This consent form authorizes Contemporary Medicine Associates ("CMA") to obtain and review my prescription history. Detailed prescription history provides your physician with information about medications being prescribed by other providers involved in your medical care. This information will improve the accuracy of our medication list in your medical chart and decrease any adverse drug reactions or inaccurate medication information such as medication names or dosages.
By signing this consent form, you agree that CMA can request and use your prescription medication history from other healthcare providers, pharmacies, and benefit payers (such as your insurance company) for treatment purposes.
Understanding the above, I hereby provide informed consent to CMA to request, view, and use my external prescription history for treatment purposes.