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MAX HEALTH MAINE FAMILY PRACTICE CONTROLLED SUBSTANCE CONTRACT Controlled substances, including narcotic pain medication, are often used in the treatment of acute pain due to trauma or surgery and

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How to fill out controlled substance contract

01

Review the contract thoroughly to understand all the terms and conditions.

02

Fill in your personal information accurately, including your name, address, and contact information.

03

Specify the details of the controlled substance being prescribed, including dosage and frequency of use.

04

Sign and date the contract to indicate your agreement to comply with the terms stated.

05

Provide any necessary documentation, such as a copy of your prescription or medical history.

Who needs controlled substance contract?

01

Individuals who are prescribed controlled substances by their healthcare provider.

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What is controlled substance contract?

A controlled substance contract is a legal agreement between a healthcare provider and a patient that outlines the terms under which controlled substances will be prescribed and used, including responsibilities and expectations on both sides.

Who is required to file controlled substance contract?

Healthcare providers, such as physicians or pharmacists, who prescribe controlled substances to patients typically need to file a controlled substance contract.

How to fill out controlled substance contract?

To fill out a controlled substance contract, the healthcare provider should include patient information, specify the controlled substances being prescribed, outline the terms of use, and include both parties' signatures for agreement.

What is the purpose of controlled substance contract?

The purpose of a controlled substance contract is to promote safe and responsible use of controlled substances, prevent misuse or abuse, and provide a clear understanding between the provider and patient regarding the treatment plan.

What information must be reported on controlled substance contract?

Information typically required on a controlled substance contract includes patient identification details, specifics of the controlled substances prescribed, usage guidelines, conditions of termination, and signatures from both the patient and provider.

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