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MM - After Hours and Weekend Resources

1258 High Street, Eugene, OR 97401

Phone 541-342-8437 | Fax 541-242-2999

Medication Management:

After Hours and Weekend Resources

Name: Date of Birth:

For NON-EMERGENCY medication concerns that cannot wait until my next appointment, I can call the office at 541-242-2900 and leave a voicemail message. I will get a return call on the next business day.

For EMERGENCY medication concerns, I can call 911 or go to the nearest emergency room.

If I am uncertain whether my concern is an emergency, I can call the 24-hour NURSE TRIAGE LINE provided by my insurance. I can find this number on my insurance card or on their website.

If I am experiencing a mental health crisis, I can see the resource list on the website at c-f-d.org or call the White Bird Crisis Line at 541-687-4000. I can also review any crisis or safety plan I have made with my therapist.

REFILLS are only provided during business hours. If I run out of medication over a weekend, I may be able to request a 1-to-2-day emergency supply from my pharmacy. I can call the medication management office on the next business day.

If I have questions about my medication treatment plan, I can review the most recent PATIENT VISIT SUMMARY, sent to my email or postal address after my last appointment. I can call the office on the next business day if I need further clarification.

Staff will obtain a signed acknowledgement of this policy at the initiation of treatment and will review each time consent to treatment is obtained.

Providers will include these instructions in each patient visit summary and provide them to me following my visits.

My signature affirms that I have read and understand this form and have had the opportunity to ask questions.

This document is being signed by: ClientPersonal Representative, see below

If you are signing as the Personal Representative, please complete the following section; otherwise, proceed to signing the form.

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Relationship to client:

Definition of Personal Representative:
For Adults: A person with legal authority to make healthcare decisions on behalf of the adult. Supporting documentation required.
For Youth: A parent, guardian, or other person acting in the place of a parent with legal authority to make healthcare decisions on behalf of the minor child. Supporting documentation may be required.

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January 29, 2024 3:00 pm PDT

MM - After Hours and Weekend Resources Uploaded by Do Not Reply - donotreply@c-f-d.org IP 192.111.94.3

January 29, 2024 3:04 pm PDT

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