Contract
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.
Source:
California Society of Addiction Medicine (CSAM)
Tags:
Description:
The California Society of Addiction Medicine (CSAM) website provides information and materials for buprenorphine treatment providers, including screening tools and sample consent and patient agreement forms, and provides links to other helpful resources.
Source:
California Society of Addiction Medicine (CSAM)
Tags:
- General information - buprenorphine
- Getting a waiver/setting up your practice
- Initial patient contact
- Screening and diagnosis
- Rules, regulations and recordkeeping
- Physician and staff training
- Addiction
- Assessment
- Confidentiality
- Consent
- Contract
- COWS
- Recordkeeping
- Screening
- Training
- Waiver
- Misc. informational materials
- Becoming waivered
- Just became waivered
- Need to refer
- Setting up a practice
Description:
This chapter of the TIP 45 discusses funding, resources, organization and patient contracts in substance abuse treatment.
Source:
Substance Abuse and Mental Health Services Administration (SAMHSA) (3 votes)
Tags:
Description:
Patient contract that can be used to set expectations and guidelines before beginning buprenorphine treatment.
Source:
Substance Abuse and Mental Health Services Administration (SAMHSA) (3 votes)
Tags:
Description:
Patient contract that can be used to set expectations and guidelines before beginning buprenorphine treatment.
Source:
American Academy of Addiction Psychiatry (AAAP) (4 votes)
Tags:
- Initial patient contact
- Managing challenging patients
- Logistics of buprenorphine treatment
- Consent
- Contract
- Patient and physician communication
- What to expect during first treatment
- Physician and patient agreements
- Patient education materials
- Experienced prescriber
- Just became waivered
- Setting up a practice
Description:
This form serves as a sample consent for release of the patient's information (type of information to be specified by the patient and/or doctor).
Source:
American Academy of Addiction Psychiatry (AAAP) (3 votes)
Tags:
Description:
This consent form informs the patient of the limited amount of research and knowledge currently available regarding buprenorphine use during pregnancy, and acknowledges that risks related to such use may exist, but are not yet known.
Source:
Colleen LaBelle, RN/Boston Medical Center (3 votes)
Tags:
