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FOR OFFICE USE ONLY: Ctrld Med ContractMedication Agreement for Long Term Controlled Substance Prescriptions This is an agreement between ___ and ___. I am being treated with controlled substance

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How to fill out long-term opioid contract use

01

Review the terms and conditions of the contract with your healthcare provider

02

Understand the risks and benefits of long-term opioid use

03

Sign the contract once you are fully informed and agree to the terms

Who needs long-term opioid contract use?

01

Individuals with chronic pain conditions that require long-term opioid therapy

02

Patients who have a history of substance abuse or addiction and need extra monitoring

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What is long-term opioid contract use?

Long-term opioid contract use refers to a formal agreement between a patient and a healthcare provider outlining the terms and conditions for the prescription of opioids for chronic pain management over an extended period.

Who is required to file long-term opioid contract use?

Healthcare providers who prescribe opioids for long-term therapy must establish and maintain a long-term opioid contract use with their patients, especially in cases of chronic pain management.

How to fill out long-term opioid contract use?

To fill out long-term opioid contract use, healthcare providers should ensure that both the patient and provider clearly understand the terms, including dosing, expectations, monitoring, and consent, and then both parties should sign the document.

What is the purpose of long-term opioid contract use?

The purpose of long-term opioid contract use is to clearly outline the responsibilities and expectations of both the patient and provider, enhance patient safety, and help mitigate the risks associated with long-term opioid prescribing.

What information must be reported on long-term opioid contract use?

Long-term opioid contract use must report patient identification details, dosage and frequency of opioid prescriptions, consent for monitoring, and any required follow-up assessments or screenings.

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