Resources

OBAT Clinical Tools and Forms

Clinical Pathway for Medication for Addiction Treatment
(Download file)

Clinic Visit Documentation

Buprenorphine-Naloxone Maintenance Visit Checklist
(Download file)

Checklist Prior to Buprenorphine-Naloxone Induction
(Download file)

Checklist Prior to Naltrexone Induction
(Download file)

Nursing Follow Up for Buprenorphine-Naloxone
(Download file)

Nursing Follow Up for Naltrexone
(Download file)

Nursing Intake Form
(Download file)

Telephone Screening Form
(Download file)

Clinical Tool

Buprenorphine Start Guide for Patients - English
This is a modified version of NIDA's guidance on conducting a buprenorphine community induction that can be given out to patients.
(Download file)

Buprenorphine Start Guide for Patients - Spanish
This is the Spanish translation of a modified version of NIDA's guidance on conducting a buprenorphine community induction that can be given out to patients.
(Download file)

Clinical Statement from BMC Regarding Formulation Change During Pregnancy
This statement, from Project RESPECT within Boston Medical Center, details the evidence-based practice of using the buprenorphine-naloxone films for pregnant women instead of the buprenorphine monotherapy.
(Download file)

Considerations for Medication for Addiction Treatment in HCV+ Patients
(Download file)

Considerations for Medication for Addiction Treatment in Patients with HIV
(Download file)

COWS Scale Opioid Withdrawal Record Induction Form
(Download file)

DSM-5 Checklist of Diagnostic Criteria Opioid Use Disorder
(Download file)

Patient Medication Guide for Injectable Buprenorphine
(Download file)

Patient Medication Guide for Injectable Naltrexone (Vivitrol)
(Download file)

Patient Medication Guide for Injectable Naltrexone (Vivitrol), Spanish Translation
(Download file)

Perioperative Management
This document gives management guidelines for patients maintained on buprenorphine who are scheduled for surgery or other procedures.
(Download file)

Pharmacotherapy for Alcohol Use Disorder
(Download file)

Pharmacotherapy for Opioid Use Disorder
(Download file)

Transfer Guidelines for Methadone to Buprenorphine or Buprenorphine to Naltrexone Transition
(Download file)

Consents and Treatment Agreements

Appointed Pharmacy Consent Form
(Download file)

Consent for Release of Information
(Download file)

Consent for Treatment with Buprenorphine-Naloxone
(Download file)

Consent for Treatment with Buprenorphine-Naloxone in Pregnancy
(Download file)

Consent for Treatment with Disulfiram
(Download file)

Consent for Treatment with Injectable Buprenorphine
(Download file)

Consent for Treatment with Naltrexone
(Download file)

Treatment Agreement for Buprenorphine-Naloxone
(Download file)