Patient agreement form: buprenorphine/naloxone take-away doses*This document is available in English as well as in languages other than English. Links to the English and multilingual resources can be accessed further below. To download information click on the selected language. This will take you directly to the resource. The information in brackets gives the format and file size if known. Note that some PDFs can be quite large and may take several minutes to download.
Title: Patient agreement form: buprenorphine/naloxone take-away doses (Links to English resource)
Summary: This agreement form is for patients on buprenorphine/ naloxone to ensure they are fully aware of the structure and responsibilities of receiving buprenorphine/naloxone take-away doses.
Organisation: Department of Health & Human Services
Last reviewed: February 2017
Target audience: General
English resource: Report broken link
Burmese (PDF file)
Chinese (Simplified) (PDF file)
Dinka (PDF file)
Farsi (Persian) (PDF file)
Greek (PDF file)
Italian (PDF file)
Macedonian (PDF file)
Serbian (PDF file)
Spanish (PDF file)
Turkish (PDF file)
Vietnamese (PDF file)
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* Resources on the Health Translations Directory are reviewed regularly. This resource is one that will be reviewed soon.