Medications affect the way your body and mind function. Every medication, whether prescribed, over the counter or “natural”, changes your chemistry, at least temporarily, or may have permanent harmful effects. The treatment we have recommended aims to balance many factors including your preferences and concerns, the severity or your condition and symptoms, the consequences of no treatment, the risks and benefits of other treatments, and more. Please ask any and all questions about your treatment and provide us with as much information as possible so we may determine the best course of treatment with you. We may prescribe for you a new medication or recommend that you try an over-the-counter (OTC)
product as part of your treatment. It is vital for your safety that you follow all directions closely that
come from the pharmacy, are printed on the package or insert, or are on the container. Always
consider the following information:

Call your family physician or Primary Care Provider (PCP) to let them know of the new medication. He or
she may modify our recommendation or recommend against the new medication entirely based on his or her
knowing your history. Please inform us immediately of any such changes so we can update our records.
Tell the pharmacist ALL of the medications and supplements you take. This may slow your visit to the
pharmacy, but will reduce the possibility of a drug interaction which could be dangerous.
Any medication can have unpredicted side effects or may make you feel poorly. The first time (or first few
times) you take a new medication, you should do so in a safe environment where you have access to help if

Never drive a vehicle
or undertake any activity that requires your full attention when taking a new medication
until you understand its effects, if any, upon you.

(Acetaminophen, APAP)
Never take more than 4000 milligrams (4 gram) of this medication in a 24 hour period. Eight (8) Extra-Strength
Tylenol™ tablets (500 milligrams each) equals 4000 milligrams. Twelve (12) Regular Strength Tylenol™ tablets (325
mg each) equals 3900 milligrams. Do not consume alcohol when taking Tylenol as this can cause severe or fatal liver
MANY OTC and PRESCRIPTION PRODUCTS CONTAIN TYLENOL™. You must be aware of all the contents of all
the medications you take in order not to exceed the limit of 4000 milligrams from all sources in a 24 hour period.
Narcotic Pain Medications
Some names include Percocet™, Vicoden™, Percodan™, Lortab™, Tylenol™ #3, Darvocet™, Darvon™, Propoxyphene,
Dilaudid™, Oxycodone, Oxycontin™, Hydrocodone, Codeine, Hydromorphone, Morphine, MS Contin™, Methadone,
Fentanyl™ patch and many others.
Many of these also contain Tylenol™ (see above).
Never drive a vehicle or undertake any activity that requires your full attention when taking a narcotic medication –
even if you “feel fine” or are “used to it”. You may harm yourself or others.
Never mix narcotic medications with the use of sedatives or alcohol. The combined effect can be unpredictable and
Anti-Inflammatory Medications (NSAID’s)
Some names include Ibuprofen (Advil™, Motrin™, Nuprin™), Naproxen (Naprosyn™, , Aleve™, Anaprox™), Celebrex™,
Arthrotec™, Diclofenac (Cataflam™) (Voltaren™), Diflunisal (Dolobid™, Etodolac, Fenoprofen, Flurbiprofen (Ansaid™),
Indomethacin, Ketoprofen (Oruvail™), Ketorlac (Toradol™), Meclofenamate, Meloxicam (Mobic™), Nabumetone
(Relafen™), Oxaprozin (Daypro™), Piroxicam (Feldene™), Salsalate, Sulindac (Clinoril™), Tolmetin and others.
Ibuprofen is included in many OTC preparations as well.
Aspirin is a related medication.
You should only take one of these medications in a single day, unless otherwise, specifically directed by us or your
family doctor with a discussion of which medications your are taking. Additional medications may be needed to protect
your stomach. If you have a personal or family history of heart, liver, kidney or gastro-intestinal (GI, stomach) disease,
please be additionally certain to discuss this with us, your family doctor and/or other specialists.
Generally, Tylenol™ can be taken safely with these medications.
Consumption of alcohol with the use of these medications raises the risks of stomach problems, ulcers, and other
dangerous side effects.
Ultram (Tramadol)
Also comes as Ultracet™ (which includes Tylenol™, see above)
You should not take this medication if you have a history of seizures or if you take Celexa™ (citalopram), Lexapro™
(escitalopram), Luvox™ (fluvoxamine), Paxil™ (paroxetine, Pexeva™), Prozac™ (fluoxetine), Zoloft™ (sertraline),
Lidoderm Patches
You must completely remove the patch after 12 hours use and leave it off for 12 hours before applying a new one.

1. Given the nature of your injury or condition, you should only require narcotic pain medication for a certain amount of time, if at all. Every effort on our part will be used to switch you over to nonnarcotic pain medication as soon as your pain level permits. Our office, your pharmacy and your insurance company will closely monitor your prescription refills for excessive, abusive or long-term use. If necessary, you will be referred to a pain management specialist. Failure to seek care with the pain management specialist when referred could result in possible termination of your care. 2. You must use only one pharmacy for these prescriptions. If you feel that you have good reason and must change pharmacies, you must notify your doctor in advance. All pharmacies involved will be notified of the change. If, at any time, it is discovered that you are using more than one pharmacy for the same medication, you will be referred to a pain management specialist. In some situations, possible termination of care may result. 3. It is your responsibility to call our office for refill requests in a timely manner. Your doctor is not in the office everyday. Therefore, if you require a refill on your prescription by a certain day, please make sure you provide a minimum of three business days notice to our office. Refill requests will not be addressed on weekends or after office hours. 4. We ask patients to inform us of their present medications. Please tell us of any new medications that you have received from other physicians at each appointment. It is your responsibility to make sure that any new prescriptions that you receive from other physicians are not similar or the same medications, perhaps by different or generic names, for other painful conditions. We must be kept aware of all medication changes by other physicians, as this can be a potentially dangerous situation. If at any time it is discovered that you are using several different doctors to obtain narcotics, you will immediately be referred to a pain management specialist and immediate termination of care may result. 5. We do not keep pain medications in our office. 6. EARLY REILLS WILL NOT BE HONORED FOR ANY REASON DO NOT LOSE YOUR PRESCRIPTION(S) DO NOT LET OTHERS USE YOUR MEDICATIONS FOR ANY REASON DO NOT PLACE YOUR MEDICATIONS IN AN UNLABELED CONTAINER These are highly controlled medications. It is your responsibility to take them only as prescribed and according to directions. It is your responsibility to store them legally, safely and out of reach of others. Your irresponsibility or failure to do so will result in an immediate change to non-narcotic medications, possible referral to a pain management specialist, and possible termination of care. I HAVE READ AND UNDERSTAND THE ABOVE MEDICATION POLICY. PATIENT’S SIGNATURE:_____________________________________________ DATE:______________________________


Information for people with diabetes

INFORMATION FOR PEOPLE WITH DIABETES Diabetes Diabetes mellitus is a chronic condition caused by too much glucose (sugar) in your blood. Your blood sugar level can be too high if your body does not make enough of the hormone insulin. Insulin is produced by the pancreas (a gland behind the stomach) and moves glucose out of the blood and into cells, where it is broken down to produce energy.

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