Controlled Substance Acknowledgment Agreement Sample Contracts
Patient: Provider: Medication list: Please list your medications here or provide a list to attach to this agreementControlled Substance Acknowledgment Agreement • May 7th, 2019
In accordance with Oklahoma Law SB1446, prior to giving me a controlled substance prescription, my provider is required to discuss with me the risks of taking controlled dangerous substances specifically any form of Opiates and the potentially dangerous interaction with some other prescription drugs. Due to the seriousness of the Oklahoma Opioid Abuse Crisis, the physician is asking me to sign this form to acknowledge our conversation.