Templates › Inspections › SEO page

Run: COWS Opioid Withdrawal Assessment

Use this COWS Opioid Withdrawal Assessment template to score withdrawal symptoms consistently, document severity, and record the medication response in one p...

Fill this out, get a PDF emailed to you. No account required. Want to run it with your team and track results? Sign up free →

Assessment Context and Patient Readiness

Assessment date and time recorded

Patient is awake, able to participate, and assessment conditions are appropriate critical (required)

Yes No N/A

Recent opioid use or withdrawal timing documented

Document last reported opioid use, time since last use, or relevant withdrawal onset details.

Baseline vital signs obtained critical (required)

Record vital signs per local protocol before or during scoring when clinically indicated.

Yes No N/A

Safety precautions and observation level appropriate critical (required)

Confirm the patient is in a safe setting for withdrawal monitoring and medication administration.

Yes No N/A

COWS Item Scoring

Resting pulse rate critical (required)

Enter the observed or measured pulse rate used for the COWS score.

Sweating critical (required)

Document the observed sweating severity.

Restlessness critical (required)

Assess observable motor restlessness.

Pupil size critical (required)

Assess pupils in adequate lighting and document dilation severity.

Bone or joint aches critical (required)

Document patient-reported aches and observable discomfort.

Runny nose or tearing critical (required)

Assess autonomic signs such as lacrimation or rhinorrhea.

Gastrointestinal upset critical (required)

Document nausea, vomiting, abdominal cramping, or diarrhea as applicable.

Tremor critical (required)

Observe hand tremor with arms extended if needed.

Yawning critical (required)

Document observed yawning frequency during the assessment period.

Anxiety or irritability critical (required)

Assess subjective distress and observable irritability.

Gooseflesh skin critical (required)

Inspect for piloerection as part of the withdrawal exam.

Total Score and Clinical Interpretation

Total COWS score critical (required)

Enter the summed COWS score from all 11 items.

Withdrawal severity documented critical (required)

Document the clinical interpretation of the total score using the facility's protocol.

Medication response or treatment action documented critical (required)

Record the medication given, dose, time, and observed response, or document why medication was withheld and what follow-up was initiated.

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Generated with MangoApps Templates — browse 250+ free