Printable form/checklist
Description:
Provides a downloadable patient satisfaction form, that can be modified and distributed to patients. The survey assesses satisfaction with the health center and staff.
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Health Resources and Services Administration (HRSA), US Department of Health & Human Services
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This consent form -- reproduced with permission from the Boston Medical Center -- can be used with your pregnant patients who want to continue taking buprenorphine during pregnancy.
Source:
Boston Medical Center (1 vote)
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Description:
This SAMHSA guideline provides information on buprenorphine treatment for nurses and other clinical support staff who assist with buprenorphine induction and maintenance.
Source:
SAMHSA
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Description:
PDF of Commonly Used CPT Codes in Primary Care
Source:
Clinical Tools, Inc.
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- Getting a waiver/setting up your practice
- Screening and diagnosis
- Induction and dosing
- Logistics of buprenorphine treatment
- Insurance and billing issues
- Billing
- CPT
- Drug codes
- HCPCSs
- Induction
- Buprenorphine treatment for heroin addiction
- Printable form/checklist
- Experienced prescriber
- Just became waivered
- Setting up a practice
Description:
The ASI Self-Report Form asks questions about the following topics: your background and employment, your health and family relationships, your legal situation, and your drug and alcohol use.
Source:
Center for Health Care Evaluation (CHCE)
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Description:
This patient consent form (in Word®) explains buprenorphine treatment and warns about the adverse effects of mixing buprenorphine with other medications. The section at the bottom is for the patient and a witness to sign and date, indicating that the patient understands and wishes to receive treatment.
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California Society of Addiction Medicine (CSAM)
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Description:
The new version of the Diagnostic and Statistical Manual (DSM V) is scheduled for publication in May 2013. The following website lists the new proposed criteria for a "Opioid Use Disorder" diagnosis.
Source:
American Psychiatric Association
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Description:
This appendix from TAP 13: Confidentiality of Patient Records for Alcohol and Other Drug Treatment provides sample consent forms for substance abuse patients.
Source:
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Description:
An example of the wording and structure necessary in a consent for release of information form.
Source:
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Description:
This is a basic form that helps physicians keep track of when and what quantity of buprenorphine they dispense.
Source:
American Academy of Addiction Psychiatry (AAAP) (3 votes)
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