MAT updated f/u

Today's visit was completed [select name="LOCATION" value="In office|via telehealth. Patient and/or Guardian has verified being in the state of Kentucky and has given verbal consent to be treated via telehealth consultation. Today's visit is being completed via; telehealth. Patient and/or Guardian provided full consent to use this technology. Patient and/or guardian was advised of the limitations of a telehealth visit. Provider completed this visit within his/her office. Patient's location during this visit- Home.|via phone. Patient and/or Guardian has verified being in the state of Kentucky and has given verbal consent to be treated via telephone consultation. Today's visit is being completed via; telephone due to limited access to reliable internet connection/access to reliable video platform. Patient and/or Guardian provided full consent to use this technology. Patient and/or guardian was advised of the limitations of a phone visit. Provider completed this visit within his/her office. Patient's location during this visit- |"] [checkbox name="locale" value="home|work on break in private area"] 
[text name="NAME"] has been taking [checkbox name="type" value="sublingual|IM|Sub-Q"]  [checkbox name="DRUG" value="Buprenorphine|buprenorphine/naloxone"] [checkbox name="dose" value="16/4 mg qd|12/3 mg qd|8/2 mg qd|4/1 mg qd |5.7/1.4 mg 2 tabs qd|5.7/1.4 mg qd|8.6/2.1 mg qd|2.9/0.71 mg qd|300 mg IM monthly|100 mg IM monthly|8 mg sub-q weekly|16 mg sub-q weekly|24 mg sub-q weekly|32 mg sub-q weekly|64 mg sub-q monthly|96 mg sub-q monthly|128 mg sub-q monthly "] to control symptoms of opioid use disorder. Seen weekly, as directed by medical director, to perform safety check and evaluate relapse risk while participting in audio only appointments. Denies side effects of medications, symptoms of withdrawal and denies opioid sedation with current dosing. Encouraged to continue participation in OUD counseling. Discussed the importance of counseling and behavioral health care, as necessary, while participating in MAT. Reports understanding and willingness to continue participating in treatment. Reports compliance with current medication regimen. Denies misuse of buprenorphine, selling, or involvement in any criminal activities. No evidence of diversion. [select name="taper" value="Does not wish to reduce medication at this time due to fear of relapse/fears sobriety from illicit opioid use is not sustainable without continuation of current dose.|Would like to discuss reduction of medication at this time, feels ready to try reduced dose."] [text name="tapering"]    
Patient denies signs of liver failure, including jaundice, abdominal pain/pain focused in the upper right quadrant, abdominal swelling, excessive vomiting, disorientation or confusion. If client develops these symptoms agrees to contact 911/go to E.R. Naloxone education and training provided to decrease overdose risk and encouraged to keep naloxone on hand. Advised to monitor naloxone expiration date and notify if refill needed. Client cooperative, engaged and participated appropriately during conversation. Denies any suicidal or homicidal thoughts. Support and encouragement provided. [textarea name="addinfo"]  
Illicit substances used since last visit per patient report:   [text name="used"] 
Most recent UA completed on:   [text name="UDS"] 
[select name="crave" value="Endorses|Denies"] Opiate  cravings.
[select name="relapse" value="Endorses|Denies"] Opiate relapses.
Compliance with OUD therapy? [select name="therapy" value="yes|no. Missed most recent therapy appointment. Was provided date and time of upcoming therapy appointment."] 

Females of childbearing age:
[checkbox name="repo" value="N/A|Tubal|Hysterectomy|Post Menopause|Depo/oral contraceptive|Risk Counseling- Patient denies recent positive pregnancy test. Patient advised of the importance of contraception during MAT treatment.  Patient agrees to report any positive test to the clinic immediately. Patient advised the risks of buprenorphine treatment during pregnancy and indicated understanding and is willing to continue with treatment."]

