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Old 12-15-2006, 10:08 PM   #1
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Pain Contracts, I never signed one?

I noticed alot of you mentioning pain management contract that you had to sign with your pain Dr's. I have never seen or heard of such a thing. What does it say? What happens if you don't do or break a rule? I also notice some people saying they are only allowed to go to one pharmacy. Is that in the contract and why?

I have a great relationship with my PM Doc. I never had a contract with him, but he does say I am one of his most honest and trust worthy patients.

Tell me more

California Chris

 
Old 12-15-2006, 10:38 PM   #2
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Re: Pain Contracts, I never signed one?

Dear Djemcee,

I have been to two Pain Clinics before I found my wonderful Internal Medicine doctor who now Rx's my Pain Management stuff. I haven't ever had a contract either.

I get the feeling people will say that drug seekers typically use multiple pharmacies, but I don't agree with that particular rule. What happens if your one pharmacy doesn't have your medication when it is due? This is something that can easily happen--and it has happened to me. I'm glad I wasn't restricted from locating my medication elsewhere.

However, I always make sure that my Rx's are ordered several days in advance. With the money I spend at my pharmacy--they seem to be very pleased to keep my controlled substances on hand at the right time!

The people who are required to sign a contract, though, can answer your concerns better than I can!

Sincerely,
Jon (Conductor)

 
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Old 12-15-2006, 10:56 PM   #3
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Re: Pain Contracts, I never signed one?

Hi Chris,
I see my internist for pain management, and she has started specializing in treating chronic conditions. I had been with her for about 8 years when she told me she was having all her patients sign a contract, Because the DEA likes it when doctors can show them that they are monitoring patient behaviour closely. (She did add that she had never had any concerns about me being compliant, which I apprieciated!)
The contract was written by the doctor, I think everyone's is a little different, but mostly the same. Mine says that I will not see any other doctor for my DDD, nerve damage, or lower back issues, and if I require emergency care she will be informed. I cannot accept another narcotic prescription from another doctor for those specific problems, but of course I can for dental issues or if I broke my leg or something. It says I will take my meds as prescribed, and not try to fill them early, and only use one pharmacy, However, you can use any pharmacy in the same chain, so if one doesnt have your meds, you can go to another, as long as they are connected by computer records. This is to stop people from doctor shopping and using different pharmacys for non compliant prescriptions.
The contracts protect the doctor, if the patient is caught selling their meds, or ODs. the doctor has proof that he or she made the proper use of the meds crystal clear to the patient. It also enables the doctor to drop the patient suddenly if any part of the contract is broken.
I know some doctors also do pill counts, where you have to come in and show them what you have left, and also unine tests to make sure you have the right amount in your system (too much means abuse, too little or none could mean you were selling them) My doctor doesnt do anything like that, at least not to me.
Hope this answered at least some of your questions.
Your Friend, Fabby

 
Old 12-16-2006, 01:15 AM   #4
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Re: Pain Contracts, I never signed one?

I know here in my city in Alberta (Canada) doctor's don't have the same liabilities as in the States. Here the emphasis is on patient responsibility. If a concern ever arose, the onus would be on ME, and NOT my doctor. Doctors would be scot-free. It would be eup to the patient to explain if they were doing something bad.

I've never heard of a pain contract being used here. I've never even been told "the rules" either, so if I broke one, and they questioned me about it, I wouldn't even know what to say, because I wouldn't know what I had done wrong. And if there is a rule here about using more than one doctor or going more than once a month for meds, then I break it all the time. First, my doc only likes to prescribe 2-3, maybe 4 weeks of meds. at a time. This is HIS preference, NOT mine lol. I'd like to only have to see him every month instead of twice a month. And a few times this year, my doctor has gone away when I didn't have meds left, so I HAD to see another doctor. But I have never lied about it. When I go to a different doctor, or the ER, I tell them everything, as openly as possible. Many times if I remember to, I take along my pill bottle. And if any doctor or medical authority ever said I was doing something worng.....you better bet your last dollar that I'd quit whatever it was right then and there. I'm not stupid enough to lose my less-painful life just for some stupid thing. I know all to often how bad my pain gets.....to think of being that way forever.......NOTHING worth that lol.

But I don't know how Canada and the States differ. I know some provinces here are slightly different, and I most definitely know that my city is VERY different from most other parts of Alberta.

