Setting up a practice

Description: 
Provider's Clinical Support System (PCSS-MAT) is a national training and mentoring project. Offerings include online training modules and webinars, resources, and a mentor program for providers of medication assisted treatment who are getting started or have less experience.
Source: 
PCSS/MAT
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Physician stage in practice: 

Transfer from Methadone Form

Description: 
This form provides a list of important considerations when determining whether a methadone patient is a candidate for transfer to buprenorphine treatment, including social, medical, and psychiatric history.

 

 Request Transfer from Methadone Maintenance to Office-Based Opioid Treatment 
Utilizing Buprenorphine 


Client Name: ______________________________
Date: ______________________________________
Admission Date: ___________________________
ID#: ________________________________________
DOB: _______________________________________

 

Transfer Criteria (please check the appropriate box and fill in as much information as possible):

[] On 30mg or less of Methadone.

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Commonly Used Forms: 
Physician stage in practice: 
Description: 
This web page provides information for the patient on pronunciation, brand names, common uses, how to use, missed doses, precautions, side effects, drug interactions, proper storage, and more.
Source: 
Kaiser Permanente
field_vote: 
Description: 
This web page provides information for the patient on pronunciation, brand names, common uses, how to use, missed doses, precautions, side effects, drug interactions, proper storage, and more.
Source: 
Drugs.com
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Description: 
This handout discusses how a prescribing physician may prepare for a visit from the DEA. Such visits are required by law for physicians prescribing buprenorphine, and involve things such as prescription and dispensing records, and adherence to prescribing limits on number of patients.
Source: 
PCSS
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Physician stage in practice: 
Commonly Used Forms: 
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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Physician stage in practice: 
Resource Type: 

CTI Referral Form for Substance Abuse Treatment

Description: 
Form3used for referral to substance abuse treatment or counseling.

This form is for use by a primary care provider to refer a patient for substance abuse treatment. It could also be used to refer the patient for counseling.

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