Thank you for your participation in the Maryland State Opioid Response (MD-SOR) Evaluation! Your continued support of data collection efforts is extremely appreciated. Completing this form provides the evaluation team at University of Maryland School of Medicine with essential information regarding your client and documents related to their participation, as well as the full Baseline GPRA Interview.

This is a HIPAA-compliant platform.

For any line that requires specification, please be sure to write in or select an answer.

THE SURVEY MAY NOT BE SUBMITTED WITHOUT A SIGNED AND DATED PARTICIPATION AGREEMENT (signed by program staff if a client declines to participate, or signed by the client if they wish to participate).

If you have any questions, please contact Marie Yuille at (443) 718-0334 or myuille@som.umaryland.edu, or Joanna Prout at (443) 814-9924

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