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Progress Report – Form C

Submitted by jesse on Mon, 6 Oct 2025 - 11:43
  • Read more about Progress Report – Form C
Document
Form_C_Progress_Report_May_2014.pdf (641.06 KB)
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health care service providers

Form B: Initial Assessment

Submitted by jesse on Mon, 6 Oct 2025 - 11:43
  • Read more about Form B: Initial Assessment
Document
Form_B_Initial_Assessment_May_2014.pdf (637 KB)
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forms
health care service providers

Form A: Intake Report

Submitted by jesse on Mon, 6 Oct 2025 - 11:42
  • Read more about Form A: Intake Report
Document
Form_A_Intake_Report_May_2014_rev.pdf (626.23 KB)
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health care service providers

Medical Cannabinoids - Informed Consent & Agreement

Submitted by jesse on Mon, 6 Oct 2025 - 11:41
  • Read more about Medical Cannabinoids - Informed Consent & Agreement
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Patient Treatment Agreement Sample 2 May 2019.pdf (469.8 KB)
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Patient Treatment Agreement: Medical Cannabis

Submitted by jesse on Mon, 6 Oct 2025 - 11:39
  • Read more about Patient Treatment Agreement: Medical Cannabis

A patient agreement form outlining conditions for the authorized medical use of cannabis, including usage, storage, and compliance responsibilities.

Document
Patient-Treatment-Agreement-Sample.pdf (58.5 KB)
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forms
health care service providers

Informed Consent for the Use of Opioid Medication

Submitted by jesse on Mon, 6 Oct 2025 - 11:39
  • Read more about Informed Consent for the Use of Opioid Medication

A consent and treatment agreement outlining the risks, responsibilities, and safe use of opioid medications for managing chronic pain.

Document
Opioid-Informed-Consent-And-Agreement-Sample.pdf (330.04 KB)
PDF
forms
health care service providers

Opioid Medication Treatment Agreement

Submitted by jesse on Mon, 6 Oct 2025 - 11:38
  • Read more about Opioid Medication Treatment Agreement

A treatment agreement form outlining a patient's responsibilities and conditions for safely using prescribed opioid medications.

Document
Opioid-Treatment-Agreement.pdf (259.83 KB)
PDF
forms
health care service providers

Mandatory Generic Exemption Request

Submitted by jesse on Mon, 6 Oct 2025 - 11:37
  • Read more about Mandatory Generic Exemption Request
Document
WCB MGP fillable Form.pdf (129.26 KB)
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Substance Abuse Assessment Form

Submitted by jesse on Mon, 6 Oct 2025 - 11:36
  • Read more about Substance Abuse Assessment Form
Document
Substance Abuse Assessment - Mar 2017.pdf (44.69 KB)
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NON-OPIOID Special Authorization Request Form

Submitted by jesse on Mon, 6 Oct 2025 - 11:35
  • Read more about NON-OPIOID Special Authorization Request Form

A medication request form for prescribers to submit detailed treatment information to Medavie Blue Cross, with specific instructions for opioid-related requests.

Document
NON-OPIOID Special Authorization Request Fillable Form.pdf (41.36 KB)
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