OBAT Clinical Tools and Forms | Resources | Grayken Center for ...
Initiation of Brixadi® Extended-Release Injectable Buprenorphine for Opioid Use Disorder Guidance for starting a patient on Brixadi® extended-release injectable buprenorphine for the treatment of opioid use disorder. This is not meant to replace clinical decision-making. Visit webpage Initiation of Naltrexone for … 展开
Brixadi® Dosing Conversion Tables Suggested Brixadi® corresponding dosage for patients transitioning from daily sublingual buprenorphine or monthly Sublocade® treatment to monthly or weekly Brixadi® treatment. Tables show the suggested … 展开
Consent for Release of Information (CFR 42) Consent for Treatment with Disulfiram Consent for Treatment with Injectable Buprenorphine Consent … 展开
Buprenorphine Initiation Note Download file Initial Screening Note Template Download file OBAT Nursing Follow-up Note Example of an OBAT nursing follow-up note used for ongoing assessment of patients engaged in treatment. This template includes … 展开
ESM assessment forms and manuals | Mass.gov
Open DOCX file, 42.1 KB, Youth and Young Adult Intake Form (DOCX) (English, DOCX 42.1 KB)
YES NO Are you currently taking other opioid medications? Examples: Duragesic (fentanyl), Oxycontin (oxycodone), Vicodin (hydrocodone), morphine ONE Program Outcomes Worksheet
When did you begin using an opioid every day? When did you first became dependent, or get sick if you did not use regularly? Have you ever injected opioids or other drugs?
Opioid Dependence Treatment History Dates Type of treatment (methadone, buprenorphine, counseling, residential, other) Where did you get your treatment? Why did you leave …
This Patient Intake Form is designed to guide substance use navigators (SUNs) through conversations with patients and collect information along the way. The tool is meant to be …
decreased opioid tolerance. Provided counseling about the importance of being fully withdrawn from opioids prior to initiating naltrexone to mitigate the risk of precipitated or spontaneous …
Have you been diagnosed with an opioid use disorder, if so which FDA-approved medication did you receive for the treatment of this opioid use disorder in the past 30 days? [CHECK ALL …
CIN Series on Opioid Overuse, Webinar 10 — Controlled Substance Issues Committee: Intake Form (7/28/2017) Author: California Health Care Foundation Subject: Many patients with …
As a participant in buprenorphine treatment for opioid misuse and dependence, I freely and voluntarily agree to accept this treatment contract as follows: 1. I agree to keep and be on time …
