I understand that Suboxone is currently being sold illegally in Tennessee.
I understand that Suboxone which is sold illegally often ends up in the prisons of Tennessee.
I understand that selling Suboxone is a crime.
To receive Suboxone, I understand that I have a responsibility for public safety.
I understand that random film/pill count are used by Jabbok Treatment Center to protect public safety.
I understand that I will not be prescribed Suboxone if:
I understand that Suboxone is a narcotic. All narcotics, including Suboxone, have a set of benefits and set of risks to me. I will work to increase the benefits I receive from Suboxone. I acknowledge that the requirement of Federation of State Medical Boards is that I continue to improve in function in order to continue to receive my Suboxone.
PART I - HISTORY OF PRESENT ILLNESS
What are the principal substances that you currently have difficulty with or use?
PART II - SUBSTANCE HISTORY
PRESCRIPTION PAIN KILLERS:
What did you use, how many per day, and how many to get high?
METHADONE MAINTENANCE TREATMENT:
PART III - MEDICAL HISTORY
Traumatic Brain Injury:
PART IV - PSYCHIATRIC HISTORY
PART V - FAMILY HISTORY
PART VI - SOCIAL HISTORY
Hollingshead Job Categories:
Contact with Criminal Justice:
Employment and Support: