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This application is used to verify compliance of residential intoxification monitoring services with Chapter DHS 75.09, Wisconsin Administrative Code.
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How to fill out community substance abuse services
How to fill out Community Substance Abuse Services Residential Intoxification Monitoring Service Recertification Application
01
Begin by gathering all required personal and service information.
02
Fill out your name, address, and contact information in the designated fields.
03
Provide details about the facility where services were rendered.
04
Include the dates of service and the nature of the substance abuse treatment provided.
05
Attach any necessary documentation to support your application.
06
Review the completed application for accuracy and completeness.
07
Sign and date the application form.
08
Submit the application by the specified deadline through the preferred method indicated in the guidelines.
Who needs Community Substance Abuse Services Residential Intoxification Monitoring Service Recertification Application?
01
Individuals or facilities seeking to maintain their certification for providing monitoring services related to substance abuse treatment.
02
Organizations that operate residential intoxification monitoring programs and need to comply with state or federal regulations.
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People Also Ask about
What is the ASAM criteria in Minnesota?
The ASAM Criteria are a comprehensive set of guidelines for placement, continued stay and transfer/discharge of individuals with substance use disorders. These criteria help providers ensure appropriate and effective levels of care. The “ASAM Criteria, 3rd Edition” covers both adults and adolescents.
What is ASAM Level 4 care?
This level of care offers 24-hour nursing care and daily physician care for severe, unstable problems in any of the following ASAM dimensions: i) acute intoxication or withdrawal potential; ii) biomedical conditions and complications; iii) emotional, behavioral, or cognitive conditions and complications.
What is the ASAM level of care in Minnesota?
Enrolled Minnesota Health Care Programs (MHCP) providers offering substance use disorder outpatient services can apply to offer ASAM level of care 2.5 - partial hospitalization starting Jan. 1, 2025. The Centers for Medicare & Medicaid Services approved the ASAM level of care 2.5 - partial hospitalization for MHCP.
What are the 5 levels of care for substance abuse treatment?
The levels of care in addiction treatment are early intervention, outpatient, intensive outpatient/partial hospitalization, residential/inpatient, and medically managed intensive inpatient. The lowest level of care would be early intervention, while the highest level of care is medically managed inpatient.
What is ASAM level 2.5 of care?
Level 2.5 is partial hospitalization, which is at least 20 hours a week but is less than 24-hour care. This level of care provides structure, and daily oversight for people who need daily monitoring, but not 24/7 care.
What is a 245G license in Minnesota?
245G refers to a specific section of Minnesota and Federal law that governs the provision of substance use disorder treatment services. More specifically, 245G outlines the requirements and standards that treatment programs must meet in order to be licensed and operate in the state.
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What is Community Substance Abuse Services Residential Intoxification Monitoring Service Recertification Application?
It is an application process that allows organizations to seek recertification for providing residential intoxification monitoring services in compliance with community substance abuse protocols.
Who is required to file Community Substance Abuse Services Residential Intoxification Monitoring Service Recertification Application?
Organizations or facilities that are currently providing residential intoxification monitoring services and need to renew their certification must file this application.
How to fill out Community Substance Abuse Services Residential Intoxification Monitoring Service Recertification Application?
The application should be filled out by providing the necessary organizational details, services offered, compliance information, and any updates since the last certification period. Specific guidelines may be provided in the application form.
What is the purpose of Community Substance Abuse Services Residential Intoxification Monitoring Service Recertification Application?
The purpose is to ensure that organizations continue to meet the standards required to provide safe and effective services for individuals experiencing intoxification, thereby supporting community health and safety.
What information must be reported on Community Substance Abuse Services Residential Intoxification Monitoring Service Recertification Application?
Organizations must report details such as service capacity, staff qualifications, compliance with health regulations, incident reports, and any changes to their operational protocols since the last certification.
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