File name: Pain Management Contract Pdf
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PAIN MANAGEMENT AGREEMENT I, _____ [print patient’s name], have agreed to submit to the care of _____ [print physician’s name], and/or his associates. It is my understanding . Sample Opiate/Pain Management Agreement* The purpose of this Agreement is to prevent misunderstandings about certain medications you will be taking for pain management. This .PAIN MANAGEMENT AGREEMENT: I UNDERSTAND AND AGREE TO THE FOLLOWING: That this pain management agreement relates to my use of any and all medication(s) (i.e., opioids, also called ‘narcotics, painkillers’, and other prescription medications, etc.) for chronic pain prescribed by my physician. I. pain management agreement TO THE PATIENT: As a patient, you have the right to be informed about your condition and the recommended medical or diagnostic procedure or drug therapy to be used, so that you may make the. THE PURPOSE OF THIS AGREEMENT IS TO PREVENT MISUNDERSTANDINGS ABOUT CERTAIN MEDICINES YOU WILL BE TAKING WHILE UNDER CARE FOR PAIN MANAGEMENT. THIS IS TO HELP YOU AND YOUR PROVIDER TO COMPLY WITH THE LAW REGARDING CONTROLLED PHARMACEUTICALS.
