Controlled Substance Refill Program - Patient Agreement Form - 4Med Systems, Inc.
The purpose of this agreement is to provide the patient with information about the medications they will be taking and to assure that the physician is in compliance with all state and federal regulations concerning the prescribing of controlled substances.
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The physician’s goal is to provide the best quality of life possible given the reality of the patient’s clinical condition. The success of treatment depends on mutual trust and honesty in the physician/patient relationship and full agreement and understanding of the risks and benefits of using controlled substances.
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