Suboxone contract

Suboxone contract

Download Suboxone contract




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Date added: 21.03.2015
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receive Suboxone from Marquette General Health System, you must fully agree to this. Treatment Contract and place your initials next to each item and sign this

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starting a patient on buprenorphine treatment. Some providers choose to use a printed patient contract that clearly spells out the rules and terms of treatment.and voluntarily agree to accept this treatment agreement/contract, as follows: • I understand that Suboxone(buprenorphine/naloxone combination) is an opiate medication is a serious violation of this agreement and would result in my treatment The pros and cons of the medication, SUBOXONE, will be presented. Sample #3 – Agreement for Treatment with Subutex® or Suboxone®. Sample Information for Patients entering treatment with buprenorphine Page 1 of 3.

Thank you for considering Southlake Psychiatry for your Suboxone treatment. Please read and sign the Suboxone contract, complete the opiate and other HCH BUPRENORPHINE (SUBOXONE) TREATMENT AGREEMENT. As a participant in buprenorphine (Suboxone) treatment for opioid addiction, I agree to the SUBOXONE CONTRACT. GENERAL. 1. You must cLEARLY uNdERstANd, uNdER No ciRcumstANcEs cAN You tAkE YouR mEdicAtioN othER thAN how it is PATIENT SUBOXONE TREATMENT CONTRACT. Patient Name: Date: As a participant in buprenorphine treatment for opioid misuse and dependence, I freely Agreement for Treatment with Suboxone. Yes. No 1. I agree to keep all of my ASAP appointments. If I must reschedule an appointment I will call the ASAP office

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