Anthony Marshall
 
 
 Anthony Marshall DOB: 1999-04-08 (Random 2 yo M) Acc No. 52799 Doc Name: Controlled Substance Agreement 
 Anthony Marshall DOB: 1999-04-08 (Random 2 yo M) Acc No. 52799 
 2015-08-27 
 I will keep follow-up visits as directed by LA Health Solutions. If I must cancel an appointment, I will give at least 
 24 hours notice and reschedule. I will also keep all therapy appointments with LA Health Solutions. If I do not 
 show up for therapy appointments I understand that LA Health Solutions may cancel my appointment with the 
 medical doctor and that I may not be able to obtain a refill on my prescription. 
 I acknowledge treatment with controlled substances is contingent on evidence of benefit. I am aware my case will be 
 reviewed periodically to determine whether I am improving or that progress is being made to improve my function and 
 quality of life. If my treatment regimen does not show any evidence of this, I know I may be tapered off controlled 
 medications and a new treatment may be prescribed. 
 I will use caution and common sense while taking this medication. I will ask questions if I do not understand something 
 or if I feel I may be having trouble with the medication. 
 X 
 / 
 Patient?s Name (Print) 
 Patient?s Signature 
 Date 
 Signed On:2024-02-22 
 03:19:14 PM CDT 
 efile:///C:/Users/ashton/AppData/Local/Temp/eCW.5fkglis2.pj3/63ae77f4-1e94-4ade-a192-c9a67765b950.html 
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 Anthony Marshall DOB: 1999-04-08 (Random 2 yo M) Acc No. 52799 
 Anthony Marshall DOB: 1999-04-08 (Random 2 yo M) Acc No. 52799 Doc Name: Controlled Substance Agreement 
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