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Desert Shores Pediatrics Stimulant/NonStimulant Medication AgreementPatient Name: ___DOB: ___Parent/Guardian Name: ___ Date: ___ Provider Name: ___Desert Shores Pediatrics (DSP) is committed to providing the safest care for our patients with Attention Deficit Hyperactivity Disorder (ADHD). Drug Enforcement Agency (DEA) controlled substances may be used as a therapeutic option to manage symptoms associated with this condition. The following agreement is designed to help improve treatment
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How to fill out stimulantnon-stimulant medication agreement

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How to fill out stimulantnon-stimulant medication agreement

01
Begin by gathering patient information including name, date of birth, and contact details.
02
Clearly state the purpose of the agreement, emphasizing the importance of adherence to medication.
03
Outline the types of stimulants and non-stimulants that may be prescribed.
04
Specify the treatment goals and expected outcomes of the medication.
05
Include a section on potential side effects and responsibilities of the patient.
06
Detail the follow-up schedule for medication review and adjustments.
07
Ensure a section for signatures from both the provider and the patient to acknowledge understanding of the agreement.

Who needs stimulantnon-stimulant medication agreement?

01
Patients diagnosed with attention deficit hyperactivity disorder (ADHD) who are prescribed stimulant or non-stimulant medications.
02
Individuals seeking structured support and accountability for their medication management.
03
Parents or guardians of children receiving ADHD treatment to ensure awareness and consent.
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A stimulant/non-stimulant medication agreement is a formal document between a patient and a healthcare provider that outlines the terms and conditions for prescribing stimulant or non-stimulant medications, particularly for the treatment of attention deficit hyperactivity disorder (ADHD) and similar conditions.
Typically, patients who are prescribed stimulant or non-stimulant medications for ADHD or related conditions are required to sign a stimulant/non-stimulant medication agreement. This ensures both the provider and patient are on the same page regarding the treatment plan.
To fill out a stimulant/non-stimulant medication agreement, a patient must provide personal information, details of their medical history, current medications, and any past issues with drug misuse or dependence. The healthcare provider may also include specific expectations and guidelines for medication use.
The purpose of a stimulant/non-stimulant medication agreement is to promote safe and responsible use of prescription medications, minimize the risk of misuse, ensure compliance with the treatment plan, and establish clear communication between the patient and provider.
The information that must be reported on a stimulant/non-stimulant medication agreement typically includes patient identification details, the specific medication being prescribed, the prescribed dosage, treatment goals, potential side effects, and the patient's agreement to follow the rules set forth regarding medication use.
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