Long-Term Controlled Substances Therapy for Chronic Pain Agreement

Form Template

This Long-Term Controlled Substances Therapy for Chronic Pain Agreement form can be accessed anywhere via smart phone or tablet.

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Language: English
Country: United States of America

Terms include: You are expected to inform our office of any new medications or medical conditions, and of any adverse effects you experience from any of the medications that you take. The prescribing physician has permission to discuss all diagnostic and treatment details with dispensing pharmacists or other professionals who provide your health care for purposes of maintaining accountability. You may not share, sell, or otherwise permit others to have access to these medications. These drugs should not be stopped abruptly, as an abstinence syndrome will likely develop. Unannounced urine or serum toxicology screens may be requested, and your cooperation is required. Presence of unauthorized substances may prompt referral for assessment for addictive disorder.

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