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Agreement to Abstain from Alcohol and Substance Abuse
And Consent to Random Testing
USMC Kidney/Pancreas Transplant Program
Alcohol and substance use or abuse can significantly reduce a patients chance
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How to fill out agreement to abstain from

How to fill out an agreement to abstain from:
01
Clearly state the purpose of the agreement: Begin by clearly stating the purpose of the agreement, which is to abstain from a certain activity or behavior. This could be anything from abstaining from alcohol or drugs to abstaining from gambling or smoking.
02
Provide the names and details of the parties involved: Include the names, addresses, and contact details of all parties involved in the agreement. This typically includes the individual or individuals abstaining from the activity, as well as any relevant sponsors or support persons.
03
Outline the duration of the agreement: Specify the duration of the abstention period in the agreement. This could be for a specific period of time (e.g., 6 months, 1 year), or it could be an ongoing commitment until otherwise stated.
04
Clearly define the terms and conditions: Clearly define the terms and conditions of the abstention agreement. This may include guidelines on what activities or behaviors are to be abstained from, any exceptions or allowances, consequences for non-compliance, and any additional agreements or commitments made by the parties involved.
05
Include signatures and dates: Ensure that all parties involved in the agreement sign and date the document. This signifies their understanding and acceptance of the terms outlined in the agreement.
Who needs an agreement to abstain from?
01
Individuals seeking personal growth: An agreement to abstain from certain activities or behaviors may be relevant for individuals who are seeking personal growth and wish to eliminate certain negative habits or addictions from their lives.
02
People in recovery: Individuals who are in recovery from substance abuse or addiction may find it helpful to have an agreement to abstain from the substances or behaviors that they are trying to overcome. This agreement can serve as a tangible commitment and reminder of their dedication to their recovery journey.
03
Support networks and sponsors: Support networks, sponsors, or loved ones who are involved in a person's recovery process may also find it beneficial to have an agreement to abstain from certain activities or behaviors. This can help establish clear boundaries and expectations, and ensure a supportive environment for the individual in recovery.
In summary, to fill out an agreement to abstain from, it is important to clearly state the purpose, provide details of the parties involved, define the duration and terms, and include signatures and dates. This type of agreement can be beneficial for individuals seeking personal growth or recovery, as well as their support networks.
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What is agreement to abstain from?
An agreement to abstain from is a voluntary commitment to refrain from a certain action or behavior.
Who is required to file agreement to abstain from?
Individuals or entities who have agreed to abstain from a particular action are required to file an agreement to abstain from.
How to fill out agreement to abstain from?
To fill out an agreement to abstain from, one must clearly state the action or behavior they are abstaining from, provide a signature, and possibly have it notarized.
What is the purpose of agreement to abstain from?
The purpose of an agreement to abstain from is to formalize a commitment to refrain from a specific action or behavior.
What information must be reported on agreement to abstain from?
The agreement to abstain from must include details about the specific action or behavior being abstained from, the parties involved, and any consequences for failing to uphold the agreement.
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