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I will not attempt to obtain any controlled medications including opiates stimulants or antianxiety medications from another doctor healthcare provider emergency room or urgent care center. Greenwich Pure Medical LLC Controlled Medication Contract The purpose of this agreement is to prevent misunderstanding about certain medications you are taking for Adult ADHD. 222 Railroad Avenue Suite B / Greenwich CT 06830 / 203 869-2800 / 203 869-2803 fax / Office GreenwichPureMedical.com I will not...
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How to fill out controlled medication contract
01
Read the contract carefully to understand the terms and conditions.
02
Provide your personal information, including your name, address, and contact details.
03
Fill in the details of the healthcare professional who prescribed the controlled medication.
04
Include the name and dosage information of the medication.
05
Specify the duration for which the contract is valid.
06
Sign and date the contract to acknowledge your agreement to the terms.
07
Keep a copy of the contract for your records.
Who needs controlled medication contract?
01
Individuals who are prescribed controlled medications by a healthcare professional.
02
Patients who have a history of substance abuse and require strict monitoring and regulation of their medication usage.
03
People who use medications with a high potential for abuse or addiction, such as opioids or stimulants.
04
Healthcare facilities and institutions that administer controlled medications to their patients.
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