I agree that Certus providers will be the only providers who will prescribe the above medication for me. I will not seek to obtain it from any other prescriber. In case of a situation where I receive a controlled substance from another prescriber, I will notify my provider as soon as possible.
I understand the importance of taking the medication at the dose and frequency prescribed by my provider. I agree not to change the dose of the medication without first discussing it with my provider. I understand that expected prescription refill dates will be used to promote optimal use of the medication. I agree to NOT abruptly stop my medication . Discontinuing controlled substances suddenly after extended use can cause potentially serious withdrawal symptoms or side effects.
I agree to NOT consume other sedating medications or alcohol with this medication. The use of controlled substances with other medications that may cause drowsiness such as opioid pain relievers (including non-prescription codeine) or with alcohol can be serious and life-threatening.
I agree to maintain regular appointment attendance and participate in consultations. I understand that I need to be present at all appointments that are scheduled with my provider and psychotherapy if recommended by my provider. This will include inoffice visits as requested by my provider, no less than two times per year.
I will always be responsible for the secure storage of my medication. I will not share or give my prescribed medication to another person, nor will I accept these medications from anyone else. In the case of change or discontinuation, I will take it to my pharmacy for safe disposal.
My provider will require random urine testing as a matter of routine monitoring and positive results from illegal substances or non-prescribed medications may impact future refills of the above medication(s). These screenings are required when requested in order to receive controlled substances.
I consent to open communication between my provider and any other health care professionals involved in my medication management, such as pharmacists, other doctors, emergency departments, etc.
I understand that if I break this agreement , my provider has the right to stop prescribing controlled substances for me.
I understand that medication refills should be requested through the pharmacy or using the patient portal . These requests will be handled within 48 business hours. If it has been longer than 48 business hours , you may contact the office again. Certain medications may not be refilled without an office visit. ***Some wait times may be longer if prior authorization is required***
The patient portal is the fastest way to request refills. Messages sent there go to your provider and their assigned medical assistant.
