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Get Tx Health Resources Patient Controlled Substance Agreement 2016-2025
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How to fill out the TX Health Resources Patient Controlled Substance Agreement online
Filling out the TX Health Resources Patient Controlled Substance Agreement is essential for ensuring your safe and responsible use of controlled substances. This guide will provide you with clear instructions on how to complete the agreement online effectively.
Follow the steps to fill out the agreement accurately and responsibly.
- Click ‘Get Form’ button to obtain the form and open it for editing.
- Begin by entering your full name in the designated field, confirming that you are the individual being prescribed a controlled substance.
- Next, indicate the specific controlled substance you are being prescribed, ensuring accuracy to adhere to prescribed regulations.
- Read through the agreement thoroughly to understand the rules regarding the use of controlled substances and your responsibilities.
- Complete the section related to your pharmacy by providing the name, phone number, and address of the pharmacy where you will fill your prescriptions.
- Answer the question regarding whether you have received any prescription medications from other physicians in the past thirty days. If yes, fill in the names of the physicians and the medications prescribed.
- Review the commitment statements regarding medication safety and adherence to appointments, ensuring you understand the implications of non-compliance.
- Sign the agreement in the designated field to confirm your understanding and acceptance of the terms.
- Have your physician sign the document in their designated field afterward, which will finalize the agreement.
- Save your changes, and choose to download, print, or share the completed form as needed.
Complete your TX Health Resources Patient Controlled Substance Agreement online today to ensure your safe and responsible treatment.
Texas no longer issues state licenses for controlled substances. Enter all zeros for state license number on forms. Renewal forms will prepopulate the form with the previous state license number.
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