Doctor-Patient Contract on Use of Hydrocone as a Painkiller
This documents represents an agreement between . (the patient), and (the doctor), as regards to the use of hydrocodone, a pain highly narcotic pain killer, to alleviate the chronic pain resulting from an arthritic condition. While this drug may not completely wade off the pain, it should exhibit some efficiency and improve the quality of my life.
1. I acknowledge that the medication is a highly concentrated pain killer, and have been informed of its potential side-effects and the risks that are pegged to its use.
2. I understand that the use of this drug may induce a fit of pleasure and could have calm drowsy effects; this may create euphoria in the cause of reducing pain.
3. I agree to receive prescription on my condition from one doctor and to fill the same form one pharmacy
4. I understand that overdose of this drug may lead to death as a result of stoppage of breath; a reversal of this is only possible through an emergency medical procedure. Therefore, I intend to wear a life bracelet, so that in the event of this occurrence, the hospital will be notified automatically.
5. I understand that under the prescription of the medication may cause drowsiness, dizziness or sedation, therefore, I agree not to operate machinery, drive vehicles as this could put my or other people’s life in danger.
6. I agree to use the medication in the prescribed dosages, at the prescribed dosage and at the scheduled time (to be attached to the agreement).
7. I pledge not to sell, lend or give this drug to any other person
8. I agree to safely keep the medication securely as stolen or lost drugs may not be replaced.
9. I agree to inform the doctor of any side-effects that may arise as a result of use of the medication.
10. I agree to attend all the pre-scheduled medical visits to the doctor s as to monitor the progress of the medication failure to which the treatment is deemed discontinued.
11. In the event of a recommendation by the doctor to stop the medication, perhaps due to undesirable side-effects, I shall do so.
I have read the agreement above, raised my concerns, and have understood it. If I violate the agreement, the doctor may cease to offer treatment.
Patient Signature ..
Doctor’s Signature .
The contact is legally valid while the patient is attending chronic pain treatment from the undersigning doctor and is following the stipulated terms of the contract.
In the event that the patient cannot perform their obligations, the contract is deemed null and void, and the doctor ceases to be responsible for them.
McKendrick, E. (2005). Contract law. Basingstoke: Palgrave Macmillan.