CONSENT FOR TREATMENT WITH NALTREXONE Logo
  • CONSENT FOR TREATMENT WITH NALTREXONE

    Oral Naltrexone (Revia) and Extended-Release Injectable Naltrexone (Vivitrol)
  • For patients 18 years of age and older:

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  • Clear
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  • After completion, scan form into patient record and provide a copy to the patient.
  • Should be Empty: