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:

Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

Fill in child’s name and date of birth:

Child’s Name:

Date of Birth:

Case Number:

Court fills in case number when form is filed.

JV-224

County Report on Psychotropic
Medication

The social worker or probation officer must file this form for any hearing for
which the court is providing oversight of psychotropic medications. This
includes all scheduled progress reviews on orders authorizing psychotropic
medication and every status review hearing. If you are filing this form for a
status review hearing, file it with the status review hearing report. If you need
more space for any of the items, write the item number and additional
information on page 4 of this form. If you need more space than page 4, attach
a sheet or sheets of paper. If you do not know the answer to a question, write “I
do not know.”

Your name:

2 Your relationship to the child:

Social worker

Probation officer

Other county staff (specify):

Caregiver's relationship to child:

a.
b. Date of last communication with caregiver:

Child Information

Child’s height:

Prescribing physician’s name:
Date last seen by prescribing physician:

Next appointment date:

d.
e.
f. Therapist’s name:
g. Date last seen by therapist:

b. Child’s weight:

5 List current court-approved psychotropic medications. (Verify that this is what child is taking.)

Name of Medication

Dosage

Name of Medication

Dosage

The child is taking the medication

in . This was verified by

child

caregiver

other (specify):

The child is not taking the following medication
child

caregiver

This was verified by

(specify):

in
other (specify):

Judicial Council of California, www.courts.ca.gov
Rev. September 1, 2020, Mandatory Form
Welfare and Institutions Code, §§ 369.5, 739.5, 14028
California Rules of Court, rules 5.640 and 5.642

County Report on Psychotropic
Medication

JV-224, Page 1 of 4

Case Number:

The court has not authorized three or more psychotropic medications at the same time for 90 days or more.

The court has authorized three or more psychotropic medications at the same time for 90 days or more.
Does the court case file contain a signed copy of Position on Release of Information to Medical Board of
California (form JV-228)?

Child’s name:

(1)
(2)
(3)

Yes
No
I do not know.

medication was begun.

9 Describe the caregiver’s observations regarding how the child's behaviors and/or symptoms have changed since the

10 Describe the caregiver’s observations regarding the side effects of the medication.

11 Describe any concerns the caregiver has regarding the medication.

Describe what the child says about whether his or her behaviors and/or symptoms have changed since the
medication was begun.

Rev. September 1, 2020

JV-224, Page 2 of 4

County Report on Psychotropic
Medication

Child’s name:

Describe what the child says about the side effects of the medication.

Case Number:

Describe any concerns or complaints the child has regarding the medication.

List the dates of all medication management appointments since the last court hearing.

List the dates and reasons of other follow-up medical appointments since the last court hearing.

Describe other mental health treatments that are part of the child's overall treatment plan (for example, frequency
and type of counseling, wraparound, etc.) or attach mental health treatment plan from treating clinician.

Rev. September 1, 2020

JV-224, Page 3 of 4

County Report on Psychotropic
Medication

Child’s name:

Provide any other information you think the judge should know.

Case Number:

Check here if you need more space for any of the items. Write the item number and additional information here.
If you need more space, attach a sheet or sheets of paper.

Date:

Type or print name of person completing this form

Signature

Child welfare services staff (sign above)
Probation department staff (sign above)
Other (sign above)

(specify):

Rev. September 1, 2020

JV-224, Page 4 of 4

County Report on Psychotropic
Medication

County Report on Psychotropic Medication

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): 70
Average fields per page: 17
Reading Level: Grade 6
LIST Grouping(s): 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.

