Initial patient contact
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:
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 patient questionnaire from the California Society of Addiction Medicine (CSAM) is useful when beginning a new patient on buprenorphine maintenance treatment.
Source:
California Society of Addiction Medicine (CSAM) (3 votes)
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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)
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Description:
This checklist can be used by staff to help answer buprenorphine inquiries.
Source:
American Academy of Addiction Psychiatry (AAAP) (3 votes)
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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)
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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 (2 votes)
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Description:
This flow chart for buprenorphine treatment displays the steps to patient recovery, from initial patient contact or referral, through intake process, induction, day #2, stabilization, maintenance, and tapering.
Source:
Colleen LaBelle, RN/Boston Medical Center (14 votes)
Tags:
- Initial patient contact
- Screening and diagnosis
- Induction and dosing
- Stabilization and maintenance
- Dosing
- Induction
- Intake
- Maintenance
- Screening
- Suboxone
- Tapering
- Induction/first treatment
- Medical assessment/first visit
- Misc. informational materials
- Treatment Algorithm
- Just became waivered
- Setting up a practice
Description:
This checklist provides a list of the forms that must be signed, the information that should be recorded for each patient (including current medications and allergies), and tests and labs that should be drawn during the intake assessment.
Source:
Colleen LaBelle, RN/Boston Medical Center (3 votes)
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