Opioid Taper Agreement Sample Contracts
Opioid Taper AgreementOpioid Taper Agreement • August 1st, 2019
This agreement should be completed in-person with the patient as an extension of the Pain Medication Patient Agreement.
The opioid taper agreement outlined below was formulated following a discussion between the patient and provider in where both parties decided to gradually discontinue opioid therapy as the benefits of therapy no longer outweigh the risks. The opioid...Opioid Taper Agreement • April 24th, 2020
Patient’s Initials Terms of Agreement I agree to attend all regularly scheduled appointments, treatments, and consultations as requested by my provider, and comply with other pain consultations and management strategies as necessary. I consent to open communication between my provider and any other healthcare professional involved in my pain management, such as pharmacists, other physicians, emergency departments, etc. I will only request and receive opiate (narcotic) pain medications and any other controlled substances from the provider whose name is listed below, or from their designee in clinic. I will not request pain medications from other doctors in any network. I agree to inform any other providers participating in my care of this agreement. I must obtain all controlled substance prescriptions from the same pharmacy. Should the need arise to change pharmacies, I will inform my provider. I have selected the following pharmacy as my pharmacy of choice and agree to fill all my