Medication Safety

ABF Controlled-Substance Treatment Agreement

Patients who are prescribed certain controlled medications must review and sign this agreement as part of ABF's medication-safety and monitoring process. Please read the entire agreement carefully. Ask the clinical team about any section you do not understand before signing.

Download the Agreement View Prescribing Requirements

What the Agreement Covers

The agreement documents important treatment expectations between the patient and the prescribing provider. The following major topics are addressed:

Identification of the patient and provider

Conditions such as pain, anxiety, or insomnia

Controlled medications, including narcotic medications and benzodiazepines

Alternative or supportive treatments

The goal of reducing symptoms to a tolerable level while improving daily function

Risks such as addiction, allergic reaction, overdose, breathing problems, drowsiness, confusion, impaired judgment, nausea, constipation, tolerance, drug interactions, and reduced effectiveness

Taking medication only as prescribed

No unauthorized changes to dose or frequency

Restrictions on early refills

Restrictions involving lost or stolen medication

Use of one pharmacy

Notification when another provider prescribes medication

Random urine or blood testing

Required ongoing appointments

Possible termination of treatment or referral when requirements are not followed

Consequences associated with non-prescribed or illegal substances

Repeat testing requirements

Patient opportunity to ask questions

Patient signature and date

Acknowledgment

I acknowledge that I have reviewed the ABF Controlled-Substance Treatment Agreement and understand that signing the agreement does not guarantee that a controlled medication will be prescribed or refilled.

This acknowledgment does not replace the patient's legally valid signature when a signature is required. The signed agreement, the patient's treatment plan, and instructions from the prescribing healthcare provider control when they differ from this summary.

Frequently Asked Questions

Why do I have to sign an agreement?

The agreement explains medication risks and establishes the responsibilities of both the patient and the prescribing team.

Does signing the agreement guarantee my prescription?

No. Prescriptions remain subject to the provider's clinical judgment, testing results, medical history, safety requirements, and applicable prescribing rules.

Can I receive a copy of the agreement?

Yes. You may download a copy using the button on this page, or request one through the ABF office.

Website information is a general summary of ABF procedures. The signed agreement, the patient's treatment plan, and instructions from the prescribing healthcare provider control when they differ from this summary.