Methadone-Associated Mortality:
Report of a National Assessment


Appendix 7. PedTox Case Report Form
(from NAME)


The following case report form is from the Pediatric Toxicology (PedTox) Registry at the National Association of Medical Examiners (NAME) web site - http://www.thename.org/pedtox_index.htm.

graphic

Note: The examples for item C under "Role" - e.g., "fall while intoxicated, drunk driver" - do not appear applicable for this population of children and require reinterpretation by the reporter.



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