Controlled Substance Policy

Controlled Substance Policy for

PRESCRIPTION WEIGHT LOSS MEDICATIONS


Phentermine, diethylpropion and phendimetrazine are all federal controlled substances which means that they carry some potential for abuse and diversion which means that we are charged with monitoring and carefully controlling these medications. To this end, we have a strict controlled substance dispensing policy. We require that all patients sign the following agreement:

Holland Clinic Controlled Substance Policy

HollandClinicRegisteredTrademarkApplicationImage2.jpg

Controlled Substance Contract Specimen (March 21, 2016)


This document is NOT a contract

The actual document will be presented to you at the time of your first visit.

This is merely an outline of the basic terms of our controlled substance contract


  1. You agree never to take MORE than your prescribed medication dose
  2. That you not attempt to obtain controlled weight loss medications (or other stimulants like Ritalin or dexedrine) from other providers during the time you are under our care.
  3. That we are unable to replace or 'exchange' lost or stolen or 'ineffective' medications no matter what the reason
  4. That we must wait until your current controlled substance prescription is DUE TO RUN-OUT before we can dispense more controlled substance
  5. The the type and dosage of controlled weight loss medication prescribed to a patient is at the sole discretion of Dr. Holland, is based upon years of experience, education and accumulated knowledge and patients who consistently argue with or try to pressure Dr. Holland into prescribing doses or forms that he deems inappropriate, unsafe or abusive will cause him to terminate care.
  6. That we WILL obtain records from State "Prescription Monitoring Programs" in New Mexico and other states before prescribing a controlled substance to a patient.
  7. That we may discharge you from our care if there is substantial reason to believe that you are abusing or diverting medication.
  8. That in some serious cases, we are required to report controlled substance problems to the State as described above

This is NOT the actual contract

     
Comments