Section 325.14404. Medical director; designation; medical director and other physicians; responsibilities; minimum client-physician encounters.

(1) A program shall have a designated medical director who assumes responsibility for the administration of  all  medical  services performed by the program.  The   medical  director    and    other    authorized program physicians shall be

licensed to practice in the jurisdiction in which the program is located. The medical director shall be responsible for ensuring that the program complies with all federal, state,  and  local laws, rules, and  regulations   regarding  medical   treatment   of narcotic addiction.

(2)   The responsibilities of the medical director and other authorized physicians within the program shall include all of the following:

(a)   Ensuring that evidence of current physiologic  dependence,  length  of history of addiction, or exceptions to criteria for admission  are documented in the patient's record before the patient  receives  the  initial methadone dose.

(b)   Ensuring that a medical evaluation, including a medical history and physical examination, has been performed before the patient receives  the initial methadone dose. However, in an emergency situation the initial dose of methadone may be given before the physical examination.

(c)     Ensuring that appropriate laboratory studies have been performed and reviewed.

(d)   Signing or countersigning all oral medical orders as required  by federal or state law. Such medical orders include all of the following:

(i)   Initial medication orders.

(ii)   Subsequent medication order changes.

(iii)   Changes in the frequency of take-home medication.

(iv)     Medication orders for additional take-home methadone for emergency situations.

(e)   Reviewing and countersigning treatment plans as follows:

(i)    The program physician or counselor shall review,  reevaluate,   and alter, where necessary, each client's treatment plan at least once every 60 days.

(ii)    The program physician shall ensure that the treatment plan becomes part of each client's chart and that it is signed  and   dated  in  the client's chart by the counselor and is countersigned and   dated  by   the supervisory counselor.

(iii)     At least once a year, the program physician shall date, review, and countersign the treatment plan recorded in each client's chart  and shall ensure that each client's progress or lack of progress in achieving the treatment goals is entered in the client's  counseling   record.  When appropriate, the treatment plan and progress notes shall deal  with  the client's mental and physical problems, apart from drug abuse, and shall include reasons for prescribing any medication for emotional or physical problems.

(f)     Ensuring that justification is recorded in the patient's record when  the frequency of clinic visits for observed medication is reduced.

(3)   There shall be a minimum of 1 client per physician encounter every 60 days. This contact shall be documented in the client's record.

History: 1981 AACS.