A table titled "ORT (Opioid Risk Tool)". It appears to be a form to help health care providers assess whether a patient is at risk for opioid misuse. The risk factors are: 1. Family History of Substance Abuse (alcohol illegal drugs and other); 2. Personal History of Substance Abuse (alcohol illegal drugs and other); 3. Age (if between 16-45); 4. History of preadolescent sexual abuse; and 5. Psychological disease (ADD OCD Bipolar Schizophrenia Depression).
For each of these risk factors a patient is assigned 0-5 points based on which criteria they meet and whether they are female or male. There is a guide in how to assess the point values: "Low (0-3) Moderate (4-7) High (8+)". There is a citation at the bottom of the page: "Webster LR Webster RM Pain Medicine 2005".
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