And just for my two cents- I believe those "contracts" and all the little "rules" actually do more harm to LEGITIMATE chronic pain sufferers than reduce the addicts......and we need to be responsible for our own destiny's. Imposing all those rules....there's absolutely no way every single pain patient is ABLE TO go to the same pharmacy every single time, or only see one doctor all the time. So when these people "break" the rule, do they get into big trouble or what? Do they have to give warnings and stuff first, and do they take into account the circumstances surrounding the "violation?" All I'm saying is that I'll never believe that these contracts and rules do more good than harm.

And that's my 2 cents for the day. Hope someone who has one of these contracts comes along soon to tell you all the details.....unfortunately, I do not know them all either.

Have a minimally-pain free day!

 
Old 12-16-2006, 08:15 AM   #5
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Re: Pain Contracts, I never signed one?

I don't think I would mind as much the seeing the same doc part, but one pharmacy seems like a monopoly. Do they tell you what pharmacy. Imagine a doctor getting kick backs because he says you can only use XYZ pharmacy. Then XYZ pharmacy kicks the doc back $. Would be espicially weird if he said you could only use the pharmacys that are sometimes inside the same building as the doc. That would be curious. And what would be even funnier is if your docs last name is Bozo and when you go to the pharmacy he tells you to go to, the pharmacist's last name is Bozo .

Anyway, I had a new pharmacy open down the street "Longs" with a drive thru window. I was going to make the switch and go there. I called and they fill absolutely no class II drugs. Weird, but they don't. I have never heard of that. So I stayed at my regular pharmacy. But I would have hated a doc telling me that I could not switch, or go to him for his permisssion.

I am really starting to like my pharmasicts. Rite-Aid had been pretty helpful. They order my drug if they don't have it, and they usually start to order something that I started on a regular basis once I start taking it. They never question me or give me bad looks, and actually are quite funny and enjoyable when I pick up my scripts. I don't think they would ever second guess what I brought in or ever call my doctor. I don't look sick on the outside, and within the last year of starting my pain doc, they were shocked that I needed the class II drugs, because I look so good. Funny, like one of the post mention, we do a great job of covering it up. I am always a fun and bubbly person, so it throws people off.

Cheers,

California Chris

 
Old 12-16-2006, 12:32 PM   #6
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Re: Pain Contracts, I never signed one?

Quote:
Originally Posted by djemcee
I don't think I would mind as much the seeing the same doc part, but one pharmacy seems like a monopoly. Do they tell you what pharmacy. Imagine a doctor getting kick backs because he says you can only use XYZ pharmacy. Then XYZ pharmacy kicks the doc back $. Would be espicially weird if he said you could only use the pharmacys that are sometimes inside the same building as the doc. That would be curious. And what would be even funnier is if your docs last name is Bozo and when you go to the pharmacy he tells you to go to, the pharmacist's last name is Bozo .

Anyway, I had a new pharmacy open down the street "Longs" with a drive thru window. I was going to make the switch and go there. I called and they fill absolutely no class II drugs. Weird, but they don't. I have never heard of that. So I stayed at my regular pharmacy. But I would have hated a doc telling me that I could not switch, or go to him for his permisssion.

I am really starting to like my pharmasicts. Rite-Aid had been pretty helpful. They order my drug if they don't have it, and they usually start to order something that I started on a regular basis once I start taking it. They never question me or give me bad looks, and actually are quite funny and enjoyable when I pick up my scripts. I don't think they would ever second guess what I brought in or ever call my doctor. I don't look sick on the outside, and within the last year of starting my pain doc, they were shocked that I needed the class II drugs, because I look so good. Funny, like one of the post mention, we do a great job of covering it up. I am always a fun and bubbly person, so it throws people off.

Cheers,

California Chris


LOL Chris. I actually agree with everything you just said (weird- never thought I'd say THAT to a guy ) I think the part of seeing the same doctor- well, I do that anyways (whenever possible) and I think this is a good idea for anyone to keep their health records all in one place.

Correct me if I'm wrong someone who does have a contract, but I'm pretty sure the pharmacy is YOUR choice.....but once you choose it, you MUST gets your meds there. It's crossed my mind before, too that these doc's could be getting even MORE kickbacks like they do from pharmaceutical companies .....but I think since you get to choose the pharmacy, there is no kickback for the doctor (or at least, it would be minimalized. )

I just think that anytime you impose restrictions like these on people, it takes away some of their dignity......and I know for me, since I left my ex-husband earlier this year b/c of extreme control, I'm super sensitive now.....if they did this to me right now, even though I have nothiing to hide, I'd probably end up acting like some sort of junkie just b/c I'd try and rebel against the perceived control. And THAT would not be good, obviously lol.

