Hello, I am Dr. Kenneth L. Kirsh of the Pain Treatment Center of the Bluegrass. I am the director of Behavioral Medicine there, located in Lexington, Kentucky. We have a question of, does the treatment agreement need to be reviewed and updated at each visit? Depending on the type of patient population you have, the answer really needs to be it depends. If you are working with very high-risk folks that are known to have either remote histories of drug abuse but you are still treating a true chronic pain issue on top of that, it might be a good idea to review it at each visit. In general, however, this is something that should be reviewed once in a while. It should be something that, if you sign it with a patient, they sign it, you put it in a chart and forget it, we have lost completely the meaning of what an opioid agreement should be. So, somewhere between sign it and forget it and every visit, you will find a happy medium that will work with your clinic in your populations. Certainly, flags arise when you have problematic behavior and you want to bring those out to have a discussion with your patients again, but you do not want to wait until a rainy day or until when something bad has already occurred. So I would say for the majority of clinics, if you use a review of the opioid agreement at least twice a year, it should not slow you down, it should be a good communication tool with your patients, and again I think it keeps everybody on the same page.