1. (1) Establishment of Consent.

   1. (a) Receiving Facilities. As soon as possible, but no longer than 24 hours from entering a designated receiving facility on a voluntary or involuntary basis, each individual shall be examined by a physician or psychiatric nurse to assess the individual’s ability to provide express and informed consent to admission and treatment. Admission to a facility requires clear evidence demonstrating the individual’s mental illness and suitability for treatment. For adults, voluntary admission and treatment is contingent upon a determination of competence to provide express and informed consent. In the case of minors, voluntary admission and treatment requires express and informed consent from a parent or legal guardian. Documentation of the assessment results shall be placed in the individual’s clinical record. The facility shall determine whether an individual has been adjudicated as incapacitated and whether a guardian has been appointed by the court. If a guardian has been appointed by the court, the limits of the authority of the guardian shall be determined prior to allowing the guardian to authorize treatment. A copy of any court order delineating a guardian’s authority to consent to mental health or medical treatment shall be obtained by the facility and included in the individual’s clinical record prior to allowing the guardian to give express and informed consent to treatment for the individual.
   2. (b) Treatment Facilities. Upon entering a designated treatment facility on a voluntary or involuntary basis, each individual shall be examined by a physician or psychiatric nurse to assess the individual’s ability to provide express and informed consent to admission and treatment, which shall be documented in the individual’s clinical record. The examination of an individual alleged to be incapacitated or incompetent to consent to treatment, for this purpose, may be limited to documenting the letters of guardianship or order of the court. If the individual has been adjudicated as incapacitated and a guardian appointed by the court or if an individual has been found to be incompetent to consent to treatment and a guardian advocate has been appointed by the court, the limits of authority of the guardian or guardian advocate shall be determined prior to allowing the guardian or guardian advocate to authorize treatment for the individual. A copy of any court order delineating a guardian’s authority to consent to mental health or medical treatment shall be obtained by the facility and included in the individual’s clinical record prior to allowing the guardian to give express and informed consent to treatment for the individual.
   3. (c) If the admission is voluntary, the individual’s competence to provide express and informed consent for admission shall be documented by a physician or psychiatric nurse. Form CF-MH 3104, “Certification of Individual’s Competence to Provide Express and Informed Consent,” which is incorporated by reference and available in Rule 65E-5.270, F.A.C. may be used for this purpose. The completed form or other documentation shall be retained in the individual’s clinical record. Facility staff monitoring the individual’s condition shall document any observations which suggest that the individual may no longer be competent to provide express and informed consent to his or her treatment. In such circumstances, staff shall notify the physician or psychiatric nurse and document in the individual’s clinical record that the physician or psychiatric nurse was notified of this apparent change in clinical condition.

   4. (d) In the event there is a change in the ability of an individual on voluntary status to provide express and informed consent to treatment, the change shall be immediately documented in the individual’s clinical record. An individual’s refusal to consent to treatment is not, in itself, an indication of incompetence to consent to treatment.

      1. If the individual is assessed to be competent to consent to treatment but refuses treatment and meets the criteria for involuntary inpatient placement, the facility administrator shall file with the court a petition for involuntary services. Form CF-MH 3032, “Petition for Involuntary Services,” which is incorporated by reference and available in Rule 65E-5.270, F.A.C. may be used for this purpose.

      2. If the individual is assessed to be incompetent to consent to treatment, and meets the criteria for involuntary inpatient placement or involuntary outpatient services, the facility administrator shall expeditiously file with the court both a petition for the adjudication of incompetence to consent to treatment and appointment of a guardian advocate, and a petition for involuntary inpatient placement or involuntary outpatient services. Upon determination that the individual is incompetent to consent to treatment and does not have a guardian with the authority to consent to mental health treatment appointed, the facility shall expeditiously pursue the appointment of a duly authorized substitute decision-maker that can make legally required decisions concerning treatment options or refusal of treatments for the individual. Forms CF-MH 3106, (August 2025), “Petition for Adjudication of Incompetence to Consent to Treatment and Appointment of a Guardian Advocate,” which is incorporated by reference and available at HYPERLINK "http://flrules.org/Gateway/reference.asp?No=Ref-18648"http://flrules.org/Gateway/reference.asp?No=Ref-18648, and CF-MH 3032, “Petition for Involuntary Services,” which is incorporated by reference and available in Rule 65E-5.270, F.A.C., may be used for this purpose.

   5. (e) Competence to provide express and informed consent shall be established and documented in the individual’s clinical record prior to the approval of a transfer from involuntary to voluntary status or prior to permitting the individual to consent to his or her own treatment if he or she had been previously determined to be incompetent to consent to treatment. Form CF-MH 3104, “Certification of Individual’s Competence to Provide Express and Informed Consent,” incorporated by reference and available in Rule 65E-5.270, F.A.C., properly completed by a physician or a psychiatric nurse may be used for this purpose.
   6. (f) Any guardian advocate appointed by a court to provide express and informed consent to treatment for the individual shall be discharged and a notice of such guardian advocate discharge provided to the court upon the establishment and documentation that the individual is competent to provide express and informed consent.
   7. (g) If the individual entering a designated receiving or treatment facility has been adjudicated incapacitated under Chapter 744, F.S., as defined in Section 394.455, F.S., express and informed consent to treatment shall be sought from the individual’s guardian.
   8. (h) If the individual entering a designated receiving or treatment facility has been determined by a physician or psychiatric nurse to be incompetent to consent to treatment as defined in Section 394.455, F.S., express and informed consent to treatment shall be expeditiously sought by the facility from the individual’s guardian advocate or health care surrogate or proxy.
   9. (i) A copy of the letter of guardianship, court order, or advance directive shall be reviewed by facility staff to ensure that the substitute decision-maker has the authority to provide consent to the recommended treatment on behalf of the individual. If the facility relies upon the expression of express and informed consent for individual’s treatment from a substitute decision-maker, a copy of this documentation shall be placed in the individual’s clinical record and shall serve as documentation of the substitute decision-maker’s authority to give such consent. With respect to a health care proxy, where no advance directive has been prepared by the individual, facility staff shall document in the individual’s clinical record that the substituted decision-maker was selected in accordance with the list of individuals and using the priority set out in Section 765.401, F.S. When a health care surrogate or proxy is used, the facility shall immediately file a petition for the appointment of a guardian advocate.

