Opioid Management Established Patient Checklist
| Assessment |
|---|
▢ H&P/ ROS completed by provider |
▢ Patient assessment completed |
| Medication Assessment |
|---|
▢ Current medications reviewed |
▢ PDMP checked |
▢ Checked ofor Opiate, Benzodiazepine, other legal drug cocktails |
| Diagnostics, Alternative Treatments and Medical Necessity |
|---|
▢ What diagnostics have been performed? |
▢ What alternative therapies or treatments have been tried? |
▢ Medical necessity has been established |
| Referral and/or Consultation |
|---|
▢ Consider referral to pain clinic |
▢ Other consult: neuro, psychologic, surgeon, alternative, etc. |
| Set Goals |
|---|
▢ Both functional and reduction of pain |
▢ Reduction of opiate dose |
| Re-Check |
|---|
▢ ABC checklist |
▢ Algorithm for low, med, high risk |
▢ Assess goal progress |
