AHA Opioid Toolkit Feedback Form

Thank you for your sharing feedback on the AHA’s Opioid Toolkit. As we review the content, we will follow-up with any additional questions and next steps.

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* 1. Full Name:

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* 2. Email address:

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* 3. Hospital or Organization:

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* 4. Position:

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* 5. Phone Number

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* 6. City

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* 7. Zip Code

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* 8. State

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* 9. Topic

Ensuring clinician education about and oversight of appropriate prescribing practices

Nonopioid pain management

Addressing stigma

Options to identify and address opioid use disorders

Ensuring patient, family and caregiver education about the risks of opioids

Safeguarding prescription opioids against diversion

Working in collaboration with communities

Other – fill in the blank

Question Title

* 10. Let us know how you are using this toolkit.
Do you have stories of challenges or examples of successful approaches to share?
Are there any additional resources you are aware of that should be included?

Question Title

* 1. Full Name:

Question Title

* 2. Email address:

Question Title

* 3. Hospital or Organization:

Question Title

* 4. Position:

Question Title

* 5. Phone Number

Question Title

* 6. City

Question Title

* 7. Zip Code

Question Title

* 8. State

Question Title

* 9. Topic

Question Title

* 10. Let us know how you are using this toolkit.Do you have stories of challenges or examples of successful approaches to share?Are there any additional resources you are aware of that should be included?

* 10. Let us know how you are using this toolkit.
Do you have stories of challenges or examples of successful approaches to share?
Are there any additional resources you are aware of that should be included?