j_v_page_item_tf__1 was JV-224[0].Page1[0].item4a_tf[0] (0.50 conf)
j_v_page_court_info_ft was JV-224[0].Page1[0].CourtInfo_ft[0] (0.30 conf)
j_v_page_case_number_ft was JV-224[0].Page1[0].CaseNumber_ft[0] (0.34 conf)
j_v_page_item_relationship_cb__1 was JV-224[0].Page1[0].item2relationship_cb[0] (0.35 conf)
j_v_page_item_relationship_cb__2 was JV-224[0].Page1[0].item2relationship_cb[1] (0.35 conf)
j_v_page_item_tf__2 was JV-224[0].Page1[0].item2other_tf[0] (0.35 conf)
j_v_page_item_tf__3 was JV-224[0].Page1[0].item1_tf[0] (0.35 conf)
j_v_page_item_relationship_cb__3 was JV-224[0].Page1[0].item2relationship_cb[2] (0.35 conf)
j_v_page_item_atf was JV-224[0].Page1[0].item3atf[0] (0.35 conf)
j_v_page_item_b_tf__1 was JV-224[0].Page1[0].item3b_tf[0] (0.35 conf)
j_v_page_item_b_tf__2 was JV-224[0].Page1[0].item4b_tf[0] (0.35 conf)
j_v_page_item_c_tf was JV-224[0].Page1[0].item4c_tf[0] (0.35 conf)
j_v_page_item_tf__4 was JV-224[0].Page1[0].item4d_tf[0] (0.35 conf)
j_v_page_item_e_tf was JV-224[0].Page1[0].item4e_tf[0] (0.35 conf)
j_v_page_item_f_tf was JV-224[0].Page1[0].item4f_tf[0] (0.35 conf)
j_v_page_item_g_tf was JV-224[0].Page1[0].item4g_tf[0] (0.28 conf)
j_v_page_table_row_field__1 was JV-224[0].Page1[0].Table1[0].Row1[0].TextField2[0] (0.30 conf)
j_v_page_table_row_field__2 was JV-224[0].Page1[0].Table1[0].Row1[0].TextField2[1] (0.30 conf)
j_v_page_table_row_field__3 was JV-224[0].Page1[0].Table1[0].Row2[0].TextField2[0] (0.30 conf)
j_v_page_table_row_field__4 was JV-224[0].Page1[0].Table1[0].Row2[0].TextField2[1] (0.30 conf)
j_v_page_table_row_field__5 was JV-224[0].Page1[0].Table1[0].Row3[0].TextField2[0] (0.30 conf)
j_v_page_table_row_field__6 was JV-224[0].Page1[0].Table1[0].Row3[0].TextField2[1] (0.30 conf)
j_v_page_table_row_field__7 was JV-224[0].Page1[0].Table1[1].Row1[0].TextField2[0] (0.30 conf)
j_v_page_table_row_field__8 was JV-224[0].Page1[0].Table1[1].Row1[0].TextField2[1] (0.30 conf)
j_v_page_table_row_field__9 was JV-224[0].Page1[0].Table1[1].Row2[0].TextField2[0] (0.30 conf)
j_v_page_table_row_field__10 was JV-224[0].Page1[0].Table1[1].Row2[0].TextField2[1] (0.30 conf)
j_v_page_table_row_field__11 was JV-224[0].Page1[0].Table1[1].Row3[0].TextField2[0] (0.30 conf)
j_v_page_table_row_field__12 was JV-224[0].Page1[0].Table1[1].Row3[0].TextField2[1] (0.30 conf)
j_v_page_item_child_cb__1 was JV-224[0].Page1[0].item7child_cb[0] (0.35 conf)
j_v_page_item_cb__1 was JV-224[0].Page1[0].item7other_cb[0] (0.35 conf)
j_v_page_item_caregiver_cb__1 was JV-224[0].Page1[0].item7caregiver_cb[0] (0.35 conf)
j_v_page_item_tf__5 was JV-224[0].Page1[0].item7other_tf[0] (0.35 conf)
j_v_page_item_tf__6 was JV-224[0].Page1[0].item6_tf[0] (0.35 conf)
j_v_page_item_caregiver_cb__2 was JV-224[0].Page1[0].item6caregiver_cb[0] (0.35 conf)
j_v_page_item_cb__2 was JV-224[0].Page1[0].item6other_cb[0] (0.35 conf)
