Questionnaire

Health Center Patient Satisfaction Survey
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.
Source: 
Health Resources and Services Administration (HRSA), US Department of Health & Human Services
0
Your rating: None
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Self-Administered Addiction Severity Index (ASI-Self Report)
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)
0
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Initial Patient Contact About Buprenorphine Form
Description: 
This checklist can be used by staff to help answer buprenorphine inquiries.
Source: 
American Academy of Addiction Psychiatry (AAAP)
4.333335
Your rating: None Average: 4.3 (3 votes)
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Telephone Screen for Buprenorphine
Description: 
This document provides a form for recording important information about prospective patients, including drug use history, treatment history, criminal history, health information, and more.
Source: 
Colleen LaBelle, RN/Boston Medical Center
5
Your rating: None Average: 5 (2 votes)
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Initial Patient Contact About Buprenorphine Form
Description: 
A form that contains a checklist of requirements, confidentiality, instructions for initial appointment, and an area for patient information.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
3.5
Your rating: None Average: 3.5 (4 votes)
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