3. I agree to follow the treatment guidelines set for me with my medication as directed and to not alter the dosing or frequency of controlled medication use without consulting first with my LIOBM provider. I understand that taking more medication than prescribed can result in very dangerous outcomes including over sedation, accidental overdose, organ damage, coma or death.
I also understand that if I overuse or run out of my medications early or stop taking them suddenly, I could have uncomfortable and possibly dangerous withdrawal symptoms.
For women - I understand that if I should become pregnant, there are some known and unknown risks to an unborn child. Pregnancy and medication issues must be discussed with my LIOBM provider.
4. I agree/understand that at the discretion of my LIOBM provider and at least once per year, I will be asked to provide body fluid testing for a random drug test at the office or lab. Failure to comply with the testing will result in discontinuation of controlled medication treatment.
5. I understand the potential risks and side effects of taking the medication prescribed to me. I understand that drinking alcohol, using opioid pain medications and or using marijuana while on my medications can have serious adverse consequences and can be very dangerous. I should not combine any of these things with my meds.
6. I agree/understand that controlled medication prescriptions can only be given to me at my scheduled office visits. A missed visit may result in not being able to get a prescription until the next scheduled appointment.
7. On-Call/After hours providers from LIOBM are not able to refill controlled substance prescriptions (including sleeping meds and anxiety meds) on evenings, weekends or holidays. Upon verifying a drug/ dose with the established pharmacy, the On-Call provider may release just a dose or 2 to get the patient to the next business day to seek a regular refill. But this is at the discretion of the On-Call provider. There will be a prescription call in fee and the cost of the medication is the responsibility of the patient. Stimulant medications are NEVER ordered/refilled via the On-Call service.
8. I agree not to sell, share or give away any of my medication to another person. I will keep my medications in a safe and secure place and out of reach of children or unauthorized others. Lost, misplaced or stolen medications/prescriptions will not be replaced regardless of the reason.
9. I agree/understand that altering a prescription or medication order in any way is a serious offence that will result in immediate discharge from care with your LIOBM provider and may result in criminal charges.