LOST OR STOLEN MEDICATIONS. I agree to safeguard all medications prescribed by the undersigned physician and understand that lost or damaged medications will not be replaced.
LOST OR STOLEN MEDICATIONS. I am responsible for properly taking and safeguarding my medication. I understand that lost, stolen or damaged medications will not be replaced.
LOST OR STOLEN MEDICATIONS. I agree to safeguard all medications prescribed by the NorCal Pain Treatment Center physician/provider and understand that lost or damaged medications or prescriptions will not be replaced.
LOST OR STOLEN MEDICATIONS. I am responsible for my controlled substance medications. I agree to safeguard all medications prescribed by the treating/prescribing physician and understand that lost, damaged or stolen medications will not be replaced. I understand that I must report stolen medications to the police. _____ Pt Initials
