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Managing Chronic Non-Terminal Pain: Patient-Provider Agreement for Ongoing Use of Controlled Meds Mobile App

The Managing Chronic Non-Terminal Pain: Patient-Provider Agreement for Ongoing Use of Controlled Medication mobile app provides procedures for chronic non-malignant or acute pain. This app includes a checklist focused pain management for Patient-Provider Agreement for Ongoing Use of Controlled Medication. These pain concerns are managed by dedicated specialized acute and chronic pain team. MyCanvas has several business-to-consumer and business-to-business applications.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Managing Chronic Non-Terminal Pain: Patient-Provider Agreement for Ongoing Use of Controlled Meds Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Patient-Provider Agreement for Ongoing Use of Controlled Medication

  • Ico date

    BIRTHDATE

  • Ico textbox

    NAME

  • Ico multiline

    The use of the following medicine(s) (list medicine names)

  • Ico textbox

    Is only one part of my treatment for

  • Ico textbox

    Primary Prescribing Doctor:

  • Ico statictext

    What should I know about this medication?

  • Ico statictext

    This controlled medication may help me.

  • Ico statictext

    Opioid pain medications often have side effects, which may include but are not limited to:

  • Ico statictext

     Itching  Rash  Severe constipation  Trouble urinating or passing stool  Depression getting ...

  • Ico statictext

    Anxiety & Sleep medicine(s) can cause:

  • Ico statictext

     Dizziness  Memory problems

  • Ico statictext

    Combining drugs can cause:

  • Ico statictext

     Overdose  Trouble breathing  Death

  • Ico statictext

    Stimulant medicines (such as for ADHD) can cause:

  • Ico statictext

     High blood pressure  Fast or irregular heart beats

  • Ico statictext

    I could become addicted to this medicine.

  • Ico statictext

    If I must stop this medicine for any reason, I need to stop it slowly.

  • Ico statictext

    If I or anyone in my family has ever had drug or alcohol problems, I have a higher chance of gett...

  • Ico statictext

    If I take this medicine and drink alcohol, use illegal drugs or use drugs prescribed by other pro...

  • Ico statictext

     I may not be able to think clearly  I could risk hurting myself (such as a car crash)  I coul...

  • Ico statictext

    My doctor can only prescribe this medicine if I do not use illegal drugs.

  • Ico statictext

    If I do not use this medication exactly as prescribed, I risk hurting myself and others.

  • Ico statictext

    I will not increase my medicine dose without being told to do so by my doctor.

  • Ico statictext

    This medicine will not be refilled early.

  • Ico statictext

    I am in charge of my medicine.

  • Ico statictext

     I know my medicine will not be replaced if it is stolen or lost.

  • Ico statictext

    Bring my pill bottles with any pills that are left to each clinic visit.

  • ...and More!

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