j_v_page_item_child_cb__2 was JV-224[0].Page1[0].item6child_cb[0] (0.35 conf)
j_v_page_item_cb__3 was JV-224[0].Page1[0].item6and7_cb[0] (0.35 conf)
j_v_page_item_cb__4 was JV-224[0].Page1[0].item6and7_cb[1] (0.35 conf)
j_v_page_item_specify_tf was JV-224[0].Page1[0].item7specify_tf[0] (0.35 conf)
j_v_page_date_field was JV-224[0].Page1[0].DateField1[0] (0.31 conf)
j_v_page_childsname_ft was JV-224[0].Page1[0].childsname_ft[0] (0.35 conf)
j_v_subform_childsname_ft__1 was JV-224[0].#subform[1].childsname_ft[0] (0.35 conf)
j_v_subform_case_number_ft__1 was JV-224[0].#subform[1].CaseNumber_ft[0] (0.34 conf)
j_v_subform_item_tf__1 was JV-224[0].#subform[1].item8_tf[0] (0.35 conf)
j_v_subform_item_tf__2 was JV-224[0].#subform[1].item9_tf[0] (0.35 conf)
j_v_subform_item_tf__3 was JV-224[0].#subform[1].item10_tf[0] (0.35 conf)
j_v_subform_item_tf__4 was JV-224[0].#subform[1].item11_tf[0] (0.35 conf)
j_v_subform_item_cb__1 was JV-224[0].#subform[1].item8_cb[0] (0.35 conf)
j_v_subform_item_cb__2 was JV-224[0].#subform[1].item8_cb[1] (0.35 conf)
j_v_subform_item_sub_cb__1 was JV-224[0].#subform[1].item8sub_cb[0] (0.35 conf)
j_v_subform_item_sub_cb__2 was JV-224[0].#subform[1].item8sub_cb[1] (0.35 conf)
j_v_subform_item_sub_cb__3 was JV-224[0].#subform[1].item8sub_cb[2] (0.35 conf)
j_v_subform_childsname_ft__2 was JV-224[0].#subform[2].childsname_ft[1] (0.35 conf)
j_v_subform_case_number_ft__2 was JV-224[0].#subform[2].CaseNumber_ft[1] (0.34 conf)
j_v_subform_item_tf__5 was JV-224[0].#subform[2].item13_tf[0] (0.35 conf)
j_v_subform_item_tf__6 was JV-224[0].#subform[2].item14_tf[0] (0.35 conf)
j_v_subform_item_tf__7 was JV-224[0].#subform[2].item15_tf[0] (0.35 conf)
j_v_subform_item_tf__8 was JV-224[0].#subform[2].item16_tf[0] (0.35 conf)
j_v_subform_item_tf__9 was JV-224[0].#subform[2].item12_tf[0] (0.35 conf)
j_v_subform__1 was JV-224[0].#subform[3].T22[0] (0.35 conf)
j_v_subform_printname_tf was JV-224[0].#subform[3].printname_tf[0] (0.35 conf)
j_v_subform_childsname_ft__3 was JV-224[0].#subform[3].childsname_ft[2] (0.35 conf)
j_v_subform_case_number_ft__3 was JV-224[0].#subform[3].CaseNumber_ft[2] (0.34 conf)
j_v_subform_item_cb__3 was JV-224[0].#subform[3].item18_cb[0] (0.35 conf)
j_v_subform_signature_cb__1 was JV-224[0].#subform[3].signature_cb[0] (0.35 conf)
j_v_subform_signature_cb__2 was JV-224[0].#subform[3].signature_cb[1] (0.35 conf)
j_v_subform_signature_cb__3 was JV-224[0].#subform[3].signature_cb[2] (0.35 conf)
j_v_subform__2 was JV-224[0].#subform[3].T105[0] (0.35 conf)
j_v_subform_item_tf__10 was JV-224[0].#subform[3].item18_tf[0] (0.35 conf)
j_v_subform_item_tf__11 was JV-224[0].#subform[3].item17_tf[0] (0.35 conf)

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

County Report on Psychotropic Medication

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