My guess why that drive-thru pharmacy that opened in your area doesn't carry any of these drugs (Triplicate) is b/c with the drive-thru window, their robbery risk is much, much higher. Probably a saftey issue, since someone could drive-thru and demand these drugs and show a gun or something and no one would be any wiser.... I don't know. Other than that, my guess it that it's some personal choice of theirs.

 
Old 12-16-2006, 07:47 PM   #7
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Re: Pain Contracts, I never signed one?

I don't like to even divulge what I'm about to tell you, but I was arrested in 1996 for a supposed crime. Let me go ahead and tell you that the judge was so irritated with this set of circumstances that he vacated my plea of not guilty and then dismissed the charge--making it appear, from a legal standpoint, that this hell never happened. He made it clear by making a Judicial Order to the attorneys, the Court Reporter, and especially the detective that was involved that this "incident" should not even remotely appear in any records!

Here's what happened on that fateful day. At the time, I was teaching school, and my Principal stopped by my room and asked me to see him before I went home. His mannerisms gave me no indication of brewing trouble. Plus, it was not unusual for an administrator to ask to speak to you.

So, after the students were gone and it was time to leave, I stopped by his office. Things then got weird. He said, "Please shut the door." At that point, I couldn't think of anything I had done--you know...like offending a student by not looking at him or her the right way. Oh, wait. Griping about teaching and dealing with the public is really something for a different forum, I'm sure.

He went on to say something like, "There is a warrant out for your arrest, and you are to turn yourself in at the Sheriff's Office." Now, I may speed now and then, but getting arrested? I asked him if he was serious, and he really was. He didn't know what the charge was, though. He was just delivering the message.

I was completely freaked out for several reasons, but the main one was that I was starting Evening Division Law School the next day. I figured this would ruin everything for sure! (And, I didn't even know what "this" was.) So, I went into a private office and called my parents' attorney because I had no clue. He told me to come to his office before doing anything.

Well, in March of 1996 I went to a walk-in clinic to obtain Fioricet because my regular Internist was in California (I live in Florida) attending a medical convention. Her standing order was to go to this walk-in place if she is not available. I explained the situation to the doctor at the walk-in place, and he Rx'd my Fioricet. Again, this happened in March of 1996. The principal came to me on September 5th of 1996. It takes 6 months for this?

Our county has a set of 3 deputies that have the job of going through pharmacy logs to see who is "doctor shopping". If I had remembered to tell my Internist about going to the walk-in place, I would not have commited this terrible crime! I didn't see her until August (I think), so it never crossed my mind to tell her. It wasn't even in my memory at that point.

I was charged with a 3rd degree Felony: "Obtaining or Attempting To Obtain a Controlled Substance Through Fraud, Deceit, or Subterfuge". My attorney found out what the bond was, and had me purchase it before I turned myself in. When I went in for this enjoyable experience, there were over 20 other people who were arrested for the same exact charge that day. One of them happened to be an extremely respectable man that I used to work for--he was the President of the bank where I worked as a teller. As we all sat there realizing what was really going on, the two desk policeman were extremely unhappy with this detective for causing all of this absurdity. NOW...I'm sure some of these others might have truly been drug-seekers. Who knows? But, I handed the detective my drivers' license, got processed, and left (since I already had by bond). My attorney gave me some of the best advice: "Jon...Shut up."

Just one more time...the judge was really unhappy with this whole concept.

Nonetheless, it is my suggestion to everyone that you make sure you divulge every bit of info to everyone so you don't get in trouble. I came very close to losing my job even though the charges were dismissed, and I didn't "sneak" around. Under a teacher's contract, you can be dismissed because of the "morals clause". I was removed from my classroom for nearly 4 weeks while I was "investigated". Yeah, I'm still waiting for that apology.

My head still spins just thinking about this situation. It's one of those things that happens, and--no matter what you do--you can't stop it. I still have never had a PM contract, but my doctor sure as heck knows about this situation because I do not want it to ever bite me in the rear end. When I told her about it, she laughed and didn't believe me at first. I had to tell her that it was true--and completely humiliating.

Contracts might help some situations; they might harm others. The main thing is to be up-front and honest about all PM issues! Isn't it pathetic? I feel guilty all over again, and I didn't even knowingly do anything wrong. Law School, however, certainly made it clear that ignorance of the law is rarely a mitigating factor! All of this happened because of 30 Fioricet tablets (which aren't even a Scheduled medicine in my state).

