Program Description. A clinically managed medium intensity treatment program provides a structured environment in combination with medium intensity treatment and ancillary services to support and promote recovery. Patients who are appropriate for this level of treatment: Meet the current edition of the American Society of Addiction Medicine Patient Placement Criteria for Level III.3, or its equivalent as approved by the Administration; Are chronic alcohol or other drug dependent individuals; Do not need skilled nursing care; May have a history of multiple admissions to alcohol or drug abuse or dependence programs as defined in COMAR 10.47.01; May have physical and mental disabilities as a result of prolonged alcohol or other drug use; and Have been identified as individuals for whom a controlled environment and supportive therapy are necessary for an indefinite period of time. Staffing. Services shall be provided by appropriately credentialed staff as described in COMAR 10.47.01.06. The patient to alcohol and drug counselor ratio may not exceed 15 patients to one full-time alcohol and drug counselor. At least one staff member certified in cardiopulmonary resuscitation and trained in crisis intervention shall be on duty between 11 p.m. and 7 a.m. Program Services. A program shall provide the following services: An assessment as described in COMAR 10.47.01.04 within 1 week of admission; An individualized treatment plan as described in COMAR 10.47.01.04 completed and signed by the alcohol and drug counselor and patient within 3 working days of the comprehensive assessment and updated every 30 days; Alcohol and drug education; Individual counseling; Leisure and recreation counseling; and Assistance with vocational issues. Documentation. A designated clinical staff shall write a patient progress note at the end of each week services are provided and place the progress note in the patient's record. Referral Services. The program shall offer the following services or maintain a listing of agency referral agreements for the following services: Physical examinations as determined by medical condition, within a reasonable time; Medical care; Services through the Division of Rehabilitation Services; Vocational assistance; Mental health services, which shall include, as appropriate to the severity and urgency of the patient's mental condition: Medication monitoring for patients who are admitted on or are prescribed psychotropic medications; and At least one of the following services: Services available by telephone within 8 hours of a request; or Services available onsite or closely coordinated off-site within 24 hours of a request; Substance abuse treatment programs; Legal assistance; Family services; and Social services.