Controlled Substances Sample Contracts

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

If the patient has a high risk for medication abuse or has a history of substance abuse, the physician should consider the use of a written agreement between physician and patient outlining patient responsibilities, including:

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TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

If the patient has a high risk for medication abuse or has a history of substance abuse, the physician should consider the use of a written agreement between physician and patient outlining patient responsibilities, including:

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

🞎 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The patient should receive prescriptions from one physician/practice, with that physician/practice designated in the agreement.1

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 A physician must have a written treatment agreement with the patient and shall require the patient to have a clinical visit at least once every three (3) months, while treating for pain, to evaluate the patient’s response to treatment, compliance with the therapeutic regimen and any new condition that may have developed and be masked by the use of Schedule II or III controlled substances.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

🞎 The patient is responsible for safely using medication, meaning that the patient should store the medication in a secure location and safely dispose of any unused medication.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

- Effective 4-14-2016, psychiatric APRNs can prescribe psychotropic controlled substances for the treatment of mental disorders, per written protocol with a psychiatrist.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 Patients shall be seen by the physician at appropriate intervals, not to exceed 12 weeks to monitor the patient and evaluate progress.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

🞎 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

If the patient is at high risk for medication abuse, or has a history of substance abuse, or psychiatric comorbidities, the prescribing physician shall use a written agreement for treatment with the patient outlining patient responsibilities. This written agreement for treatment shall include:

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017 • District of Columbia

If the patient is determined to be at high risk for medication abuse or have a history of substance abuse, the physician shall employ the use of a written agreement between the physician and patient outlining the patient’s responsibilities, including, but not limited to:

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.1

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

If the patient is at high risk for medication abuse or has a history of substance abuse or substance dependence, the clinician should use a written agreement between clinician and patient outlining patient responsibilities, including:

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 If a physician prescribes controlled substances to a patient for more than 90 days for treatment of chronic pain and chooses not to use a pain management agreement, then the physician shall document in the patient’s medical records the reason(s) why a pain management agreement was not used.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

🞎 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

Treatment agreements are recommended for patients on short-acting opioids at the time of third visit within two months, on long-acting opioids, or for patients expected to require more than three months of opioids, and should include:1

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TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

If the patient is at high risk for medication abuse or has a history of substance abuse, the physician should consider the use of a written agreement between physician and patient outlining patient responsibilities, including:

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

🞎 The patient’s consent to drug monitoring testing in circumstances where the physician determines that drug monitoring testing is medically necessary.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

If the treatment plan includes extended drug therapy, the physician should consider the use of a written pain management agreement between the physician and the patient outlining patient responsibilities, including:

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The patient is responsible for safely using medication, meaning that the patient should store the medication in a secure location and safely dispose of any unused medication.

TREATMENT AGREEMENT
Controlled Substances • January 13th, 2017

 The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement.

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