Sincerely,
Jon (Conductor)

 
Old 12-16-2006, 08:24 PM   #8
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Re: Pain Contracts, I never signed one?

My experience is different from the previous post. I have been to 2 pain management practices. One in my previous state and one where I am now. IN the between time my internal medicine physican was controlling my pain management. Anyway, I have had to sign contracts with all three of them.

The main thing in the contracts is that you only use 1 pharmacy (if something happens just call them and let them know you can go somewhere else you just have to tell them what happened.)

2. I only see this physican for my pain managment problems, and if its found that I am "doctor shopping" they will release me from their care.

3. They can and will do random urine drug test just to make sure

4. And I think this is one of the biggest things is that you understand that you can not get more meds than ordered if they are "lost, stolen, dropped" ect ect then you are out of luck.

That you understand that nothing will be prescribed after office hours and you agree not to call the staff at their home. (wow I would have NEVER thought of doing this)

and their are a few other statements in there just for liability purposes.

All of them have explained to me that they just do this so that you understand what they expect of you. They make every single person sign them so that they are not accused of profiling or whatever. I have never had a problem with any of the places. And as long as you are open and honest with the doctors then you will not have problems.

Like I was out of town once when It was time for my refill, so I could not use my "regular" pharmacy, I called and explained the situation, and they said ok thanks for notifying us. And that was that.

I personally think they do it to try and "weed out" for lack of a better word the one who are not truely in pain and needed pain management. The one who are just looking for drugs. This way also they have documentation of everything if there ever is an issue with the DEA.

Hope this helps, sorry it got so long winded. If any others are here with contracts are yours similar? all 3 of mine were almost identical. I wonder if it depends on the area you live or state?

happy holiday
Jenn

 
Old 12-16-2006, 10:11 PM   #9
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Re: Pain Contracts, I never signed one?

Hi Jenn,
Yep, yours sounds just like mine, I forgot about the parts where it says if you lose or have your meds stolen or they fall in the toilet or something, too bad, so sad. you have to wait for your next fill. Mine also has the thing about not calling after hours or on weekends. I think they are all pretty much the same, and I feel the same way you do, I don't see it as a big deal, or take it personally. I also have had to use an out of town pharmacy, or fill a day early for a trip, and all I need to do is call and let them know, it has never been a problem for me, and Ive been with her for about 5 years now since she started using the contracts.
I'm all for it, because I feel that doctors need a way to protect their practices, and the alternative might be fewer doctors willing to prescribe for ANYONE.
Jon, I am so sorry you went through that, OMG its like some kafkaesque nightmare, it could have been any of us in that situation. So glad you came through it okay and the record was wiped clean.
Happy Holidays!~Fabby

 
Old 12-16-2006, 11:23 PM   #10
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Re: Pain Contracts, I never signed one?

It is so interesting to me the lost or stolen or dropped in the toilet clause. It seems like everytime I am at my pain docs office I hear the nurse talking to someone about how they are not going to re-write a script and how no they are not going to help. I know they must hear that everyday, because almost everytime I am there I hear it. The Doc always shrugs his head and knowes who the not so honest and more sneaky patients are. I was thinking however, I have never lost or dropped my drugs in the toilet, EVER! But I also though, would if it did really happen. I would imagine that would be the worst day of your life. It would sound so bad calling and saying that, but what if it were true. The contract tells you no re-writes, no new scripts. I really think if I called and told my doc that, he would re-write me, but I think it would only happen once. I feel he would be the kind that would give you that one chance. I really really really think the docs are pretty smart and know who the problem children are. They know. Just like any of us who do a job for many years and have many years of education, they know who's honest and who's not. That is why I am glad I don't have a contract. Incase that one fateful day that it might happen (I don't ever think it will), he would help me that one time. I would suggest never opening your pills near any sink, toilet, black hole, etc.....

Thanks everyone so far for the great input.

Sorry about the arrest situation. Glad you told us. I had never heard of Doc shopping until the Rush L. situation.

I never even knew that there was such a thing, and never even thought of trying it.

California Chris

 
Old 12-17-2006, 04:56 AM   #11
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Re: Pain Contracts, I never signed one?

Hi All-
I do have a contract with my PM doctor. This was preluded by a movie on the prescribing of opioid medications, doctor responisbilities and my responsibilities as a patient. Before my PM doctor showed me the movie, he gave me the contract and told me to follow along with the movie as I review & read the contract. So, not only did I get the contract, but also the 12 minute film that described, in detail, the meaning of each of his rules. I took this as a kind of "re-enforcement" type measure so that no one can say, "Well, I didn't know what this meant."

