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Washington Chronic Opioid Request Form

Washington Chronic Opioid Request Form

Name: Washington Chronic Opioid Request Form
Brand: US Legal Forms
Price: 59.00 USD
Rating: 4.58 (214 reviews)

Category:

Washington Workers Compensation - Official - Claims

State:

Washington

Control #:

WA-SKU-3079

Format:

Instant download

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Description

Chronic Opioid Request Form The Washington Chronic Opioid Request Form (CORE) is an online process that allows healthcare providers to request authorization for the use of opioids for the treatment of chronic pain in the state of Washington. CORE is designed to help healthcare providers better manage the safe and effective prescribing of opioids for patients with chronic pain. There are two types of CORE requests: Short-Term and Long-Term. The Short-Term request is intended for prescriptions of less than three months, while the Long-Term request is intended for prescriptions of more than three months. Both requests require healthcare providers to provide detailed medical information about the patient, including diagnosis, treatment plan, and the amount and type of opioid requested. Additionally, healthcare providers must meet specific clinical criteria and document the use of non-opioid therapies as part of the patient's treatment plan. CORE requests are reviewed by the Washington Prescription Drug Monitoring Program (PUMP), which makes the final determination on whether the request is approved or denied.

The Washington Chronic Opioid Request Form (CORE) is an online process that allows healthcare providers to request authorization for the use of opioids for the treatment of chronic pain in the state of Washington. CORE is designed to help healthcare providers better manage the safe and effective prescribing of opioids for patients with chronic pain. There are two types of CORE requests: Short-Term and Long-Term. The Short-Term request is intended for prescriptions of less than three months, while the Long-Term request is intended for prescriptions of more than three months. Both requests require healthcare providers to provide detailed medical information about the patient, including diagnosis, treatment plan, and the amount and type of opioid requested. Additionally, healthcare providers must meet specific clinical criteria and document the use of non-opioid therapies as part of the patient's treatment plan. CORE requests are reviewed by the Washington Prescription Drug Monitoring Program (PUMP), which makes the final determination on whether the request is approved or denied.

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FAQ

(A) Prior to treating, or continuing to treat subacute or chronic pain with an opioid analgesic, the physician shall first consider and document non-medication and non-opioid treatment options.

3. Max Quantity Limits: Limit the quantity of opioids prescribed to 90 MME/day. Prescribers may request a PA for higher doses up to 200 MME/day. Note: MME refers to morphine milligram equivalent.

1. No more than seven days of opiates can be prescribed for adults; 2. No more than five days of opiates can be prescribed for minors; 3. The total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day; 4.

All written prescriptions must be manually signed on the day issued by the prescriber in the same manner as the prescriber would sign a check or legal document. Indicate the appropriate and explicit directions for use. Specify the number of times or the period of time for which the prescription may be refilled.

The limits are: No more than 18 doses (approximately a 3-day supply) for patients age 20 or younger. No more than 42 doses (approximately a 7-day supply) for patients age 21 or older.

Opioids, such as fentanyl, oxycodone, and morphine, are often needed to manage the pain caused by a major surgery, such as a knee replacement, or a traumatic injury, such as a serious burn or broken bone.

Doctors prescribe opioids ? like hydrocodone, oxycodone, and morphine ? to treat moderate to severe pain. Opioids are often prescribed following a surgery or injury or for certain health conditions. These medications carry serious risks of addiction and overdose, especially with prolonged use.

The Ohio Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-Terminal Pain use 80 mg morphine equivalency dosing (MED) as a ?trigger threshold,? as the odds of an overdose are higher above that dose.

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Complete all sections of the form. • Submit the form at least 2 weeks before coverage ends to avoid abrupt stoppage in coverage.Fax this form to: 1-866-434-5523. Phone: 1-866-434-5524. The info requested in this form, although extensive, is based on best practice standards and the CDC Chronic Pain Opioid Guidelines. This form is required when patients begin chronic use of opioid, when daily opioid doses exceed 120 MME, or when both occur. It must be legible, correct, and complete or form will be returned. Exception Request and Record of Justification (SMA-168) Form . Chronic – New requirements for ALL opioid prescriptions. To submit a request once an opioid prescription and attestation has been received: Bill the opioid prescription first.

Washington Chronic Opioid Request Form

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