Attestation Questions

1. Name

2. Do you hold a board certification in addition psychiatry or addiction medication from one of the following associations: American Board of Medical Specialists, American Board of Addition Medicine, American Osteopathic Association?

3. Have you graduated, in good standing, from an accredited school of allopathic medicine, osteopathic medicine, dental surgery, dental medicine, physician assistant, or advanced practice nursing in the United Stated during the 5-year period immediately preceding the date on which you first submitted a registration or renewal and the curriculum included not less than 8 hours of training?***

*** A. Treating and managing patients with opioids or other substance use disorders, including the appropriate clinical user of all drugs approved by the Food and Drug Administration for the treatment of opioid use disorder or B. The safe pharmacological management of dental pain and screening, brief intervention, and referral for appropriate treatment of patients with or at risk of developing opioid and other substance use disorders.

4. Have you completed not less than 8 hours of training with one or more of the following from the approved training requirements?***

*** The American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Medical Association, the American Osteopathic Association, the American Dental Association, the American Association of Oral and Maxillofacial Surgeons, the American Psychiatric Association, or any other organization accredited to the Accreditation Council for Continuing Medical Education (ACCME) or the Commission for Continuing Education Provider Recognition (CCEPR)