Sample Opioid Treatment Agreements
Part 2. Lists things you agree to do. Part 3. What could happen if you do NOT do the things listed in Part 2. Part 4. Sign the form. You and [INSERT OPIOID PRESCRIBER NAME] must sign the form. PART 1. MY PAIN MEDICINE . PART 2. THINGS I AGREE TO DO. I will… only get my pain medicine from [OPIOID PRESCRIBER’S] office. take my pain medicine ... ................
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