Prescribing Opioids
Promote the safe, effective use of prescription opioids
Chronic Pain Management Agreement
Provides a template for an agreement that describes the patient's responsibilities and commitment not to engage in certain activities.
Agreement for Opioid Maintenance Therapy for Non-Cancer/Cancer Pain
Sample Patient Agreement Forms
Sample Informed Consent Form
Helps ensure patients who are beginning long-term therapy with opioid analgesics understand the side effects, risks, conditions, and purpose of their treatment. Facilitates clear communication between patients and healthcare providers about long-term opioid therapy, defines treatment expectations, and resolves any patient questions or concerns.
Informed Consent and Agreement for Opioid Therapy of Pain
Provides information on the potential benefits and risks of opioid medications and documents that both the patient and provider agree on a care plan.
Agreement To Use Pain Medicine for the Long Term
Asks the patient to agree to follow the treatment plan, keep appointments, and take medicine as prescribed.
Notice of the Use of Controlled Substances for the Treatment of Intractable Pain and Patient's Informed Consent
Details the material risks associated with the medication and risk of physical dependence.
Opioid Treatment Agreement
Provides a sample treatment agreement that describes the patient's responsibilities as well as the risks and side effects of using opioid medications.
Long-Term Controlled Substances Therapy for Chronic Pain: Sample Agreement
Consent form on which patient agrees to follow policies related to long-term use of opioids because these drugs have potential for abuse or diversion.
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