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MAT Pre-group and Pre-visit check-in
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MAT Pre-group and Pre-visit check-in
MAT Pre-group and Pre-visit check-in
Traci Stortz
2020-10-06T13:34:50-08:00
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Name
*
First
Last
Date
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Email
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Buprenorphine Symptoms: Cravings
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Buprenorphine Symptoms: Side Effects
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Buprenorphine Symptoms: Pain
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(Zero = Low 10 = High)
Buprenorphine Symptoms: Constipation
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(Zero = Low 10 = High)
Buprenorphine Symptoms: Depression
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(Zero = Low 10 = High)
Buprenorphine Symptoms: Anxiety
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(Zero = Low 10 = High)
Sleep:
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Triggers I encountered this week:
What I did for my recovery this week:
Other Concerns:
Time Constraints for group today:
Need to see the Dr. individually:
Yes
No
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