This is a form designed to be a pull in component of a standard office form to specifically address the documentation needed for chronic pain management and the development of a narcotic contract. The form records all data in discrete fields and allows for it to be pulled forward with the next use of the form by the click of a radio button. It also promotes the use of a standard problem and directive to indicate chronic pain management with the use of a radio button. Once the form is completed it can auto populate an informed consent letter and narcotic contract for the patient to sign.
Purpose
To standardize documentation of chronic pain management
To facilitate the creation of a narcotic contract
Applicable Age Range
Adult
Special Features
Push to clinical list of pain management diagnosis
Ability to pull forward values
Abilty to see previous values
Ability to auto populate narcotic contract
Sources of Evidence for Clinical Decision Support
There are very limited resources for evidence based approaches to pain management. Most of what exists is expert opinion and guidelines promulgated by groups including the American Pain Society, DEA, State Board of Medicine etc.. The form was specifically created to recognize these recommendations incorporate them within a usable form that would allow retrieval of information.
Notes
This form was developed for use within The Capital Region Health Care system. We make no claims as to its accuracy or clinical content; therefore, testing is suggested prior to implementation within the clinical environment. This form or its clinical decision support is not meant to replace clinical judgement. Verfication of the accuracy of the clinical content and decision support is the sole responsiblity of the user.
*The term "Clinical Kit" is an industry standard amongst Centricity physician office EMR users. It refers to a group of items which can be imported into any Centricity physician office EMR. The zip file contains the pain management encounter form and the corresponding pain management contract patient handout and letter which are generated using the information entered into the encounter form.
Use 'and' or '+' to search for specific terms. Example: 'lung' and 'cancer'. For multiple word searches, enter all keywords. Example 'heart cholesterol'.
