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Medication Changes:
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Med Change Comments
|
|
New Medication Rationale
• • •
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Continue Medication Rationale
• • •
|
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Taper Medication Rationale
• • •
|
|
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Venous Puncture
|
|
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Labs
• • •
|
Lab Comments
|
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Lithium Labs
|
Clozapine Labs
|
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Labs for anticonvulsants
|
Routine labs
|
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SGA Labs
|
MTL Molecular Testing
|
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Spravato Paperwork
|
Ketamine Assessment
|
|
Referrals
• • •
|
Referral Comments
|
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Follow-Up
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Release of information
|
|
Read
• • •
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General Instructions
• • •
|
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Education
• • •
|
Education Comments
|
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Diet
• • •
|
Diet comments
|
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GOALS:
|
|
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Standard Time Statement:
|
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Total Time with Patient in Minutes:
|
|
|
SBIRT TIME-Only charge if Positive
|
|
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Individual Therapy Time:
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