PCSS-B Training

Below you will find an extensive list of clinical tools that you may find useful.

Patient/Family Information

Sample Buprenorphine Patient Information

Sample Buprenorphine Information for Family Members

Resources For More Information About Buprenorphine

Intake

Sample Intake Questionnaire

Sample Consent for Release of Information

Sample Initial Patient Contact About Buprenorphine

Sample Medical History and PE Form

DSM-IV Criteria for Opioid Dependence

Treatment Agreements

Sample 1 Treatment Agreement

Sample 2 Treatment Agreement

Sample 3 Treatment Agreement

Sample 4 Treatment Agreement

Induction

Clinical Opiate Withdrawal Scale

Modified OOWS Form

Drug Accountability Forms (if dosing in office)

Buprenorphine Stock Drug Accountability Record

Buprenorphine Patient Log

Ongoing Treatment

Progress Note Example

Protocol for Follow-up Appointments

Follow Up Appointments

Billing Information

Notification of Intent

Notification of Intent

TIP

Tip 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs

Tip 40: Clinical Guidelines for the Use of Buprenorphine

Tip 30: Buprenorphine: A Guide for Nurses