Washington Administrative Code
Title 246 - Health, Department of
PROFESSIONAL STANDARDS AND LICENSING
Chapter 246-922 - Podiatric physicians and surgeons
OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT
Section 246-922-715 - Patient evaluation and patient record
Universal Citation: WA Admin Code 246-922-715
Current through Register Vol. 24-24, December 15, 2024
(1) For the purpose of this section, "risk assessment tool" means validated tools or questionnaires appropriate for identifying a patient's level of risk for substance abuse or misuse.
(2) The podiatric physician shall evaluate and document the patient's health history and physical examination in the patient record prior to treating for chronic pain.
(a) History. The patient's health history
must include:
(i) The nature and intensity of
the pain;
(ii) The effect of pain
on physical and psychosocial function;
(iii) Current and past treatments for pain,
including medications and their efficacy;
(iv) Review of any significant
comorbidities;
(v) Any current or
historical substance use disorder;
(vi) Current medications and, as related to
treatment of the pain, the efficacy of medications tried; and
(vii) Medication allergies.
(b) Evaluation. The patient
evaluation prior to opioid prescribing must include:
(i) Appropriate physical
examination;
(ii) Consideration of
the risks and benefits of chronic pain treatment for the patient;
(iii) Medications the patient is taking
including indication(s), type, dosage, quantity prescribed, and, as related to
treatment of pain, efficacy of medications tried;
(iv) Review of the PMP in accordance with the
provisions of WAC 246-922-790;
(v)
Any available diagnostic, therapeutic, and laboratory results;
(vi) Use of a risk assessment tool and
assignment of the patient to a high-, moderate-, or low-risk category. The
podiatric physician should use caution and shall monitor a patient more
frequently when prescribing opioid analgesics to a patient identified as
high-risk;
(vii) Any available
consultations, particularly as related to the patient's pain;
(viii) Pain related diagnosis, including
documentation of the presence of one or more recognized indications for the use
of pain medication;
(ix) Treatment
plan and objectives including:
(A)
Documentation of any medication prescribed;
(B) Biologic specimen testing ordered;
and
(C) Any labs or imaging
ordered.
(x) Written
agreements, also known as a "pain contract," for treatment between the patient
and the practitioner; and
(xi)
Patient counseling concerning risks, benefits, and alternatives to chronic
opioid therapy.
(c) The
health record must be maintained in an accessible manner, readily available for
review, and contain documentation of requirements in this subsection, as well
as all other required components of the patient record, as established in
statute or rule.
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