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Department of Psychiatry and Behavioral Sciences

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Project ECHO at Tulane University
Registration Form

Please provide the contact information for the primary site where you expect to provide medication assisted treatment (MAT).
Are you DATA Waived?
Which of the following best describes the primary site where you expect to provide medication assisted treatment (MAT)? (Check all that apply)
Are there behavioral health or care management providers in your practice either full-time or part-time? These can include psychiatrists, social workers, case managers, peer support specialists or other providers.
How many full time equivalents (FTE) of each type of behavioral health provider is in your practice? For instance, if a care manager works in your clinic 2.5 days a week, that would be 0.50 FTE.
Please indicate whether you currently treat patients from any of the following parishes. Check all that apply:
Does your collaborating physician prescribe buprenorphine?



Screening for opioid use disorder may take different forms including urine drug testing, screening questionnaires, or questions about opioid use. Which best describes your practice's approach to screening for opioid use disorder?




Are you currently prescribing naltrexone to any patients with opioid use disorder?


What is the status of your buprenorphine waiver and prescribing?





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