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NIATx: Sample forms
Buprenorphine/naloxone (Suboxone) sample note templates
When you are having moderately severe withdrawal (verge of having diarrhea), then take 1/2 a suboxone under the tongue. IF YOU ARE FEELING BETTER (not worse) in 2-4 hours, then you can take another 1/2. On day 2, take 1 full tablet. In 2-4 hours afterwards, you can take another 1/2 tablet, then another ½ if needed in a few hours.
Suboxone HPI/Follow/Plan - The SOAPnote Project
Aug 29, 2019Follow/up: Patient has been taking sublingual Suboxone[ ] to control symptoms of opioid use disorder. Patient stated that craving is fairly control. No side effect of medication reported including headache, pain, insomnia, nausea, constipation, depression, respiratory depression or anxiety. No withdrawal symptoms reported including sweating, restlessness, joint pain, runny nose, tearing eyesMissing:progress noteMust include:progress note[PDF]
Suboxone/buprenorphine Therapy Progress Report -
Suboxone/buprenorphine Therapy Progress Report . Patient Name: _____ Suboxone dose _____ mg/day Date: _____ Please tell us how you are doing by answering the following questions: Are you having frequent cravings for opioids? YES NO . Are you having problems with pain? YES NO . Are you having constipation? YES NO . Are you having trouble sleeping?[PDF]
PROGRESS NOTE (GIRP FORMAT) Client will identify three triggers of substance use in order to reduce risk of relapse, and will increase control over cravings, as evidenced by using learned coping skills from 0 times per day to 3x per day. He will decrease depressive symptoms by engaging in positive social interactions 1x per week.File Size: 62KBPage Count: 4[PDF]
Clinical Guidelines for the Use of - Beacon Health Options
A Treatment Improvement Protocol Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction TIP 40 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment wwwsa BP Buprenorphine Clinical Guide Reviewed: 4/8/16 SRC, 4/19/16 CMMC[PDF]
Sample Primary Care Clinic Buprenorphine Prescribing
GMC Guidelines for Buprenorphine-Naloxone (Suboxone®) Prescribing Basic Principles • Buprenorphine-naloxone is a partial opioid agonist that is approved for treatment of opioid dependence or severe opioid use disorders (ICD-10 code: F11 or F11). • YOU MUST HAVE A SPECIAL X-license in order to prescribe buprenorphine-naloxone. In[PDF]
Progress Note Samples - American Osteopathic Academy of
Progress Notes – Sample #2 Patient 2 9/3/10 1. Denies heroin or other illicit drug use. Last urine (date) was positive for cocaine, which patient adamantly denies using. 2. Indicates increasing marital discord related to his drug use. 3. Although he agrees that going to a support group is a good idea, he has
Clinical Tools
Funding for this initiative was made possible (in part) by grant no. 1H79TI081968 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S[PDF]
Jun 13, 2011THERAPY PROGRESS REPORT (Adapted from Subjective Opiate Withdrawal Scale) Instructions: - Patient fills out “COMPLETED BY PATIENT” section and brings form to counselor - Counselor fills out and signs “COMPLETED BY COUNSELOR” section and returns form to patient - Patient brings form to physician.[PDF]
Documentation of Substance Use Disorders: Progress Notes
progress notes are important to chart a client’s journey through the various levels of care of their treatment journey. Note writing is an opportunity to reflect on the session, your role and work with the client, and the client’s progress or barriers to progress.
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