Pain Care Physicians – Testing Protocol with Central Tox
Section 1: Analyzer results
(Any positive will reflex the corresponding confirmation codes)
| Analyte | Positive (Check box if screen is positive) |
|---|---|
| Amphetamine (CMETH) | |
| Barbiturates (CBARB) | |
| Benzodiazepines (CBENZO) | |
| THC (CTHC) | |
| Cocaine (CCOC) | |
| Opiates (COPI) | |
| Methadone (CMTD) | |
| Oxycodone (COXYC) | |
| Buprenorphine (CBUP) | |
| Ethanol (CETG) |
Section 2: Reflex Medications
(Any of these medications will reflex COPI, COXYC, CBUP, CFENT, CMEP, CTAP, and CTRAM)
| Medications | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Buprenorphine (Butrans,Suboxone,Subutex) | |||||||||||
| Fentanyl (Actiq, Duragesic, Fentora, Lazanda) | |||||||||||
| Meperidine (Demerol) | |||||||||||
| Tapentadol (Nucynta) | |||||||||||
| Tramadol (Ryzolt, Ultram) | |||||||||||
| Codeine (Tylenol #3, Tylenol #4) | |||||||||||
| Morphine (Avinza, Embeda, Kadian, MS Contin, MSIR) | |||||||||||
| Hydrocodone (Lorcet, Lortab, Norco, Vicodin, Vicoprofen) | |||||||||||
| Hydromorphone (Dilaudid, Exalgo) | |||||||||||
| Oxycodone (Oxy IR, OxyContin, Percocet, Roxicodone) | |||||||||||
| Oxymorphone (Opana ER, Opana IR) | |||||||||||
Section 3: High Risk Profile
This section is if the patient is deemed “High Risk” and will auto reflex all of the high risk confirmations in addition to any test reflexed above.
Confirmations included in the high risk panel are: – ETG – Bath Salts – Buprenorphine – Soma (Muscle Relaxants) – Cocaine – Fentanyl
– Opiates (6AM, Codeine, Morphine, Hydrocodone, Hydromorphone, Norhydromorphone) – Ketamine – MDMA – Meperidine – Methadone – Methylphenidate
– PCP – Synthetic Cannabinoids – THC – Tapentadol
Is this a high risk patient?