Common Contracts
2 similar Controlled Substance Agreement contracts
CONTROLLED SUBSTANCE (NARCOTIC) AGREEMENTControlled Substance Agreement • November 17th, 2020
The purpose of this consent is to protect your access to controlled substances and to protect our ability to prescribe for you. The long-term use of such substances as opiates (narcotic analgesics), benzodiazepine, tranquilizers, and other sedatives are controversial because of uncertainty regarding the extent to which they provide long- term benefit. There is also the risk of an addictive disorder (psychological dependence/physical dependence) developing or of relapse occurring in a person with a prior addiction. The percent of this risk is not certain. Because these drugs have the potential for abuse or diversion, strict accountability is necessary when use is prolonged. For this reason the following policies are agreed to by you, the patient, as consideration for, any condition, the willingness of the physician and/or physician assistant whose signature appears below to consider the initial and/or continued prescription of controlled substances to treat your chronic pain.
Neuroscience Specialists CONTROLLED SUBSTANCE (NARCOTIC) AGREEMENTControlled Substance Agreement • February 17th, 2015
The purpose of this consent is to protect your access to controlled substances and to protect our ability to prescribe for you. The long-term use of such substances as opiates (narcotic analgesics), benzodiazepine, tranquilizers, and other sedatives are controversial because of uncertainty regarding the extent to which they provide long-term benefit. There is also the risk of an addictive disorder (psychological dependence/physical dependence) developing or of relapse occurring in a person with a prior addiction. The percent of this risk is not certain. Because these drugs have the potential for abuse or diversion, strict accountability is necessary when use is prolonged. For this reason the following policies are agreed to by you, the patient, as consideration for, any condition, the willingness of the physician and/or physician assistant whose signature appears below to consider the initial and/or continued prescription of controlled substances to treat your chronic pain.