2. (2) Authorization for Treatment.

   1. (a) Express and informed consent, includes the right to ask questions about the proposed treatment, to receive complete and accurate answers to those questions, and to negotiate treatment options. An individual who is competent to consent shall be asked to give express and informed consent for admission or treatment. If the individual is incompetent to consent to treatment, such express and informed consent shall be obtained from the duly authorized substitute decision-maker for the individual before any treatment is rendered, except where emergency treatment is ordered by a physician for the safety of the individual or others. Chapter 394, Part I, F.S., and this rule chapter govern mental health treatment.
   2. (b) A copy of information disclosed while attempting to obtain express and informed consent shall be given to the individual and to any substitute decision-maker authorized to act on behalf of the individual.
   3. (c) When presented with an event or an alternative which requires express and informed consent, a competent individual or, if the individual is incompetent to consent to treatment, the duly authorized substitute decision-maker shall provide consent to treatment, refuse consent to treatment, negotiate treatment alternatives, or revoke consent to treatment. Form CF-MH 3042a, (August 2025) “General Authorization for Treatment Except Psychotropic Medications,” which is incorporated by reference and available at HYPERLINK "http://flrules.org/Gateway/reference.asp?No=Ref-18649"http://flrules.org/Gateway/reference.asp?No=Ref-18649, or its equivalent, shall be completed at the time of admission to permit routine medical care, psychiatric assessment, and other assessment and treatment except psychotropic medications. The more specific form CF-MH 3042b, (August 2025) “Specific Authorization for Psychotropic Medications,” which is incorporated by reference and available at HYPERLINK "http://flrules.org/Gateway/reference.asp?No=Ref-18650"http://flrules.org/Gateway/reference.asp?No=Ref-18650, or its equivalent, shall be completed prior to the administration of any psychotropic medications, except under an emergency treatment order. The completed forms, or equivalent documentation, shall be retained in the individual’s clinical record.
   4. (d) No facility or service provider shall initiate any mental health treatment, including psychotropic medication, until express and informed consent for psychiatric treatment is sought from an individual legally qualified to give it, except in instances where emergency treatment is ordered by a physician or psychiatric nurse to preserve the immediate safety of the individual or others.
3. (3) Receiving and treatment facilities shall request copies of any advance directives completed by individuals admitted to the facilities, from the individual or the individual’s family or representative.

4. (4) In addition to any other require

   1. (a) Identification of the proposed psychotropic medication, together with a plain language explanation of the proposed dosage range, the frequency and method of administration, the recognized short-term and long-term side effects, any contraindications which may exist, clinically significant interactive effects with other medications, and similar information on alternative medications which may have less severe or serious side effects.
   2. (b) A plain language explanation of all other treatments or treatment alternatives recommended for the individual.
5. (5) If a change in psychotropic medication is recommended which was not previously acknowledged and consented to in accordance with the above, an explanation and disclosure of the altered treatment plan must be provided by the physician or psychiatric nurse, express and informed consent must be obtained from the individual authorized to provide consent, and both must be documented in the individual’s clinical record prior to the administration of the treatment or psychotropic medication.
6. (6) The facility or service provider staff shall explain to a guardian, guardian advocate, or health care surrogate or proxy, the duty of the substitute decision-maker to provide information to the facility or service provider on how the substitute decision-maker may be reached at any time during the individual’s hospitalization or treatment to provide express and informed consent for changes of treatment from that previously approved.
7. (7) Electroconvulsive therapy when recommended to the individual or the individual’s substitute decision-maker by a physician or psychiatric nurse shall be documented in the individual’s clinical record. Form CF-MH 3057, (August 2025), “Authorization for Electroconvulsive Treatment,” which is incorporated by reference and available HYPERLINK "http://flrules.org/Gateway/reference.asp?No=Ref-18651"http://flrules.org/Gateway/reference.asp?No=Ref-18651, may be used for this purpose. If used, this form shall also be signed by the individual, if competent, by the guardian advocate, if previous court approval has been given in accordance with Section 394.4598(7), F.S., by the guardian where the individual has been found by the court to be incapacitated, or by the health care surrogate if the individual had expressly delegated such authority to the surrogate in the advance directive. Express and informed consent from the individual or his or her substitute decision-maker, as required by Section 394.459(3), F.S., including an opportunity to ask questions and receive answers about the procedure, shall be noted on or attached to form CF-MH 3057, or its equivalent, as documentation of the required disclosures and of the consent. Each signed authorization form is permission for the individual to receive a series of up to, but not more than, the stated number of electroconvulsive treatments identified on the form. Additional electroconvulsive treatments require additional written authorization. The signed authorization form shall be retained in the individual’s clinical record and shall comply with the provisions of Section 458.325, F.S.

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.459, 394.4597, 394.4598, 394.4599, 394.4625(1), 394.463, 394.4655, 458.325, 765.401 FS. History–New 11-29-98, Amended 4-4-05, 11-27-25.