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  • Opioid Risk Assessment Template

Get Opioid Risk Assessment Template

Opioid Overdose . Risk Assessment Checklist. Patient name: Date: Opioid medication/dosage: Use this checklist to help assess whether your patient .

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How to fill out the Opioid Risk Assessment Template online

The Opioid Risk Assessment Template is an essential tool for evaluating a patient's risk of opioid-induced respiratory depression. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the assessment online.

  1. Click ‘Get Form’ button to obtain the Opioid Risk Assessment Template and open it in the editor.
  2. Begin by entering the patient's name and the date of the assessment in the designated fields at the top of the form.
  3. In the section for opioid medication/dosage, enter the specific medication name and the prescribed dosage clearly.
  4. Review the checklist provided on the form. For each applicable risk factor that pertains to the patient, check the corresponding box. Consider the patient's history of substance abuse, potential for accidental exposure, prescribed dosage, current health conditions, and any medications they may be using.
  5. After completing the checklist, review all entries for accuracy to ensure that the information reflects the patient's current situation.
  6. Once you have filled out all necessary fields, you may choose to save your changes, download a copy of the form, print it, or share it with relevant parties.

Complete the Opioid Risk Assessment Template online today for effective patient management.

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The Screener and Opioid Assessment for Patients with Pain- Revised (SOAPP®-R) is a tool for clinicians to help determine how much monitoring a patient on long-term opioid therapy might require. This is an updated and revised version of SOAPP V. 1 released in 2003.

A score of 2 or lower indicates low risk for future opioid use disorder; a score of >/= 3 indicates high risk for opioid use disorder. Cheatle M, Compton P, Dhingra L, Wasser T, O'Brien. Development of the Revised Opioid Risk Tool to Predict Opioid Use Disorder in Patients with Chronic Non-Malignant Pain.

The DIRE is a clinician-rated instrument designed for use by primary care physicians to predict the efficacy of analgesia and adherence with long-term opioid therapy. The DIRE score can range from 7 to 21, with a score of 13 or below suggesting that a patient is not a suitable candidate for long-term opioid therapy.

This tool should be administered to patients upon an initial visit prior to beginning or continuing opioid therapy for pain management. A score of 2 or lower indicates low risk for future opioid use disorder; a score of >/= 3 indicates high risk for opioid use disorder.

The Screener and Opioid Assessment for Patients with Pain (SOAPP)® is a tool for clinicians to help determine how much monitoring a patient on long-term opioid therapy might require.

The Screener and Opioid Assessment for Patients with Pain (SOAPP)® Version 1.0 is a tool for clinicians to help determine how much monitoring a patient on long-term opioid therapy might require.

The DIRE Score is a clinician rating designed for the primary care physician. It is used to predict efficacy of analgesia and patient compliance with long-term opioid analgesic treatment.

Current Opioid Misuse Measure (COMM®) Total score can range from 0–68. A score of ≥9 is suggestive of current ADRB with 77% sensitivity and 66% specificity. The COMM is one of the most commonly used tools for patients on long-term opioid therapy and has been validated by high quality studies.

It is meant to supplement other risk assessments or to diagnose a substance use disorder. It is not meant to predict abuse or addiction but to provide the clinician a sense of the probability the patient will display aberrant drug related behavior within a year if prescribed an opioid.

The DIRE is a clinician-rated instrument designed for use by primary care physicians to predict the efficacy of analgesia and adherence with long-term opioid therapy. The DIRE score can range from 7 to 21, with a score of 13 or below suggesting that a patient is not a suitable candidate for long-term opioid therapy.

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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
Help Portal
Legal Resources
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