JV-216, Page 1 of 1Order Delegating Judicial Authority Over Psychotropic MedicationJudicial Council of California, www.courts.ca.gov Revised September 1, 2018, Optional Form Welfare and Institutions Code, 247247 369.5, 739.5 California Rules of Court, rule 5.640 Order Delegating Judicial Authority Over Psychotropic Medication JV-216a. Parent or legal guardian (name):The court finds as follows:b.The parent or legal guardian in is authorized to approve or deny the administration of psychotropic medication for the child, unless such authority is modified by a subsequently issued order. 1 Date:The parent or legal guardian has the capacity to authorize psychotropic medications.The parent or legal guardian poses no danger to the child.(SIGNATURE OFJUDICIAL OFFICER )Clerk stamps date here when form is filed. Fill in court name and street address: Superior Court of California, County of Court fills in case number when form is filed.Case Number: Fill in child's name and date of birth:Child's/Nonminor's Name:Date of Birth: 3 2 1 American LegalNet, Inc.