Client Consent for Medication Management-Example


An example of an agreement between a client (patient and/ or caregiver) and organizations involved in a pilot study of an automated medication dispenser. The example agreement explains 1) who is involved in the pilot study, as well as roles and responsibilities of the stakeholders, 2) liabilities, 3) supplies and equipment, including who is assumed to be responsible for their provision, 4) the length of the pilot and what is to occur once the pilot ends, and 5) information that will be collected and with whom it will be shared.


Stakeholders involved in design and implementation of technology-enhanced medication management programs.

Helpful Tips

The example is oriented to a pilot involving home health agencies, home health clients, and a vendor of an automated medication dispenser but it could be modified for suitability in other situations.

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