Madison Clinic


A survey of providers revealed that most would welcome a formal policy to help guide the prescription of chronic opiates for clinic patients.

HMC Pain Contract [pdf] - UW ID required

Benefits and Risks of Treatment with Opiods [pdf] - Patient Education

You can also access these forms from EpicCare (see instructions below).

To print the education pieces from Epic you can:

  • Open the SmartSet with a ZZ patient encounter
  • Check the box for the patient information piece
  • Sign SmartSet – this will insert piece into Patient Instructions and AVS
  • Go to Patient Instructions section on Visit Navigator – Click on Print button on very top right toolbar of Epic

  • go to AVS section on Visit Navigator – Click on Preview, then Print AVS

    After discussion at recent provider meetings the following policy will be enacted:

    1. All Madison Clinic patients who require chronic opiate therapy with schedule II medications (oxycodone, morphine, fentanyl, hydromorphone and methadone) for greater than 30 consecutive days should sign the standard HMC pain contract [pdf].  Providers are free to modify the contract to fit the particular clinical circumstances although extensive exceptions to the standard contract will compromise its effectiveness and ease of implementation.
    2. Providers are free to use a pain contract for patients on schedule III narcotics (hydrocodone/vicodan, Tylenol with codeine) but are not required to do so.
    3. The pharmacy will maintain a listing or registry of all patients who have signed a contract and work to insure that prescribing and dispensing of narcotics is consistent with the contract.  Establishing this registry should facilitate the timely delivery of prescriptions to the PCP for signature and avoid confrontations regarding the need “emergency prescriptions”....but will also require that providers regularly check their mailboxes for prescriptions needing review and signature.

    To help initiate the Registry please forward the names of all of your patients whom you know to be on chronic schedule II narcotics.  Please send these names to Brad Kosel or Bob Loeffelbein in the pharmacy.


    1. Pain Management - FAQ - DOH Website
    2. Opioid Dosing Guideline and DOH Pain Management Rules [CME]
    3. Opioid Dosing Guideline for Chronic Non-Cancer Pain
    4. Prescription Monitoring Program - DOH Website








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