Evidence status: CURRENTLY DISTRIBUTED PRACTICE AGREEMENT. Indiana Health Group’s live Forms page currently lists both electronic and paper versions of its Controlled Substance Agreement.

Scope of the practice form

The Indiana Health Group agreement applies broadly to controlled substances prescribed through the practice. It is therefore broader than Indiana’s chronic-pain opioid rule and should not be treated as a verbatim implementation of 844 IAC 5-6 alone.

Selected agreement terms

  • Medication must be taken only as prescribed, and medication changes must be discussed during an office visit.
  • The patient must disclose other medications and controlled substances and the clinicians prescribing them.
  • The agreement directs the patient to avoid alcohol and illicit or illegal drugs while taking controlled substances.
  • Random urine or saliva screening may be requested at any time and is described as routine office procedure for people taking controlled substances.
  • The patient may be required to bring prescription bottles for pill counts.
  • Lost or stolen medication will not be replaced.
  • No early refills are provided.
  • Refills are tied to keeping scheduled appointments.
  • The patient must personally call at least three days before a controlled-substance refill is needed; pharmacy refill requests are not accepted.
  • Repeated missed or cancelled appointments may lead to termination from the practice.
  • Rude, disruptive, physical, or verbal abuse is stated to result in immediate termination.
  • Agreement violations may result in controlled substances no longer being prescribed by any Indiana Health Group provider and possible termination from the practice.

Indiana rule versus practice policy

Indiana’s chronic-pain opioid rule requires agreement terms involving treatment goals, medically necessary drug-monitoring consent, adherence to prescribed dosing, no sharing, disclosure of controlled substances and alcohol use, random pill counts, and reasons therapy may change or stop. Indiana Health Group’s universal screening language, no-lost-medication rule, no-early-refill rule, three-day refill procedure, appointment consequences, and conduct rules are additional practice terms.

Sources

Reviewed: October 4, 2026.

Evidence boundary: Current public distribution is verified. The practice form is broader than the state’s chronic-pain opioid agreement requirement and includes independent clinic policies.