Patient and Provider Contract - Opioid Pain Medication - HCCIntelligence™ Premier Resource - 2024-Patient and Provider Contract - Opioid Pain Medication - HCCIntelligence™ Premier Resource

Patient and Provider Contract - Opioid Pain Medication - HCCIntelligence™ Premier Resource - 2024

Pdf Summary

This document is a patient-provider contract regarding the use of opioid pain medication for chronic pain. The agreement outlines several key points that the patient must understand and agree to. <br /><br />Firstly, the patient acknowledges that opioid analgesics are strong medications with associated risks and side effects. They understand that these medications can cause physical dependence, and abrupt discontinuation may lead to withdrawal symptoms. If the patient is pregnant or becomes pregnant while on opioids, their child may also be physically dependent and at risk of life-threatening withdrawal symptoms. <br /><br />The patient is informed that overdose on opioid medication can be fatal, as it can stop their breathing. They are advised to wear a medical alert bracelet to inform emergency personnel of their medication use. If the medication causes drowsiness or sedation, the patient agrees not to drive or operate machinery. <br /><br />The patient agrees to report any side effects to the provider and to take medication as prescribed, without changing the dosage or frequency without discussing it. They understand that misuse, such as running out of medication early or escalating doses without permission, may result in discontinuation of treatment. The patient also agrees to see only one provider for opioid prescriptions and to fill them at one pharmacy, without obtaining medication from other providers or pharmacies. <br /><br />The patient is responsible for storing their medication safely and securely, as lost or damaged medication will not be replaced. They agree not to share their medication with others and not to consume alcohol or other mood-altering drugs while taking opioids. The patient consents to urine testing for alcohol and drugs when requested by the provider. <br /><br />The patient acknowledges the importance of attending follow-up visits and participating in other chronic pain treatment modalities recommended by the provider. They understand the small risk of opioid addiction and agree that if addiction occurs, the medication will be discontinued, and referral to a drug treatment program may be necessary. <br /><br />Both the patient and provider sign the agreement, indicating their understanding and agreement to the terms outlined. If the patient violates the agreement, the provider has the right to discontinue treatment.

Keywords

patient-provider contract

opioid pain medication

chronic pain

medication risks

physical dependence

withdrawal symptoms

overdose

side effects reporting

medication misuse

storage of medication