The DSI Agreement can be downloaded here as a printable PDF.

The DIGNITY, SELF-RESPECT and INTEGRITY “Sign On” Agreement.

I ______________________ a legal representative of _____________________________ (the company) hereby declare and confirm that ___________________________________ (He/she/pharmacist) will always, under all working circumstances, be permitted and allowed the following privileges, rights, concessions and dispensations.

He/she/pharmacist will be allowed to take a 30 minute uninterrupted meal/rest period for each 8 hours of work and an additional 15 minute uninterrupted rest period during a 12 hour shift.

He/she/pharmacist will always be managed by a pharmacist. He/she will never be managed by a non-pharmacist.

He/she/pharmacist will be allowed the time to counsel patients on all aspects of their drug therapy according to both the spirit and the letter of the law and in accordance with her/his own personal standards. I recognize that this only enhances the reputation of the company and is the basis of modern patient care.

He/she/pharmacist will never be expected to tolerate abuse from customers, medical professionals, fellow employees or managers.

He/she/pharmacist will receive direct compensation, in addition to his/her wage, for providing specialized professional services. E.g., extemporaneous compounding. MTM. Immunizations.

He/she/pharmacist and representative agree that violation of this agreement is actionable.

This Agreement is signed and executed on this date ______________ at _______________________ (city)

in the state of________________________________

He/she/pharmacist___________________________

Representative______________________________