|
Treatment Duration
|
Medication
|
|
KASPER reviewed?
|
KASPER comments:
|
|
COWS reviewed?
|
COWS comments:
|
|
Attending Counseling?
|
Confirmations Appropriate?
• • •
|
|
Hepatitis?
• • •
|
HIV?
|
|
Film/Pill count appropriate?
|
Pregnant?
• • •
|
|
Birth Control?
• • •
|
|
|
Progress towards goals?
|
|
|
PHYSICAL EXAM
|
|
|
Opiod Dependency
|
Doing Well
|
|
Continue Present Treatment
|
Ready for taper?
|
|
Plan medication
• • •
|
Dosage & Quantity
|
|
Follow Up in.........
• • •
|
Labs ordered.......
|
|
Other
|
Counseled regarding.......
• • •
|
