415-050-0145 Medical Services (1) At a minimum, programs must ensure each of the following: (a) Sufficient medical treatment staff staffing with the ability to transfer or admit patients to ASAM Level 3.7-WM program or a hospital as necessary; (b) A LMP must be available daily for onsite evaluation of patients; (c) A LMP must be available for phone consultation with staff 24 hours a day, 7 days per week; and (d) Medical treatment staff, onsite and readily available 24 hours a day, 7 days per week, that are trained and competent to: (A) Facilitate entry into withdrawal management services; (B)Recognize the signs and symptoms of intoxication and withdrawal; (C) Administer medical treatment; (D) Monitor conditions; (E) Implement LMP-approved protocols for patient; and (F) Facilitate the transfer of patients to other ASAM Levels of Care. (2) Medications must be administered in accordance with physician or LMP orders, or nursing orders that are in accordance with LMP orders. (3) The medical assessment and examination must: (a) Contain a complete physical examination and a thorough comprehensive health history, which includes review of behavioral and physical health diagnoses, a description of behavior problems, prior evaluations, treatment history and a review of current use of prescription and over-the-counter medications. (b) Be completed by a LMP within 24 hours of entry for each patient in ASAM Level 3.7-WM programs; or (c) By a medical treatment staff within 24 hours of entry for each patient in ASAM Level 3.2-WM programs; and (d) Documentation must include: (A) The ASAM Level of Care placement determination utilizing ASAM Dimensions 1, 2 and 3; (B) Use of the ASAM dimensional admission criteria and documentation that demonstrates the patient meets ASAM 3.7-WM level of care by justifying the patient is: (i) Experiencing severe intoxication or withdrawal and needs 24-hour nursing care and daily access to a LMP; (ii) In addition, may be experiencing severe risk in Dimensions 2 and 3; and (iii) Unlikely to complete withdrawal management without medical monitoring. (C) A conclusion that the withdrawal syndrome can be safely managed at the ASAM Level of care placed; (D) A recommended length of stay; (E) Medication orders; (F) Current protocols; and (G) Identification of the patient’s medical needs relevant to stabilization. (4) A medical stabilization plan must be informed by the medical assessment and: (a) Be completed by a medical treatment staff; (b) Identify initial orders for the stabilization of each identified substance for withdrawal; (c) Identify criteria for meeting safe completion of medical protocols for acute withdrawal management services per substance being treated, including the recommended length of services; (d) Note the extent of the patient's participation in developing the content of the stabilization plan; (e) Document any modifications; and (f) The inclusion or notification of significant others in the stabilization planning process, when applicable. (5) The following information must be recorded in the patient’s service record at the time of admission: (a) Name, address, and telephone number; (b) Contact information for individual to contact in case of an emergency or unplanned exit of services, when a corresponding release of information, compliant with 42 CFR part 2 and HIPAA, is also on file and valid; (c) Identification of patient's family and social support, if any; (d) The time and date of admission; (e) The name and credentials of program staff completing the admission documentation; (f) Documentation of the patient’s ability to evacuate the home consistent with the program’s evacuation plan developed in accordance with the Oregon Structural Specialty Code and Oregon Fire Code; (g) Documentation of any safety risks; (h) Documentation of follow-up actions and referrals when an patient reports symptoms indicating risk of suicide; and (i) When medical services are provided, the following documents must be part of the Service Record as applicable: (A) Medication administration records as per these rules; (B) Laboratory reports; and (C) LMP orders for medication, protocols or procedures. (6) At the time of transition from withdrawal management services, a medical stabilization summary must be completed by medical treatment staff. The medical stabilization summary must contain: (a) Final evaluation of the patient's progress toward stabilization for each of the substances treated; (b) Identification of any unresolved withdrawal symptoms; (c) List of medications prescribed for continuation following the transition; and (d) Where applicable, a medical opinion of the patient’s capacity to resolve the identified issue(s) due to any known or observed cause, such as a co-occurring behavioral or medical condition. Statutory/Other Authority: ORS 413.042 & ORS 430.256 Statutes/Other Implemented: ORS 430.306 & ORS 430.345-430.375 History: ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023