High-Risk Medication Consent

The High-Risk Medication Consent form is designed for medications that carry significant risk profiles and require documented informed consent before initiation. This includes biologics and immunosuppressants, opioids and controlled substances, teratogenic medications requiring pregnancy prevention programs, anticoagulants, chemotherapy agents, and other drugs with black box warnings. The form ensures patients understand what they are taking, why it has been prescribed, and what risks they are accepting.

The form captures the medication name, dosage, route of administration, and the condition being treated. A risk acknowledgment section covers common and serious side effects, drug interactions, and lifestyle modifications required during treatment. For medications requiring laboratory monitoring, the form documents the monitoring schedule and the patient's agreement to comply with required blood draws or imaging. A pregnancy prevention acknowledgment section is included for teratogenic drugs, and a controlled substance agreement section addresses expectations for opioid and benzodiazepine prescriptions.

Essential for pain management clinics, rheumatology practices prescribing biologics, dermatology offices using isotretinoin, oncology centers managing chemotherapy regimens, and any practice initiating high-risk pharmacotherapy. The form creates an auditable record that the informed consent conversation occurred and that the patient received appropriate education before starting the medication.