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OBOT
OBOT
OBOT
Last Name
*
First Name
*
Yes or no, since the last appointment are you experiencing any of these symptoms:
Sedation
*
Yes
No
Needing extra suboxone or using more suboxone than prescribed
*
Yes
No
Agitation
*
Yes
No
Cravings
*
Yes
No
Anxiety
*
Yes
No
Muscle aches
*
Yes
No
Insomnia
*
Yes
No
Runny nose
*
Yes
No
Sweating
*
Yes
No
Yawning
*
Yes
No
Abdominal cramps
*
Yes
No
Diarrhea
*
Yes
No
Vomiting
*
Yes
No
Constipation
*
Yes
No
Dreams of using drugs
*
Yes
No
Used illegal drugs
*
Yes
No
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