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  • Opioid Attestation Form

Get Opioid Attestation Form

Chronic Opioid Attestation Form 13835A must be submitted to initiate prior authorization. See the following page for instructions to submit your request. For more information go to: https://www.hca.wa.gov/billersproviders/programsandservices/opioids PatientDate.

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Like the 2016 guideline, the 2022 guideline recommends that when opioids are needed for acute pain, they should be prescribed at the lowest effective dose and for no longer than the expected duration of pain severe enough to warrant opioids.

For this reason, we recommend Five A's of assessment: Analgesia, Activity, Adverse reactions, Aberrant behavior and Affect. Every person for whom opioids are prescribed has the potential to abuse their medication (Webster & Dove, 2007).

The 4 A's—analgesia, activities of daily living, adverse events, and aberrant drug-taking behaviors—can structure assessment and serve as a means by which to record patient response to therapy.

The ABC acronym (Antiemetic, Breakthrough analgesia and Constipation) is a useful tool for guiding this conversation. Laxatives should be routinely prescribed when commencing opioids (including codeine), either regularly or "as needed".

The Opioid Compliance Checklist (OCC) is a self-report measure for chronic pain patients prescribed long-term opioid therapy. The original measure includes 'yes' or 'no' items that reflect the content of a typical opioid therapy agreement.

The most commonly prescribed opioids include the following: (®) (®, ®) (®) (®, ®) Codeine. . . .

Opioids are not the most effective treatment for long-term, non-cancer pain. In fact, opioids are no longer recommended for the treatment of most patients with chronic pain. If prescription opioids are used, you will be given information on possible side effects, other risks, and monitoring needed for your safety.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232