Suboxone Forms For Physicians
Creelman md read keep this form. As a participant in buprenorphine suboxone treatment for opioid use disorder i agree to the following.
With federal statute the drug addiction treatment act of 2000 data 2000 physicians must have completed 8 hours of approved training to qualify for a waiver.
Suboxone forms for physicians. Haven t been prescribed zubsolv or bunavail previously not hep c positive not currently pregnant apply for approval in patient assistance program and meet prescribing doctors approval. This form can be found on the samhsa web site www buprenorphine samhsa gov. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the department of health and human services.
The combination of buprenorphine and naloxone has been used to prepare the suboxone medicines and this combination has mainly three forms buccal film sublingual film and sublingual tablet. I agree not to sell share or give any of my medication to another person. Physicians also must fax their training certificate after completing the waiver form to show that they have completed the required training to prescribe and dispense buprenorphine.
Nor does mention of trade names commercial practices or organizations imply endorsement by the u s. We are always with you for your addiction treatment. Suboxone treatment follow up appointments.
Burlington washington 98233 360 757 0027 360 757 3698. Funding for this initiative was made possible in part by grant no. Suboxone is a brand name drug that contains two ingredients.
Creelman family practice pllc. Here s a link to a suboxone advocacy group. To keep all my scheduled appointments or change the appointment in advance except in case of emergency.
One year after the physician submits the initial notification the physician can submit a second. An oral film and. Buprenorphine suboxone treatment agreement.
The generic version comes in two forms. Beck arnp suboxone materials confirmation. Uf shands pain management service 4037 nw 86 th terrace 3 rd floor phone 352 265 4357 help springhill medical office building gainesville fl 32606 fax 352 265 7053 way buprenorphine clinic intake packet rev 03 2013 university of florida 3 page re ad and retain this form in itial the.
Suboxone is also available in a generic version. How our suboxone treatment program works. The national alliance of advocates for buprenorphine treatment.
The following links take you to the forms needed to be filled out before coming in. Nashville addiction clinic s 95 new beginnings program with free medication for up to a year is for new patients that meet the following criteria. You must also have filed a notification of intent to prescribe to samhsa.
Applying the right dose of medicine is an effective step for curing.
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