This is an agreement between the patient and the doctor.
I am being treated with opioid medication for my chronic pain, which I understand my not completely rid me of my pain, but will decrease it enough that can be more active. I understand that, because this medication has risks and side effects, my doctor needs to monitor my treatment closely in order to keep me safe. I acknowledge my treatment plan my change over time to meet my functional goals, and that my doctor will discuss the risks of my medicine, the dose, and frequency of the medication, as well as any changes that occur during my treatment. In addition, I agree to the following statements:
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