Pregnant Women Prescribed buprenorphine:
[checkbox value="N/A|Neonatal abstinence syndrome discussed with patient during today’s visit.  Neonatal abstinence syndrome may occur in a newborn who was exposed to medications or drugs in utero. Babies of mothers who drink alcohol during pregnancy may have a similar condition. Infants prenatally exposed to opioids may experience hyperactivity of the central and autonomic nervous systems. May have symptoms affecting the gastrointestinal tract and respiratory system. Signs of withdrawal from opioids may begin at any time, from minutes to hours to 2 weeks after birth, most appear within 72 hours. Neonatal abstinence syndrome may require management with opioid agonist medication in tapering dosages for approximately half of opioid-exposed infants. Often may require extended hospital stay and/or supportive care.|Patient advised there are several steps to protect her and the fetus. If smoking, may enroll in tobacco cessation programs. If abusing alcohol, opioids, or other substances should participate in treatment programs as appropriate. Encouraged to maintain healthy weight and take prenatal vitamins as recommended by OBGYN. Encouraged to enroll in parenting classes. Patient advised that reducing dose of buprenorphine during pregnancy does not reduce risk of NAS expression or severity. Discussed importance of and compliance with OB/GYN appointments. Discussed with patient need for provider to consult with OB/GYN during her pregnancy. Patient declines consult with OB/GYN at this time due to fear of OB/GYN recommending decreased dose/discontinuation of OUD treatment. Provided reassurance; however, still declines but agrees to a records request.   "]

REVIEW OF SYSTEMS: Denies weight change, fatigue, weakness, fever, chills, night sweats. Skin: Denies rashes, bruising, lacerations.No bruises and no ulceration. The patient denies headache, nausea, vomiting, visual changes. Eye, ears, nose, sinuses, mouth, throat and neck: No complaints. Respiratory: Denies shortness of breath, wheeze, cough, and hemoptysis. Cardiac: Denies chest pain or palpitation. Gastrointestinal: The patient has normal appetite. Denies nausea, vomiting, dysphagia, abdominal pain, constipation or diarrhea. Urinary: Has normal urination. Musculoskeletal: Denies muscle weakness. No pain or joint stiffness. The patient has full range of motion of the upper and lower extremities. Psychiatric:Denies SI/HI.Denies depression and anxiety. Denies delusions, paranoia, hallucinations.  

MENTAL STATUS EXAM: 
[checkbox value="Client is alert and oriented to person, place, time, orientation. Client engages and cooperative. Appearance clean, appropriately dressed. Psychomotor activity appears normal. Speech is spontaneous, normal reaction time, rate, appropriate volume, and no problems expressing self. Appropriate eye contact. Client expresses mood is euthymic. Affect congruent. Thoughts logical, coherent and goal directed. Client denies delusions, paranoia and hallucinations Memory reports as good and appears intact. Understands questions and responds appropriately. Concentration appropriate. Denies SI/HI, self-injurious thoughts. Insight and judgment remain stable.|Client is alert and oriented to person, place, time, situation. Client engages appropriately in conversation and is cooperative. Unable to assess eye contact, affect, appearance and psychomotor activity due to audio only. Speech is spontaneous, normal reaction time, rate, appropriate volume, and no problems expressing self. Client expresses mood is euthymic. Thoughts logical, coherent and goal directed. Client denies delusions, paranoia and hallucinations Memory reports as good and appears intact. Understands questions and responds appropriately. Concentration appropriate. Denies SI/HI, self-injurious thoughts. Insight and judgment good."]

[checkbox name="PhysicalExam" value="PHYSICAL EXAM: Awake, alert and oriented. No acute distress. Well developed, hydrated and nourished. Appears stated age. Head: The head is normocephalic without visible masses, depressions, or scarring. Extremities: Upper and lower extremities are atraumatic in appearance without deformity. Gait steady. Neurological: The patient is awake, alert and oriented to person, place, and time with normal speech. Motor function is normal. Memory is normal and thought process is intact. No gait abnormalities are appreciated. Psychiatric: Appropriate mood and affect. No visual or auditory hallucinations. No suicidal or homicidal ideation."]
[checkbox name="PHYSICAL" value="A physical exam was not completed during today's visit due to constraints of audio only appointment."]