MAT Note
Patient is a [text name="variable_1" default="sample text"] yrs. old, [select name="variable_1" value="male|female|other"] who presents today for MAT. Patient started on opioids [text name="variable_1" default="sample text"]ago. Has been using opioids for [text name="variable_1" default="sample text"] years. Patient stated (s)he uses around [text name="variable_1" default="sample text"] per day. Patient [select name="variable_1" value="does|does not|N/A"]admit to using heroin [text name="variable_1" default="sample text"]times. Here with his/her [text name="variable_1" default="sample text"]. Desires to get off opioids because: [textarea name="variable_1" default="sample text"] Patient applied for Medication Assisted Treatment (MAT) and the [clinic] MAT Team reviewed and approved patient for MAT. Patient has agreed to participate in all aspects of treatment plan including follow-up appointments, counseling, group visits, urine drug testing, and other requirements as noted in the treatment protocol and patient agreement. Last opioids [text name="variable_1" default="sample text"] hours ago of [select name="variable_1" value="short-acting|long-acting|unsure"] opioid. Today, patient feels pretty lousy. Anxious, slight abdominal pain. Patient has [select name="variable_1" value="good|limited|unsure"] social supports with family, neighbors, and friends. Specifically, patient will have support from [text name="variable_1" default="sample text"] Opioid Use Disorder Criteria. Mark all that apply to this patient. Include in HPI. Opioids are often taken in larger amounts or over a longer period of time than intended. There is a persistent desire or unsuccessful efforts to cut down or control opioid use. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects. Craving, or a strong desire to use opioids. Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids. Important social, occupational or recreational activities are given up or reduced because of opioid use. Recurrent opioid use in situations in which it is physically hazardous Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids. *Tolerance, as defined by either of the following: o a need for markedly increased amounts of opioids to achieve intoxication or desired effect o markedly diminished effect with continued use of the same amount of an opioid *Withdrawal, as manifested by either of the following: the characteristic opioid withdrawal syndrome, the same (or a closely related) substance are taken to relieve or avoid withdrawal symptoms
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Sandbox Metrics: Structured Data Index 0.31, 13 form elements, 352 boilerplate words, 8 text boxes, 1 text areas, 4 drop downs, 13 total clicks
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