How to Fill Out Texas Form 3713: Nursing Facility Antipsychotic Consent

To fill out Texas Form 3713, the prescriber completes Section I with the condition being treated, the expected benefits, the probable side effects and risks, and the proposed dosage and duration; the resident or a legally authorized representative then signs Section II in writing after being told that consent can be revoked at any time. The signed form has to be in place before the first dose of a new antipsychotic or neuroleptic prescription is given, and nursing facility staff are not permitted to sign on the resident’s behalf.¹

Download the Current Version First

Form 3713 is published by the Texas Health and Human Services Commission on its forms page covering numbers 3000–3999. The current version carries an effective date of October 2024. HHSC notes the PDF may not open in a browser’s built-in viewer and recommends downloading it and opening it in Adobe Reader.² Using an outdated copy you’ve had on file is a common way to end up with a form that no longer matches what a surveyor expects to see.

Section I: The Prescriber’s Disclosures

Section I belongs to the prescribing clinician. It may be completed by the prescriber, the prescriber’s designee, or the nursing facility’s medical director.¹ Four pieces of information are required by 26 TAC §554.1207, and each one needs to be answered in writing:

The specific condition, diagnosis, or symptom the medication is being prescribed to treat.
The beneficial effects the prescriber expects the medication to have on that condition.
The probable clinically significant side effects and risks, which the prescriber can take from widely available pharmacy databases or the manufacturer’s package insert.
The proposed course of treatment, meaning the dosage, schedule, and expected duration.

These four disclosures are the regulatory minimum. Leaving any of them blank, or filling them in vaguely, makes the consent deficient and exposes the facility to a citation.³

Who Qualifies as a Prescriber’s Designee

HHSC does not define “designee.” The agency’s guidance tells prescribers to check with their own licensing board, such as the Texas Medical Board, to determine whether their license allows them to delegate completion of Section I.¹ Responsibility for confirming that delegation is proper rests with the prescriber, not the facility.

Section II: The Resident or Representative’s Consent

Section II is the signature block. The resident, or a legally authorized representative acting for the resident, signs to confirm that they received the Section I disclosures, understand them, and agree to the medication. The consent must be voluntary and given without coercion or undue influence.³

Section II also has to inform the signer, in writing, that consent can be revoked at any time.³ The regulation lists this as a separate validity requirement, so a form that doesn’t communicate the right to revoke is technically incomplete even if everything else is filled in.

Two rules are absolute. First, nursing facility staff are specifically prohibited from signing on the resident’s behalf.¹ Second, consent has to be written. Verbal agreement does not satisfy the rule even if a nurse documents it carefully in the chart.

When the Resident Can’t Sign for Themselves

If the resident lacks capacity, a person authorized by law to make the decision for them may sign Section II. That could be a court-appointed guardian, an agent under a medical power of attorney, or another individual recognized under Texas law as having decision-making authority for the resident.⁴ Before accepting the signature, the facility should verify that the signer actually holds the legal authority they’re claiming, and keep a record of that verification.

If Signatures Can’t Happen Together

The prescriber and the signer don’t have to be in the same room. HHSC allows the form to be exchanged by mail, fax, or secure email when everyone can’t be present at once. Whichever version becomes the final document, original or copy, has to contain every required disclosure and every applicable signature before it counts as complete.¹

When the Form Must Be Signed

For a new antipsychotic or neuroleptic prescription, Form 3713 must be completed before the first dose is administered. There is no grace period. For a resident who is already taking one of these medications when the requirement applies, or who arrives at the facility already on one, the form must be completed as soon as possible.¹ “As soon as possible” is softer than the pre-dose rule but it is not a license to delay; a surveyor reviewing the chart will want to see evidence the facility was actively working on it.

The Emergency Exception

There is one narrow situation in which an antipsychotic can be given without a signed Form 3713: a medication-related emergency. The statute defines that as a situation where the medication is immediately necessary to prevent imminent probable death or substantial bodily harm to the resident, or imminent physical or emotional harm to another person because of the resident’s overt or continual threatening acts.⁴

When this exception is used, the prescriber has to document the medical or behavioral necessity in specific terms in the clinical record, and the treatment has to be given in the manner least restrictive of the resident’s personal liberty that is still clinically appropriate.⁴ The exception covers the immediate crisis only. Once the emergency passes, written consent on Form 3713 is still required for any continued use of the drug.

How Long a Signed Form Lasts

A completed Form 3713 stays in effect until either the resident or representative withdraws consent, or the prescriber discontinues the medication.³ There is no automatic expiration and no annual renewal built into the regulation.

A medication counts as discontinued if therapy has been suspended for more than 70 days. If the same medication resumes within that 70-day window, the original consent remains valid, though the prescriber should document an oral explanation of side effects in the clinical record. If the lapse exceeds 70 days, a new Form 3713 must be signed before the medication can be restarted.³

If the resident or representative revokes consent, administration must stop. If the prescriber believes an abrupt stop would be medically dangerous, the appropriate response is a documented clinical conversation, not continued dosing over the refusal.

Where to Keep the Finished Form

The completed Form 3713, original or copy, goes in the resident’s clinical record.¹ The regulation requires that consent be evidenced in the record by both the signed form and the prescriber’s documentation, so filing it in a separate consent binder away from the chart does not meet the standard.³

When the form has not yet been signed but the medication is already being given, as can happen with an existing prescription, the facility should document every attempt made to obtain written consent, along with every communication with the prescriber, the resident, and the representative. That paper trail is what shows a surveyor the facility was pursuing compliance rather than ignoring it.¹

1
Texas Health and Human Services. Long-Term Care Regulatory Provider Letter 2022-11 – Consent for Antipsychotic and Neuroleptic Medications
2
Texas Health and Human Services. Form 3713, Nursing Facility Consent for Antipsychotic or Neuroleptic Medication Treatment
3
Cornell Law Institute. 26 Texas Admin. Code 554.1207 – Prescription of Psychoactive Medication
4
Texas Public Law. Texas Health and Safety Code Section 242.505 – Prescription of Psychoactive Medication