Clinic Toolkit for Methadone Providers - Patient Information and Treatment Agreements

Patient INFORMATION—Avoiding Methadone Overdose

Origin: CPSO | Format: PDF

This handout uses a simple question-and-answer format to provide clients with information that can help them avoid overdose during the first two weeks of treatment, when the risk is highest.

 

Client Agreement for Methadone Treatment

Origin: Dr. Michael Lester and Dr. Lisa Lefebvre, CAMH

Format: Word

This form is designed for patients to sign prior to beginning MMT. It outlines the conditions under which patients are typically admitted to this treatment and the rules they are generally required to adhere to. Users may wish to adapt it, in particular the section “Behaviour in This Clinic,” to reflect their own specific circumstances.

 

Client Agreement for Buprenorphine Treatment

Origin: Dr. Michael Lester and  Dr. Lisa Lefebvre, CAMH

Format: Word

This form is similar to the Client Agreement for Methadone Treatment, but is designed for patients to sign prior to beginning buprenorphine maintenance treatment. It outlines the conditions under which patients are typically admitted to this treatment and the rules they are generally required to adhere to. Users may wish to adapt it, in particular the section “Behaviour in This Clinic,” to reflect their own specific circumstances.

 

Sample Methadone Maintenance Treatment Pharmacist-Client Agreement

Format: PDF

This form is designed for patients to sign prior to beginning MMT in a pharmacy. It outlines both client’s and pharmacist’s expectation during methadone maintenance treatment. Pharmacists may wish to adapt it reflect their own specific practice environment.

 

Buprenorphine Maintenance Treatment Pharmacist-Client Agreement

Format: PDF

This form is similar to the Pharmacist - Client Agreement for Methadone Treatment, but is designed for patients to sign prior to beginning buprenorphine maintenance treatment in a pharmacy. It outlines both client’s and pharmacist’s expectation during buprenorphine maintenance therapy. Pharmacists may wish to adapt it to reflect their own specific practice environment.

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