For certain psychotherapeutic medications prescribed to children under 13 enrolled in Florida Medicaid, a signed informed consent form from the parent or legal guardian may be required before the medication can be processed.
Elsa Pharmacy provides this form to help families and prescribers complete the required documentation clearly and efficiently.
Download the form by clicking the download button. After completing and signing the form, please send it to Elsa Pharmacy so we can assist with processing your prescription.



