Hawaii prescribers use this Department of Health template to document informed consent before long-term opioid prescribing under HRS 329-38.5. The patient initials each statement, covering side effects, driving, dependence and withdrawal, addiction risk, overdose with sedatives or psychiatric drugs, safe storage, testosterone and pregnancy effects, and naloxone. DCD lists it among its workers' compensation forms.
The prescribing provider goes through the form with the patient, writing in the condition being treated and the non-opioid treatments discussed. The patient initials each statement, and both sign, print their names and date it.
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Informed Consent for Opioid Prescribed Pills
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HRS 329-38.5 requires informed consent before long-term opioid prescribing, and this Department of Health template was written for that requirement. DCD links it, without a form number, on its workers' compensation forms page alongside the WC-2 and the treatment plan.
No. The signed consent stays in the patient's medical record and is not filed with the Disability Compensation Division. It documents that the patient reviewed and initialed each statement with the provider, had the chance to ask questions, and consented to opioid treatment of the pain condition.