1. No self-prescribing any drug, legend or scheduled (controlled).
2. No prescribing of scheduled (controlled) drugs for relatives.
3. No prescribing any drugs for anyone without generating a patient record.
4. Avoid poppy seeds, chiefly in pastries, but also in salad dressing.
5. Avoid non-beverage alcohol; i.e. mouthwash, liquid medication with alcohol base, desserts, food cooked in alcohol, Primatene Mist, vanilla extract, etc. Remember: Alcohol in any form = positive screen.
6. It is recommended that you remove all alcoholic beverages and other non-beverage alcohol (as above) from your home, office, boat, and vehicles. This includes wine collections.
7. Do NOT consume so-called "non-alcoholic" beer and/or wine.
8. Check with NCPHP before taking any scheduled (controlled) drug, even if prescribed by another physician for a legitimate medical condition, unless an emergency exists - then you are to notify us at the earliest opportunity.
9. Beware of iatrogenic relapse. Inform any prescribing practitioner (MD, DO, DPM, DDS, DMD, etc.) that you are chemically dependent and to check with us in advance unless in an emergency, and then as soon thereafter as possible.
10. At the time you give a urine specimen, note all current medications including over-the-counter drugs.
11. Avoid the "PERCEPTION": for example, sitting at a bar consuming soft drinks, exiting a liquor store carrying a package, drinking sparkling cider out of a champagne glass at a wedding, or being a party to raucous behavior in a party setting.
12. Avoid unexcused absenses.
13. Avoid positive UDSs. (A missed UDS = A positive UDS)
14. Avoid missing payment of program and drug screening fees. If you are experiencing difficulty in meeting these obligations, please contact one of the medical directors or Kim Lamando to make arrangements.
15. In the event of an adverse situation, cover yourself with a stat UDS, preferably through your monitor, NCPHP field coordinator, hospital, etc., but certainly at the nearest convenient facility.
16. AVOID AT ALL COSTS A FRAUDULENT APPLICATION! If questions regarding chemical dependency are worded ambiguously, or if there is any reasonable doubt about the intent of an inquiry, or if you are not absolutely certain of the proper and rigorously honest answer, consult with NCPHP before answering the question.
17. Inform NCPHP office and/or your field coordinator when you will be away from your usual contact points. (i.e. vacations, etc.)
18. Make yourself available for meetings with your field coordinator. Return calls and pages immediately!
19. Use discretion when/if revealing your addiction OR your recovery.
20. Respect others' anonymity!

I have read, fully comprehend, and agree to adhere to the above admonitions. I acknowledge receipt of a copy of this document.