.33 conf)
topmost_subform_page_item_j_tf was topmostSubform[0].Page4[0].item15j_tf[0] (0.40 conf)
topmost_subform_page_item_j_cb was topmostSubform[0].Page4[0].item15j_cb[0] (0.40 conf)
topmost_subform_page_item_k_tf was topmostSubform[0].Page4[0].item15k_tf[0] (0.40 conf)
topmost_subform_page_item_k_cb was topmostSubform[0].Page4[0].item15k_cb[0] (0.40 conf)
topmost_subform_page_item_e_tf was topmostSubform[0].Page4[0].item15e_tf[0] (0.40 conf)
topmost_subform_page_item_e_cb was topmostSubform[0].Page4[0].item15e_cb[0] (0.40 conf)
topmost_subform_page_item_h_tf was topmostSubform[0].Page4[0].item15h_tf[0] (0.40 conf)
topmost_subform_page_item_h_cb was topmostSubform[0].Page4[0].item15h_cb[0] (0.40 conf)
topmost_subform_page_item_tf__11 was topmostSubform[0].Page4[0].item15i_tf[0] (0.40 conf)
topmost_subform_page_item_cb__12 was topmostSubform[0].Page4[0].item15i_cb[0] (0.40 conf)
topmost_subform_page_item_tf__12 was topmostSubform[0].Page4[0].item17_tf[0] (0.40 conf)
topmost_subform_page__10 was topmostSubform[0].Page4[0].T95[4] (0.38 conf)
topmost_subform_page__11 was topmostSubform[0].Page4[0].T95[5] (0.38 conf)
topmost_subform_page__12 was topmostSubform[0].Page4[0].T95[6] (0.38 conf)
topmost_subform_page__13 was topmostSubform[0].Page4[0].T95[7] (0.38 conf)
topmost_subform_page_item_f_tf was topmostSubform[0].Page4[0].item15f_tf[0] (0.40 conf)
topmost_subform_page_item_f_cb was topmostSubform[0].Page4[0].item15f_cb[0] (0.40 conf)
topmost_subform_page_item_l_tf was topmostSubform[0].Page4[0].item15l_tf[0] (0.40 conf)
topmost_subform_page_item_l_cb was topmostSubform[0].Page4[0].item15l_cb[0] (0.40 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

topmost_subform_page_item_aname_tf
topmost_subform_page_item_b_tf__1
topmost_subform_page_item_c_tf__1
topmost_subform_page_item_dother_tf
topmost_subform_page_item_alicnumber_tf
topmost_subform_page_item_tf__1
topmost_subform_page_item_tf__2
topmost_subform_page_item_records_tf
topmost_subform_page_item_height_tf
topmost_subform_page_item_gender_tf
topmost_subform_page_item_weight_tf
topmost_subform_page_item_ethnicity_tf
topmost_subform_page_item_dob_tf
topmost_page_case_number_ft__1
topmost_subform_item_ft__1
topmost_subform_page_item_b_cb__1
topmost_subform_page_item_dother_cb
topmost_subform_page_item_dchildpsy_cb
topmost_subform_page_item_dgenpsy_cb
topmost_subform_page_item_dfamprac_cb
topmost_page_item_dpedi_cd
topmost_subform_page_item_child_cb
topmost_subform_page_item_caregiver_cb
topmost_page_item_teacher_cb
topmost_subform_page_item_sw_cb
topmost_page_item_po_cb
topmost_subform_page_item_parent_cb
topmost_subform_page_item_records_cb
topmost_subform_page_item_cb__1
topmost_subform_page_item_b_tf__2
topmost_subform_page_item_cb__2
topmost_subform_page_item_b_cb__2
topmost_subform_page_item_tf__3
topmost_subform_page_item_pubnurse_cb
topmost_subform_page_item_tribe_cb
topmost_subform_page_item_cb__3
topmost_subform_item_ft__2
topmost_page_case_number_ft__2
topmost_subform_page_item_tf__4
topmost_subform_page_item_tf__5
topmost_subform_page_item_cb__4
topmost_subform_page_item_cb__5
topmost_subform_page_item_b_tf__3
topmost_subform_page_item_b_tf__4
topmost_subform_page_item_tf__6
topmost_subform_page_item_cb__6
topmost_subform_item_ft__3
topmost_page_case_number_ft__3
topmost_subform_page_item_b_tf__5
topmost_subform_page_item_cb__7
topmost_subform_page_item_aagreeable_cb__1
topmost_subform_page_item_b_cb__3
topmost_subform_page_item_b_tf__6
topmost_subform_page_item_b_cb__4
topmost_subform_page_item_b_cb__5
topmost_subform_page_item_anotagreeable_cb
topmost_subform_page_item_ab_cb__1
topmost_subform_page_item_ab_cb__2
topmost_subform_page_item_b_tf__7
topmost_subform_page_item_tf__7
topmost_subform_page_item_tf__8
topmost_subform_page_item_cb__8
topmost_subform_page_item_aagreeable_cb__2
topmost_subform_page_item_aother_cb
topmost_subform_page_item_c_tf__2
topmost_subform_page_item_cb__9
topmost_subform_item_ft__4
topmost_page_case_number_ft__4
topmost_subform_page__1
topmost_subform_page__2
topmost_subform_page_fill_text__1
topmost_subform_page_fill_text__2
topmost_subform_page_fill_text__3
topmost_subform_page_fill_text__4
topmost_subform_page_fill_text__5
topmost_subform_page_fill_text_n
topmost_subform_page_fill_text__6
topmost_subform_page_fill_text__7
topmost_page_fill_text_c
topmost_subform_page_fill_text__8
topmost_subform_page_fill_text__9
topmost_subform_page_fill_text__10
topmost_subform_page__3
topmost_subform_page__4
topmost_subform_page__5
topmost_subform_page__6
topmost_subform_page__7
topmost_subform_page__8
topmost_subform_page__9
topmost_subform_page_fill_text__11
topmost_subform_page_item_tf__9
topmost_subform_page_item_b_tf__8
topmost_subform_page_item_c_tf__3
topmost_subform_page_item_cb__10
topmost_subform_page_item_c_cb
topmost_subform_page_item_b_cb__6
topmost_subform_page_item_tf__10
topmost_subform_page_item_cb__11
topmost_subform_page_item_g_tf
topmost_subform_page_item_g_cb
topmost_subform_page_item_j_tf
topmost_subform_page_item_j_cb
topmost_subform_page_item_k_tf
topmost_subform_page_item_k_cb
topmost_subform_page_item_e_tf
topmost_subform_page_item_e_cb
topmost_subform_page_item_h_tf
topmost_subform_page_item_h_cb
topmost_subform_page_item_tf__11
topmost_subform_page_item_cb__12
topmost_subform_page_item_tf__12
topmost_subform_page__10
topmost_subform_page__11
topmost_subform_page__12
topmost_subform_page__13
topmost_subform_page_item_f_tf
topmost_subform_page_item_f_cb
topmost_subform_page_item_l_tf
topmost_subform_page_item_l_cb

Create an Interactive Version of this Form:

The Weaver creates a draft guided interview from a template form, like the one provided here. You can use the link below to open this form in the Weaver. To learn more, read "Weaving" your form into a draft interview.

Launch Form in Weaver

The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Physician's Request to Continue Medication—Attachment

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02