Get Samhsa Otp Mortality Report Form - Aatod

Filling out the SAMHSA OTP Mortality Report Form - Aatod is a vital process for reporting incidents related to patients enrolled in Opioid Treatment Programs. This guide provides step-by-step instructions to assist you in completing the form accurately and efficiently online.

Follow the steps to complete the SAMHSA OTP Mortality Report Form online.

1. Press the ‘Get Form’ button to access the SAMHSA OTP Mortality Report Form and open it in your preferred online editor.
2. In the background information section, enter the patient's unique OTP ID number and Program OTP number (same as SAMHSA ID), followed by their date of birth, sex, ZIP code of residence, date of death, and admission date.
3. Provide the reporter's name, ensuring it is entered clearly as last name followed by first name.
4. In section B, input the date and amount of the last opioid dose dispensed before the patient's death and specify the treatment objective at the time of death. Fill in the last time the patient was dosed at the clinic.
5. Select the opioid used (, , or ) and provide the last dose amount in milligrams.
6. Indicate if this was a split dose and enter the number of take-home doses dispensed at the last visit.
7. In section D, fill in the date of the most recent drug test and note any positive results.
8. For section F, specify whether the cause of death is preliminary or confirmed, and list the underlying cause or mechanisms.
9. Document medical and psychiatric diagnoses in section E using the appropriate ICD-9 codes.
10. In section G, list all known over-the-counter and prescription medications, including their strength, dose/amount, and frequency.
11. Provide a detailed description of the event related to the patient’s death in section H, including relevant factors surrounding the incident.
12. In section I, record any additional relevant medical history such as allergies or preexisting conditions.
13. If known, fill in the medical examiner's or coroner's contact information. Attach any available ME/coroner's report.
14. Once all fields are completed, save your changes. You can then download, print, or share the completed form as needed.

Begin completing your documents online for timely submission.