Pain Management Plan

[checkbox name="variable_1" value="Updated primary provider.|Colorado PDMP was checked and no opioids were prescribed in the last 30 days.|Colorado PDMP was checked and no unknown opioids were prescribed in the last 30 days.|Drug screening performed today."]
Last drug screening: [text name="variable_55" default=" "]

Medications: [checkbox name="variable_2" value="Continue present regimen.|Discussed the risks, side effects, benefits of chronic opioid therapy and opportunity for questions provided.|Medication adjustments:"][text name="variable_1" default=" "]

Continue Non-Pharmacological Therapies:[text name="variable_2" default=" "]

Targets before next visit
Physical (exercise, recreational activities, chores, etc): [text name="variable_3" default=" "]
Relaxation therapy (specify): [text name="variable_4" default=" "]
Social (religious services, maintaining friendships, etc): [text name="variable_5" default=" "]
Family (quality time with family, communication):[text name="variable_6" default=" "]
Vocational (Hobbies, education, fun, etc): [text name="variable_7" default=" "]

Referrals:
[checkbox name="variable_3" value="Clinical Pharmacist (if morphine equiv/day >180)|Social work|Physical Therapy|Occupational Therapy|Behavioral Health|Pain Management Clinic|Addiction Medicine"][text name="variable_95" default=" "]

Opioid Agreement: [checkbox name="variable_4" value="Opioid agreement has been signed by patient/MDPOA.|Opioid Agreement has not been signed by self/MDPOA. Will set up a time to have paperwork signed.|Patient not taking opioids at this time, so no agreement needed."]
Next face to face visit in [checkbox name="variable_6" value="1 week|2 weeks|3 weeks|4 weeks|2 months|3 months|6 months"][text name="variable_8" default=" "]