Implementation of Substance Use Treatment in Ambulatory Care
Tools and resources actually used to implement substance use in a treatment setting.
Telephone Screen for Buprenorphine
Sample Medical History and Physical Exam Form
Provides a sample for buprenorphine treatment intake history and physical.
Brief Negotiated Interview and Active Referral to Treatment Provider Training Algorithm
Includes a training algorithm that provides a detailed script of how a provider should conduct a brief intervention and referral to treatment, as well as a screening tool for alcohol and other drug use.
Buprenorphine Prior Authorization Form
Initial Patient Contact About Buprenorphine Checklist
Offers a sample checklist for treatment program personnel who answer inquiries about buprenorphine/naloxone treatment.
Protocol for Follow-up Appointments
Lists activities that should be performed during followup appointments and behaviors that should be addressed with the patient.
Addiction Behaviors Checklist (ABC)
Uses a 20-item instrument administered in an interview format to track behaviors characteristic of addiction related to prescription opioid medications in chronic pain populations. The instrument is scored based on participant responses, interviewer observations of displayed behaviors, and information gathered from medical chart review.
Severity of Dependence Scale
Provides a score indicating the severity of dependence on opioids using a 5-item questionnaire.
Nursing Intake Screener
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