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Patient Signature Doc. NT-1206a Rev. 07/24/14 Date Page 1 of 1 2014 Aegis Treatment Centers LLC. All Rights Reserved.. REPLACEMENT NARCOTIC THERAPY ADMISSION Patient Section Clinic A. Name Identification and Contact Information 1. Legal Name First Name Last Name 2. Date of Birth 3. Gender 5. Social Sec No Middle Name Male Suffix Jr Sr. etc Nickname / Preferred 4. Aliases Female 6. Driver License State Number 7. Home Address City Street Address 8. Home Phone 9. Cell Phone 11. Eye Color 12. Hair Color 14. Referred By Zip Code 10. Email 13. Mother s Maiden Name Friends / Family Internet Search Doctor/Health Care Provider School / College Hospital 15. Race Self Referral Employer / EAP Provider Directory Other Alcohol/Drug Program Other/Community/Legal 12 Step White Alaskan Native Chinese Guamanian Japanese Laotian Vietnamese African American Asian Indian Filipino Hawaiian Korean Samoan Other Asian American Indian Cambodian Mixes Other Race 16. Tattoos Description/Location if multiple list ....

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Fear and avoidance are normal responses to withdrawal experiences and can be an obstacle for people who want to use less or stop using entirely. The FDA has approved three medications for treating OUD: , and .

What is the success rate of MAT? MAT is considered to be highly effective. Studies indicate that MAT can reduce the risk of death from substance abuse by more than 50%.

Medication-assisted treatment (MAT) is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders.

The goal of medication-assisted treatment is to stabilize your body and mind so that you can feel normal during treatment and early addiction recovery. Addiction treatment can be challenging if you don't address the physical dependence of addiction.

Medication-assisted treatment (MAT) is an evidence-based treatment, when combined with counseling and other therapeutic techniques, provides a whole-patient approach.

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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