Nevada law requires a patient to enter into a “Prescription Medication Agreement” if a controlled substance is to be continued for more than 30 days for treatment of pain. I understand that This agreement will be updated every 365 days, or if there is a change to my treatment plan. I understand the treatment of pain with controlled substance comes with its risks and responsibilities on my part of which my practitioner has made me aware. The purpose of this agreement is to help both me and my practitioner comply with the law. (Please initial within each number. (Please initial and sign below to indicate your understanding of all parts of this document.)
Regarding my treatment plan and the goals of the treatment of my pain, including the appropriate us of controlled substance.