Integrated Opioid and Addiction Care ECHO Case Presentation Form
Please provide as much or as little clinical information as you feel is relevant for case review.
Any requested timeline for review will also help prioritize your case discussion. Some questions need answers urgently, while some cases may simply highlight general management issues that we can all review for future patients.
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What is your name and clinic affiliation?
What is your email address?
Patient Age
Other relevant patient demographics
What is your key question or learning point?
Please help us get to know your patient! What is their medical context (conditions, psychiatric history, etc.)? What is the patient's substance use context (current use, history of use, prior treatment successes or setbacks, patient goals for care/treatment)? What is the patient's social or community context (stressors, supports)?
What is your timeline for a response on this case?
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Thank you!
If you have any questions about this form or case presentation, please contact the Project ECHO Coordinator, Katia Chernyshov (katia.chernyshov@hcmed.org) 
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