Narcotic AgreementNarcotic Agreement • November 21st, 2020
The following policy is designated for ALL patients receiving medications in the form of controlled substances (i.e. narcotics/opiates, sedatives, benzodiazepines, etc.) from Southern Grace Pain & Regenerative Medicine.
Midwest Sports and Pain Specialists, P.C.Narcotic Agreement • October 13th, 2020
Narcotic AgreementNarcotic Agreement • March 24th, 2018
Narcotic agreement is being executed today to prevent misunderstandings about opioid analgesics I will be taking for pain management. This is to help me and my healthcare provider comply with the law regarding controlled pharmaceuticals. The goal of my treatment is to reduce pain to a level that is tolerable and allow me to improve day-to-day functioning. I understand that there are alternative treatments available including non-narcotic analgesics, physical therapy modalities including neuromuscular reeducation, psychological intervention, invasive procedures including injections and surgery.
Narcotic AgreementNarcotic Agreement • March 8th, 2018
Narcotic AgreementNarcotic Agreement • June 18th, 2019
I, understand that I am receiving opioid (narcotic) medications from Dr. Moran. I understand that there are risks associated with opioid treatment including but not limited to physical dependence, ADDICTION, change in personality, sleep changes, sedation, respiratory depression, nausea, constipation, bowel obstruction, weakness and changes in coordination, hormone changes, changes in sexual desire and performance and death. Stopping opioids suddenly can lead to rebound pain and/or withdrawal symptoms. I have read this contract, understand each point, and have been given the chance to clarify any points and ask questions, and agree to the following guidelines:
NARCOTIC AGREEMENTNarcotic Agreement • September 5th, 2013
The purpose of this agreement is to protect your access to controlled substances and to protect our ability to prescribe for you. Long term use of controlled substances is controversial due to the uncertainty regarding the extent to which they provide long-term benefits. There is also the risk of developing an addictive disorder, but the extent of this risk is unknown. Because these medications have potential for abuse and diversion, strict accountability is necessary when use is prolonged. For this reason the following guidelines must be agreed upon by you, the patient, before the provider will consider the initiation or continuation of prescribing controlled substances to treat your chronic pain:
Narcotic AgreementNarcotic Agreement • March 18th, 2016
In the course of my treatment my physician may prescribe a painkiller/sleeping medication. While these medications are generally safe and effective, certain guidelines must be followed in order to absolutely minimize any risk of dependency, addiction or other complications.
Pain Control Associates Narcotic AgreementNarcotic Agreement • September 8th, 2023
Prior to receiving any controlled substances from our practice, you must be aware of the risks, benefits, and other potential options available to you. You must read and agree to abide to the following:
Regional Anesthesiology and Interventional Pain Management.Narcotic Agreement • January 13th, 2012
Pineapple Health Narcotic AgreementNarcotic Agreement • November 30th, 2016
I, understand that for the purpose of this document, “narcotics” includes but is not limited to: Percocet, Vicodin, Hydrocodone, Lortab, Norco, Morphine, OxyContin, OxyCodone, Xanax, Valium, Alprazolam, Clonazopam, Temazepam, Klonopin, Tramadol, Ultram, Dilaudid, Demerol, Fentanyl Patches, Codeine and Tussonex:
ContractNarcotic Agreement • June 13th, 2014
