Becoming a Patient

Our team at CareFirst is dedicated to help you in your fight against chronic pain.  If you are a patient who is currently receiving opioid therapy from another physician or a patient being referred for an opioid consultation, a review of your medical records is required before an appointment can be scheduled. 
Talk to a new patient coordinator:       (903) 839-1000 or 800.624.0448

Email:  newpatient@carefirstmed.com

New Patient Forms:

• New Patient Packet (complete)
• Patient Registration Form
• History & Physical Intake Form
• Assignment of Benefits Form
• Records Release Form
• Opioid Pain Management Agreement
• Opioid Risk Tool (ORT)
• SOAPP-R

Referral Forms:

Consultation Request Form

New Patient Acceptance Criteria:

The goal of the CareFirst New Patient Acceptance Criteria is to mitigate risk and to incorporate appropriate patients for CareFirst providers given the complexities of using Chronic Opioid Therapy (COT) for the treatment of moderate to severe non-cancer pain. COT is normally administered when a patient presents with moderate to severe non-cancer pain refractory to non-opioid and non-drug therapy. The patient must have no absolute contraindications to COT, and informed consent along with a signed Pain Management Agreement must be obtained. Contraindications to COT include:

Absolute Contraindications:

• lack of efficacy;
• severe respiratory instability;
• acute psychiatric instability or uncontrolled suicide risk;
• diagnosed non-nicotine substance use disorder (DSM criteria) not in remission and not in treatment;
• true allergy to opioid agents (cannot be resolved by switching agents);
• co-administration of drug capable of inducing life-limiting drug interaction;
• corrected QT interval (QTc) > 500 milliseconds for using methadone;
• prior adequate trials of specific opioids that were discontinued due to intolerance;
• serious adverse effects that cannot be treated;
• active diversion of controlled substances (providing the medication to someone for whom it was not intended);
• illicit drug conviction

Relative Contraindications:

• treated substance use disorder;
• medical condition in which COT may cause harm (e.g., obstructive sleep apnea (OSA) not using CPAP; central sleep apnea; chronic obstructive pulmonary disease (COPD));
• QTc interval 450-500 milliseconds (e.g., increased risk of methadone use);
• paralytic ileus;
• respiratory depression in unmonitored setting;
• risk for suicide or unstable psychiatric disorder;
• complicated pain (e.g., headache not responsive to other pain treatment modalities);
• conditions that may impact adherence to COT (e.g., cognitively impaired, unwillingness or inability to comply with treatment plan, social instability).