Agreement for Long-Term Controlled Substance Prescriptions

Form Template

The Agreement for Long-Term Controlled Substance Prescriptions form is perfect for being used as an awareness device, and consent form, for doctors offices, hospitals, or clinics that write controlled substance prescriptions for Schedule I, Schedule II, Schedule III, and Schedule IV controlled substances.

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These types of medications are often used for the treatment of chronic pain, severe pain, anxiety, and other conditions, and indicated when determined by the professional judgment of a treating physician. Federal law has mandated that controlled substance prescriptions be administered by doctors with appropriate Drug Enforcement Administration (DEA) authorization. This is to prevent drug abuse from prescription drugs. The use of a DEA number/DEA registration number ensures that only valid prescriptions are administered.

Using a form such as the Agreement for Long-Term Controlled Substance Prescriptions form, any organization or professional practice that the administers prescription drugs that are subject to Drug Enforcement Administration oversight are protected by virtue of patient consent and awareness of the risks, and policies of the treating clinic/office. This form when submitted can be appended to the patient record.

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