This resource includes two sample patient agreement forms that can be used with patients who are beginning long-term treatment with opioid analgesics or .
The purpose of this Agreement is to prevent misunderstandings about certain. attempt to obtain any controlled medications, including opioid pain medications,.
Opioid (narcotic) treatment for chronic pain is used to reduce pain and improve what you are able to do each day. Along with opioid treatment, other medical .
I,. agree that Dr. will be the only physician prescribing OPIOID (also known as NARCOTIC) pain medication for me and that I will obtain all of my prescriptions for .
The purpose of this contract is to maintain a safe, controlled treatment plan.. narcotic pain medication because other treatments and medications I have. This form has been fully explained to me, I have read it or have had it read to me, and I.
Opioid Treatment Agreement Patient Name. 1.. I understand that my doctor may ask me for a urine drug screen sample or a count of my pills at any time.
SAMPLE PAIN MANAGEMENT CONTRACT. You have agreed to receive opioid (
Sample Patient Contract. for. Using Opioid Pain Medication in Chronic Pain. This is an agreement between (the patient) and. Dr. (the doctor) concerning the use .
Contents of a Contract. â€¢ Offer, Acceptance and Consideration. â€¢ Name one clinic and one pharmacy. â€¢ No phone in refills. â€¢ No night or weekend refills.