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Provider Portal
Methadone (Lvl 1), Suboxone, and Vivitrol Forms
Methadone (Lvl 1), Suboxone, and Vivitrol Forms
Human Services Block Grant Data / Comparative Effectiveness Research (CER) Tracking
***Fill out a separate form for each type of medication***
Person filling out form - Contact information
First Name
Last Name
Email
Phone
Provider Name
- Select -
ARS of Pennsylvania (Methadone)
Associates in Medical Toxicology (Vivitrol)
Harrisburg Comprehensive Treatment Center (Methadone)
Lebanon Comprehensive Treatment Center (Methadone)
Mechanicsburg Comprehensive Treatment Center (Methadone)
Pennsylvania Psychiatric Institute (Methadone)
Pennsylvania Psychiatric Institute (Vivitrol)
Pennsylvania Psychiatric Institute (Suboxone)
Positive Recovery Solutions
Substance Abuse Services (RASE Project) (Suboxone)
Select Month
- Select -
January
February
March
April
May
June
July
August
September
October
November
December
Select Year
2024
2025
Please Choose the Medication
- Select -
Methadone
Suboxone
Vivitrol
1 - Number of individuals residing in Dauphin County that have been enrolled in this specific medication-assisted treatment program for 90-179 days.
2 - Number of enrolled individuals (from entry made in box #1) that are free from illicit opioid use at each appointment during the first 90 days of his/her treatment as determined by a urine drug screen.
3 - Number of individuals enrolled for greater than 90 days (from entry made in box #1) that are currently enrolled in and actively attending counseling in conjunction with his/her medication-assisted treatment.
4 - Number of individuals residing in Dauphin County that have been enrolled in this specific medication-assisted treatment program for 180-364 days
5 - Number of individuals (from entry made in box #4) that are free from illicit opioid use as determined by a urine drug screen at each appointment from days 91 through 180 of his/her treatment
6 - Number of individuals enrolled for greater than 90 days (from entry made in box #4) that are currently enrolled in and actively attending counseling in conjunction with his/her medication-assisted treatment.
7 - Total number of individuals residing in Dauphin County that have been enrolled in this specific medication-assisted treatment program for greater than 365 days.
8 - Number of individuals (from entry made in box #7) that are free from illicit opioid use as determined by urine drug screens at each appointment from days 365 and ongoing.
9 - Number of individuals enrolled for greater than 365 days (from entry made in box #7) that are currently enrolled in and actively attending counseling in conjunction with his/her medication-assisted treatment.
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