Evidence status: CURRENT STATE-ISSUED IMPLEMENTATION MATERIALS. The Pennsylvania Department of Health currently publishes a Sample Treatment Agreement, an Act 112 checklist, prescriber considerations, patient education, and practitioner FAQs.

State sample agreement

The Department states that its Sample Treatment Agreement meets the minimum requirements of Act 112. Practitioners may use their own agreement so long as the legal requirements are satisfied.

Checklist function

The Act 112 checklist is designed to help prescribers confirm that the agreement covers required treatment goals, testing consent, prescribing policies, controlled-substance disclosure, discontinuation/change criteria, disposal, medication identifying information, counseling certification, consent, signature and date.

State guidance against overreach

The Department’s prescriber guidance makes several distinctions that matter to this evidence library:

  • Act 112 does not require a new agreement for treatment plans established before November 27, 2019.
  • Act 112 does not require limiting patients to a specific pharmacy.
  • Act 112 does not require targeted blood testing.
  • Clinical judgment should account for the effect of practice policies on individual patient needs and abilities.
  • Agreement language should avoid mistrustful, accusatory or confrontational framing that can stigmatize patients.

Why this matters

The Commonwealth’s own implementation materials provide a direct benchmark for distinguishing the statutory floor from clinic-created conditions that go beyond Act 112.

Sources

Reviewed: October 4, 2026.

Evidence boundary: The state sample is an implementation model. The statute and regulations control the legal minimum.