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Mood Swings _1
Need for higher doses to treat pain _2
Impatience with you doctors _3
Overwhelmed _4
Tension in the home _5
Counting remaining pain pills _6
Felt people judged you for pain meds _7
How often do you feel bored? _8
Taken more pain meds than allowed _9
Worried about being left alone? _10
Frequency of craving medication _11
Other's concern over your med use? _12
Friends with drug/alcohol issues? _13
Told you have bad temper? _14

OnPatient Opioid Assessment Medical Form

Pain Management Specialist

There are 10 copies in use.
Published: May 16, 2016, 6:15 p.m.
Doctor: Dr. History Physical
Rating: 0   /

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Sunnyvale, CA 94089

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