Medication Contract

EACH PATIENT HAS SPECIFIC REQUIREMENTS FOR TREATMENT.  WE WILL EVALUATE EACH PATIENT AND DETERMINE THE BEST METHOD OF TREATMENT TO INCLUDE PHYSICAL THERAPY, INJECTION THERAPY AND MEDICATIONS. TO PROVIDE THE BEST CARE IN THE MOST EFFICIENT AND TIMELY MANNER, WE ASK ALL OF OUR PATIENTS TO READ AND SIGN THE FOLLOWING CONTRACT.

______1.               NARCOTIC/SEDATIVE MEDICATIONS WILL NOT BE CALLED IN AFTER 5PM.

______2.               NARCOTIC/SEDATIVE MEDICATIONS WILL NOT BE CALLED IN OVER THE WEEKEND.

______3.               REFILLS WILL NOT BE GIVEN TO PATIENTS THAT HAVE NOT BEEN SEEN RECENTLY.  THIS WILL BE DETERMINED BY THE PHYSICIAN.

______4.               REFILLS WILL NOT BE GIVEN FOR LOST OR STOLEN PRESCRIPTIONS OF NARCOTICS OR SEDATIVES.

______5.               REQUESTS FOR MEDICATIONS MADE AFTER NOON ON FRIDAY WILL NOT BE CALLED IN UNTIL MONDAY.

______6.               WHEN CALLING FOR A MEDICATION LEAVE THE PHARMACY NAME AND NUMBER AS WELL AS YOUR NUMBER.  IF YOU HAVE CHANGED THE MEDICATIONS YOU ARE TAKING, WE NEED TO KNOW THOSE CHANGES.

______7.               ONLY ONE PHYSICIAN SHOULD BE PRESCRIBING YOUR MEDICATIONS.

______8.               MOST IMPORTANTLY:  DO NOT WAIT UNTIL THE LAST MINUTE TO REQUEST MEDICATIONS.  MEDICATIONS WILL BE CALLED IN AS QUICKLY AS POSSIBLE, BUT YOU SHOULD EXPECT A 24 TO 48 HOUR PERIOD OF TIME BEFORE YOUR MEDICATION IS CALLED IN TO YOUR PHARMACY.  IT IS YOUR RESPONSIBILITY TO KEEP UP WITH YOUR MEDS.  DO NOT WAIT UNTIL YOU RUN OUT TO CALL FOR MEDICATIONS.

I UNDERSTAND THE ABOVE STATEMENTS AND AGREE TO FOLLOW THEM AS STATED.

SIGNATURE________________________________________________ DATE_____________________

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