Mat Medication Consent Form

You should adapt this policy to fit your practice s needs for office based treatment of opioid use disorder policy 1.

Mat medication consent form. If the physician determines that the person is a good fit for mat he or she will prescribe the appropriate medication once the person begins to experience mild withdrawal symptoms. During this process the person will receive a complete physical education about the mat procedure and a consent to treatment form. Parent may omit 16 and 17 for over the counter medications sunscreen topically applied insect repellent. One form must be completed for each medication.

Multiple medications cannot be listed on one consent form. Medication administration training mat participant materials rev apr 2019 page 3 medication administration training mat overview handout 1 2 giving medication in a child care program the following are not considered medication and may be given with the written permission of the parent. Sg lg samedica tion consent20100122 commonwealth of massachusetts department of early education and care medication consent form 606 cmr 7 11 2 b. One form must be completed for each medication.

Parent must complete 1 17 and 19 22 for medication to be administered 10 working days or less. Parents must complete 1 through 23 omit 18 for medication to be administered 10 days or less or for non prescription topical medication including sunscreen diaper ointment or insect repellent. Patient consent form purpose this is an example.