Before a California dependent or ward can receive psychotropic medication, the juvenile court must authorize it, and this attachment is the prescribing physician's evidence. It covers the child's mental health, symptoms and treatment plan, current and past medications, alternatives tried in the last six months, DSM-5 diagnoses, medical history and labs, the child's and caregiver's responses, and each medication with its maximum dose.
The prescribing physician completes and signs the whole form, based on a face-to-face evaluation. The social worker or probation officer completes the JV-220 application it attaches to.
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Physician's Statement—Attachment
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Authorization to administer each medication is limited to the treatment duration you list or six months from the date the order is issued, whichever comes first. Continuing medication then needs a new request using JV-220(A) or, when eligible, JV-220(B).
Item 15 asks whether the child was told, in an age-appropriate way, about the medications, benefits, side effects and the court request, and that they may oppose it. If not, explain why, for example that the child lacks the capacity to respond.
The prescribing physician. The form records their license number, specialty, how long and in what capacity they have treated the child, and whether the request rests on their own face-to-face evaluation or on one by another named professional.