WAC 246-918-855. Patient evaluation and patient record — Chronic pain

When the patient enters the chronic pain phase, the patient shall be reevaluated as if presenting with a new disease. The physician assistant shall include in the patient's record: (1) An appropriate history including: (a) The nature and intensity of the pain; (b) The effect of pain on physical and psychosocial function; (c) Current and relevant past treatments for pain, including opioids and other medications and their efficacy; and (d) Review of comorbidities with particular attention to psychiatric and substance use. (2) Appropriate physical examination. (3) Ancillary information and tools to include: (a) Review of the PMP to identify any medications received by the patient in accordance with the provisions of WAC 246-919-985 ; (b) Any pertinent diagnostic, therapeutic, and laboratory results; (c) Pertinent consultations; and (d) Use of a risk assessment tool that is a professionally developed, clinically recommended questionnaire appropriate for characterizing a patient's level of risk for opioid or other substance use disorders to assign the patient to a high-, moderate-, or low-risk category. (4) Assessment. The physician assistant must document medical decision making to include: (a) Pain related diagnosis, including documentation of the presence of one or more recognized indications for the use of pain medication; (b) Consideration of the risks and benefits of chronic opioid treatment for the patient; (c) The observed or reported effect on function or pain control forming the basis to continue prescribing opioids; and (d) Pertinent concerns discovered in the PMP. (5) Treatment plan as provided in WAC 246-918-860 .