Common Contracts
1 similar Physician/Patient Treatment and Medication Agreement contracts
Physician/Patient Treatment and Medication AgreementPhysician/Patient Treatment and Medication Agreement • November 4th, 2019
I, (Print), have agreed to take as prescribed the following medications as part of my treatment for chronic pain. I understand that these medications may not eliminate my pain but are prescribed by my physician to reduce my daily pain in order to improve my level of activity and overall quality of life. At any given time, only one physician is allowed to prescribe me medication for the treatment of pain. My physician will make every attempt to prescribe my pain medication in a safe and responsible fashion. I understand that unintentional overdose from pain medication is a problem of epidemic proportion in our country as well as worldwide. I understand that underlying health problems such as a heart or lung condition, obstructive sleep apnea, obesity, psychiatric conditions or an unanticipated infection like pneumonia can place me at higher risk for unintentional overdose. I understand that I am at increased risk for serious, potentially life-threatening infection because of pain medica
