This resource provides two sample patient agreement forms for patients beginning or continuing long term treatment with opioid analgesics or other controlled substances. The agreement forms include information about how to obtain refills, the conditions of medication use, the circumstances under which treatment may be terminated, and the responsibilities of the health care provider. Part of the Arizona ReThink RX Abuse initiative which helps communities educate their citizens about prescription drug safety.
Funding Source: National Institute on Drug Abuse
Arizona Sample Pain Treatment Patient Agreement Forms
Sample patient agreement forms for patients on long term treatment with opioids