A complete medical history and physical examination must be conducted and documented in the Patients medical records. The medical record should document the nature and intensity of the Pain, current and past treatments for Pain, underlying or coexisting diseases or conditions, the effect of the Pain on physical and psychological function, and history of substance abuse. The medical record also should document the presence of one or more recognized medical indications for the use of a controlled substance.
		The written medical treatment plan should state objectives that will be used to determine treatment success, such as Pain relief and improved physical and psychosocial function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the individual medical needs of each patient. Other treatment modalities or a rehabilitation program may be necessary depending on the etiology of the Pain and the extent to which Pain is associated with physical and psychosocial impairment.
		The physician should discuss the risks and benefits of the use of controlled substances with the patient, persons designated by the patient, or with the patients surrogate or guardian if the patient is incompetent. The patient should receive prescriptions from one physician and one pharmacy where possible. If the Patient is determined to be at high risk for medication abuse or have a history of substance abuse, the physician may employ the use of written agreement between physician and patient outlining patient responsibilities, including.. 1.) Urine/Serum Medication levels screening when requested. 2.) Number and frequency of all prescription refills and reasons for which drug therapy may be discontinued (i.e., violation of agreement).
		At reasonable intervals based on the individual circumstances of the patient, the physician should review the course of treatment and any new information about the etiology of the Pain. Continuation or modification of therapy should depend on the physicians evaluation of progress toward stated treatment objectives such as improvement in patients Pain intensity and improved physical and/or psychosocial function, i.e., ability to work, need of health care resources, activities of daily living, and quality of social life. If treatment goals are not being achieved, despite medical adjustments, the physician should reevaluate the appropriateness of continued treatment. The physician should monitor patient compliance in medication usage and related treatment plans.
		The physician should be willing to refer the patient when necessary for additional evaluation and treatment in order to achieve treatment objectives. Special attention should be given to those pain patients who are at risk for misusing their medications and those whose living arrangements pose a risk for medication misuse or diversion. The management of Pain in patients with a history of substance abuse or with a comorbid psychiatric disorder may require extra care, monitoring, documentation, and consultation with or referral to an expert in the management of such patients.
		To prescribe, dispense, or administer controlled substances, the physician must be licensed in the state and comply with applicable federal and state regulations. Physicians are referred relevant documents for specific rules governing controlled substances as well as applicable state regulations.
		* The physician should keep accurate and complete records that include the following...
		* The medical history and physical examination
		* Diagnostic, Therapeutic, and Laboratory results
		* Evaluations and Consultations
		* Treatment objectives
		* Discussion of Risks and Benefits
		* Treatments Records
		* Medications (including date, type, dosage, and quantity prescribed)
		* Instructions and Agreements and Periodic Reviews
		* Records should remain current and be maintained in an accessible manner and readily available for review.
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