Dr. P is very clear about his rules and the fact that there is no room for interpretation. It is what it is. I too can use only one pharmacy, but it's my choice of which pharmacy I use. On the scrips, he even writes, "please fill excusively at (name of my pharmacy- Eckerd, & town it's in), however, may fill at any other Eckerd if records are verified prior to filling. So, if my original Eckerd is out of something, or doesn't have enough, I can go to another Eckerd, but they have to communicate with each other to verify that I'm not getting an early fill or anything.

I also have to sign/initial the "opioid/controlled substance" log each time I get a scrip. for any of the narcotics he prescribes for me, and he never writes narcotics with any refills. Also, because I am a patient who is prescribed controlled/narcotic substances, I do have to see him once a month. This part is kind of a drag some days because I actually have to drive from the next state and that makes my pain worse, but I don't really mind and I won't complain about it because I am so thankful to be getting proper management of my pain. I just make sure I have one of those "therma-care" bands for my back and my knee in the car in case I need them on the way home. It's about an hour & 40 minute trip each way when traffic isn't heavy.

Any way, different doctors have different rules. Some use contracts and some don't. I do know that my PM doctor is very clear about his rules, and I kept my copy of the contract so I can refer to it if I need to. I am not about to do anything to jeopardize this opportunity.

Last edited by ozzybug; 12-17-2006 at 05:00 AM.

 
Old 12-17-2006, 05:42 AM   #12
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Re: Pain Contracts, I never signed one?

I would just like to add that those of us with contracts havent done anything wrong, its just that some doctors like that extra protection, It helps us too, we will never be suddenly dropped as a patient and told 'you should have known' not to do something. We do know, and I like having whats expected of me in writing so everyone is on the same page.

I would also think that doctors who chose not to use contracts are probably audited by the DEA more often and with less favorable outcomes.

Hope everyone is having as pain free a day as possible!~Fabby

 
Old 12-17-2006, 06:23 AM   #13
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Re: Pain Contracts, I never signed one?

Using one pharmaciy isn't a huge deal, It's part of my contract too. No it isn't stated which pharamcy to use, I use the one that gave me the best price on every med. Should they run out of something or I need a fill when they are closed on sundays, I can go to any pharamcy, fill the script and am instructed to inform the PM center within 72 hours if I used a different pharamcy. Same thing with an amergency or dentall surgery, I'm not prevented from seeking medical attn for any other problem aside from my back and If I have an emergency I'm not prevented form going tothe ER or excepting a prescription from the treating doc or dentist. I must inform the PM clinic within 72 hours which seems more than reasonable as they should have a complete list of all the meds we are on.

Honestly if someone thinks so litle of their PM doc that they believe they are getting a kick back from forcing patient to use one pharamcy, I wouldn't want to be that docs patient.

Thanks for explaining it so well, Fabby.

Contracts are nothing more than educational tools and an extensive informed consent form. Nobody can say they didn't know because it was covered in the contract.

Take care, Dave

Last edited by Shoreline; 12-17-2006 at 06:38 AM.

 
Old 12-17-2006, 02:01 PM   #14
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Re: Pain Contracts, I never signed one?

I'm glad we don't use contracts here. Even after reading everyone's response to this, and considering all of the great points made, I still respectfully feel that contracts are like treating responsible adult patients like kids.....I mean, I can see if you've violated something before, but to have a catch-all clause for a doctor's entire set of patients, just seems a bit childish. I do see how they can have advantages and whatnot, but I believe in the policy here, with an emphasis on patient responsibility. Just my two cents.

 
Old 12-19-2006, 06:59 AM   #15
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Re: Pain Contracts, I never signed one?

I think we all must understand how much pressure these doctors are under by the DEA they are constantly being monitored and sent lists of people and what substances they use and where they got them. they have to cover there own butts. The law suits are ridiculous also if someone overdoses they dont want a family memeber suing because they didn't cover themselves.

We need to be thankful we have doctors willing to prescribe the medication we need. I have ran across many pm doctors not willing to even deal with heavy narcotics because of fear.
this just protects all of us.
If you follow the rules it is just a piece of paper in your file nothing more.
Everyone is entitled to their own opinion I for one do not mind at all if my doc feels the need for a contract

lisa

 
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