Patient Agreement Form: Pain Treatment with Opioid Medications

The app is intended to ensure patients understand their role and responsibilities regarding their treatment (e.g., how to obtain refills, conditions of medication use), the conditions under which their treatment may be terminated, and the responsibilities of the health care provider. This app can assist facilitate communication between patients and healthcare providers and resolve any questions or concerns before the initiation of long-term treatment with a controlled substance. The Patient Agreement Form: Pain Treatment with Opioid Medications mobile app allows you to replace your paper patient agreement with an Android, iPhone, tablet or Windows desktop computer. The mobile form includes fields to document items such as date, patient name, physician name, pharmacy and captures patient and physician signatures. Once the mobile app is filled out a secure PDF is generated. The PDF is easy to share, and a copy is stored in your account for your substance abuse assistance records. You can also use the App Builder to personalize and customize this mobile form.