Copy of Snippet "Therapy Progress Note"

Therapy Progress Note

Suboxone Therapy Progress Note:{formdate: \ MM/DD/YYYY} 
The visit was conducted by telehealth for buprenorphine refill.

I feel anxious{formmenu: default=0; 1; 2; 3; 4; 5}I feel nauseated or like I may need to vomit{formmenu: default=0; 1; 2; 3; 4; 5}
I feel like yawning{formmenu: default=0; 1; 2; 3; 4; 5}I have stomach cramps and/or diarrhea{formmenu: default=0; 1; 2; 3; 4; 5}
I Have a headache{formmenu: default=0; 1; 2; 3; 4; 5}I feel dehydrated and/or have not had much appetite{formmenu: default=0; 1; 2; 3; 4; 5}
I am perspiring{formmenu: default=0; 1; 2; 3; 4; 5}I am having difficulty sleeping{formmenu: default=0; 1; 2; 3; 4; 5}
My muscles twitch{formmenu: default=0; 1; 2; 3; 4; 5}My nose is running and/or my eyes are watery{formmenu: default=0; 1; 2; 3; 4; 5}
My joints hurt{formmenu: default=0; 1; 2; 3; 4; 5}I have goosebumps and/or chills{formmenu: default=0; 1; 2; 3; 4; 5}

I feel like using now {formmenu: default=0; 1; 2; 3; 4; 5}
I would rate my overall level of withdrawal as {formmenu: default=0; 1; 2; 3; 4; 5}

Do you feel like you need a dosage change? {formmenu: default=No; Yes - Go up; Yes - Go down}
Have you used alcohol or drugs since your last visit? {formmenu: Yes; default=No; name=}
If 'yes' please describe what, when, and how much
{formparagraph: name=Confessed usage}

Please describe the problems or situations you found most stressful during the past week.
{formparagraph: name=Stressful situations}

Pharmacy: {formmenu: Walmart Indianola; Martin's; default=Brown's Greenville; Kroger Greenville; Walgreen's Greenville; CVS Greenville; Greenwood Downtown Drug; Kroger Batesville; Kroger Granada; CVS Greenwood; Condon's; Other:\ }{formtext: name=Other pharmacy}
Drug test:
When was your last one? {formmenu: default=Not Done; Today; Yesterday; I'll do it by tomorrow.}
Results: {formmenu: Appropriate; Inappropriate; default=Not done; name=UDS} {formtext: name=If inappropriate, how?}
Where do you do your drug tests? {formmenu: default=IFMG Indianola; Family Medical Clinic, Greenville; Byrd Clinic, Clarksdale; Warrington, Clarksdale; Sharkey CC, Rolling Fork; NSMC, Ruleville; LabCorp; Other:\ ; name=UDS locations} {formtext: name=Other UDS location}

Who is in the area with you?{formmenu: default=None\ ; Family member; Boyfriend/girlfriend; Coworker} We can talk openly.{formtoggle: name=; default=yes}{endformtoggle}
Where are you right now?{formmenu: default=Private location; Home; Work\ ; Car (but not driving).}
Are you using public WiFi?{formmenu: Yes; default=No; }

PMP checked and showed {formmenu: default=no other prescribers or other medications.; another approved provider/medication.; violation(s).}{formtext: name=List any violation?}