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LONG TERM CONTROLLED SUBSTANCE THERAPY AGREEMENT The purpose of this agreement is to protect your access to controlled substances and to protect our ability to prescribe for you. The long term use
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How to fill out long term controlled substance

01
To fill out a long term controlled substance prescription, follow these steps:
02
Gather all necessary information about the patient, including their name, date of birth, address, and contact information.
03
Verify the patient's medical condition that requires the long term controlled substance.
04
Consult with the patient's primary care physician or specialist to determine the appropriate dosage and duration for the controlled substance.
05
Obtain the necessary prescription forms from the pharmacy or healthcare provider.
06
Clearly write the patient's information on the prescription form, including their name, date of birth, and address.
07
Specify the controlled substance being prescribed, including the generic and brand name, as well as the strength and quantity.
08
Include any necessary instructions for the patient on how to take the medication.
09
Sign and date the prescription form, ensuring it meets all legal requirements.
10
Provide the completed prescription form to the patient, and advise them on any additional steps they may need to take to obtain the medication from a pharmacy.

Who needs long term controlled substance?

01
Long term controlled substances are typically prescribed to individuals who require ongoing medication management for chronic conditions or severe pain.
02
Some common examples of individuals who may need long term controlled substances include:
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- Patients with chronic illnesses, such as multiple sclerosis, cancer, or HIV/AIDS, who require specialized medication to manage their symptoms or slow down disease progression.
04
- Individuals with severe and chronic pain conditions, such as those with back injuries, arthritis, or fibromyalgia, who have exhausted other treatment options and require pain relief through controlled substances.
05
- Individuals recovering from major surgeries or injuries that result in long-term pain management needs.
06
- Patients with mental health disorders, such as severe anxiety or depression, who may benefit from long term controlled substance medications as part of their treatment plan.
07
It is important for healthcare providers to carefully evaluate each patient's medical history, condition, and risk factors before prescribing long term controlled substances.

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