Program Description. A clinically managed high intensity residential program shall: Provide a highly structured environment in combination with moderate to high intensity treatment and ancillary services to support and promote recovery; and Be characterized by its reliance on the treatment community as a therapeutic agent. 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.5, or its equivalent as approved by the Administration. Staffing. Services shall be provided by appropriately credentialed staff as described in COMAR 10.47.01.06. A program shall have sufficient physician, physician assistant, or nurse practitioner services to: Provide initial diagnostic work-up; Provide identification of medical and surgical problems for referral; and Handle medical emergencies when necessary. The patient to alcohol and drug counselor ratio may not exceed 15 patients for 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: A preliminary medical assessment within 36 hours of the patient's admission; A physical examination by a medical doctor, physician assistant, or nurse practitioner within the first week of the patient's admission; An assessment as described in COMAR 10.47.01.04 within 2 days 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 2 working days of the comprehensive assessment with a treatment plan update every 30 days; Monitoring of medication, as necessary; and A minimum of 36 hours of therapeutic activities a week, including but not limited to: At least weekly individual counseling; Group counseling; Alcohol and drug education; Career counseling; Nutrition education; and Family services. 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: 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 on-site or closely coordinated off-site within 24 hours of a request; Substance abuse treatment programs; Legal assistance; and Social services.