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Diagnosis Current/Past placed in Assessment?
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Medications placed in Medications & Allergies?
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Plan
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Discussed Keta guide? - Holistic approach, Ketamine treatment recommendations 3,2,1,1,1
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Discussed Importance of psychiatry, lifestyle med, and counseling? 25/25/50%
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Explained next steps- treatment focused therapy session, infusion specialist consult, and KIT/IMKT
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Follow up meeting? Medication Management? Take over psych care or collaborate?
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Discussed NPO 4hrs, No Driving 12hrs, hold opioids/benzos 6hrs before/after, arrive 15min before appointment
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Discussed Spravato, data, recommendations, benefits/risk, alternative treatments (meds, TMS, ECT)
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Assessment Summary and Recommendations
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In Clinic Treatment Discussion
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Spravato?
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Spravato Treatment Discussion
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First Visit to Clinic?
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1st Visit Discussion
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IV Treatment?
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IV treatment discussion
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IM Treatment?
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IM Treatment Discussion
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SL Treatment?
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SL Treatment Discussion
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Referral For Ketamine or Spravato Treatment?
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PROVIDER REFERRAL FOR TREATMENT
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Spravato order?
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Ketamine Order?
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Order Spravato Treatment for:
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No Contraindications for SPRAVATO treatment
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Spravato Administered under direct supervision of provider for 2 hours.
• • •
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Order for Ketamine Treatment for Psychiatric disorder with rationale
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No Contraindications for IV/IM/SL Ketamine Treatment
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Notes
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RECOMMENDATIONS
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RECOMMENDATIONS
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REFERRAL
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Referrals
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Details if needed
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Now or later?
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LABS
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Lab Work
• • •
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Details if Needed
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Labs required prior to treatment?
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Comments
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