Copy and paste this statement below or download and print from this online document to inform the treatment facility that they must notify you for permission for all medications as well as changes in medications, treatment and changes in placement. It is the law.




_____________________________________________ is under LPS conservatorship.

( name of conservatee)

The court requires that I, __( name of conservator) _____, as conservator, approve any and all changes to medication and treatment for ____(name of conservatee)__.

The court further requires that I, as conservator, approve any change in placement of conservatee and that I notify the court and conservatee’s attorney of any change of placement.

Failure to comply with these requirements of the court is equal to treating a patient without informed consent.

I look forward to working with you and cooperating fully to achieve the best treatment for conservatee. Respectfully, I request that you comply with the LPS conservatorship requirements.

If you need to contact me, the best telephone number to reach me is _______________.

Should you have any questions, please contact me.

Thank you for your attention to this request and for your treatment of conservatee.