Medication-Assisted Treatment (MAT) Patient Registration Form

Streamline Your MAT Program Enrollment with Paperform

Managing a medication-assisted treatment (MAT) program for opioid use disorder requires careful documentation, compliance tracking, and patient assessment. This Medication-Assisted Treatment Patient Registration Form is designed specifically for healthcare providers, addiction treatment centers, and behavioral health clinics offering buprenorphine-based treatment programs.

Purpose-Built for MAT Programs

This template captures all essential patient information needed for MAT enrollment, including medical history, substance use assessment, buprenorphine induction readiness, counseling requirements, and take-home dosing eligibility criteria. The form uses conditional logic to adapt questions based on patient responses, ensuring you collect relevant information while maintaining a streamlined experience.

Key Features for Healthcare Providers

The form includes sections for demographic information, insurance verification, medical history screening, withdrawal assessment using Clinical Opiate Withdrawal Scale (COWS) indicators, prior treatment history, current medication review, and comprehensive consent for treatment. It also evaluates patients against take-home dosing criteria including treatment stability, counseling compliance, and risk factors.

Integrate with Your Healthcare Workflow

Paperform integrates seamlessly with healthcare management systems, allowing you to route patient registrations directly into your EHR, schedule follow-up appointments, and trigger automated email confirmations. Use conditional logic to flag high-risk patients for immediate clinical review or route stable patients to standard intake protocols.

For practices managing multiple treatment locations or care teams, Paperform's Agency+ plan lets you maintain separate branded forms while centralizing patient data collection. Combined with Stepper, you can automate post-submission workflows like insurance verification requests, counseling session scheduling, and provider notifications—keeping your entire MAT team coordinated without manual handoffs.

Security and Compliance Considerations

While this form template provides a professional foundation for MAT patient registration, please note that Paperform is not a HIPAA-compliant solution. Healthcare providers subject to HIPAA regulations should ensure they have appropriate Business Associate Agreements and security measures in place, or consider this template for pre-screening and administrative purposes rather than protected health information.

For addiction treatment centers, mental health clinics, and community health organizations looking to modernize their MAT enrollment process, this template offers a professional, efficient starting point that can be customized to match your specific clinical protocols and state regulations.