.| .| Clinical Opiate Withdrawal Scale| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB:
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | COWS Scale: <-COWS Scale->| | 5-12 Mild withdrawal| 13-24 Moderate| 25-36 Moderately
severe| 37+ Severe withdrawal| | Questions and Answers| | 1. Resting Pulse Rate: | <*Answer_4022*>| 2. Sweating: | <*Answer_4033*>| 3. Restlessness: | <*Answer_4035*>| 4.
Pupil size:| <*Answer_4036*>| 5. Bone or joint aches:| <*Answer_4037*>| 6. Runny nose or tearing: | <*Answer_4038*>| 7. GI upset: | <*Answer_4039*>| 8. Tremor: | <*Answer_4040*>|
9. Yawning: | <*Answer_4041*>| 10. Anxiety or Irritability:| <*Answer_4042*>| 11. Gooseflesh skin:| <*Answer_4043*>| | $~
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