Click an appendix title below to view the material:
| Appendix 1: | Consent for Release of Confidential Information |
| Appendix 2: | Treatment Information Sheet |
| Appendix 3A: | Ten Factor Office-Based Criteria Check List |
| Appendix 3B: | Guidelines for Assessing Appropriateness for Office-Based Therapy |
| Appendix 4: | Buprenorphine Treatment Agreement/Contract |
| Appendix 5: | Treatment of Opioid Dependence During Pregnancy Demographic Sheet |
| Appendix 6: | Opioid-Agonist Therapy During Pregnancy Medication Provider Checklist |
| Appendix 7: | Clinical Institute Narcotic Assessment (CINA) Scale for Withdrawal Symptoms |
| Appendix 8: | Clinical Opiate Withdrawal Scale (COWS) |
| Appendix 9: | Medication Provider Visit Flow Sheet |
| Appendix 10: | Community-Based Nursing/Social Services Checklist |
| Appendix 11: | Communication Tool Fax Form |
| Appendix 12: | Medicaid Family Planning “BE SMART” Program |
