I agreed to take any Controlled Substances exactly as instructed. I am NOT allowed to change details or number of times per day that I take my medication without first talking to my Controlled Substance Provider
I agreed to only take Control Substances prescribed by Dr. Osuji
I will not seek Controlled Substances written by another provider or specialist unless I have notified my provider prior to filling the prescription.
I agree to safe keeping my Controlled Substance prescriptions and medication. I understand that lost, miss placed, or stolen prescriptions or medication will not be replaced.
I will bring in all my Controlled Substance medications in the original pill container to every appointment
I will bring in all control substance medication?s in their original pill container for random pill count within 24 hours of when requested
I will NOT combine any narcotic medication with consumption of alcohol. Any UDS that is positive for both Control Substances and alcohol will be considered a violation of this contract.
I will NOT combine any narcotic medication with illegal/street/recreational drugs. Any UDS that is positive for both prescribe controlled substances and illicit substances will be considered a violation of this contract.
I will be responsible for making and keeping appointments for controlled substance refills at least every three months. I understand that NO refills will be written outside of my appointment and I will NOT contact the office for refills of these medications.
I will be responsible for having a working phone number which the office will use to contact me about random UDS and pill counts. I understand that once notified by the office, either directly or by voicemail, I will have 24 hours to report, or inability to do so will result in a violation of this contract.
I understand that not all insurances cover the cost of drug screening and that I may be responsible for my part of the entire bill.
I understand that I will not receive any controlled substances until my provider has been able to review my medical records. If I am a new patient, I understand that it is my responsibility to ensure my medical records have been obtained from my previous provider.
I will not lie or tell miss leading information to my provider
I will not get angry and make threatening remarks in an attempt to get controlled substances