DHS 75.59(10)(c)5.d.d. The medical director signs and dates the recordings under subd. 5. c. before the initial dose is administered to the patient or within 48 hours after administration of the initial dose to the patient.

DHS 75.59(10)(c)9.9. Ensuring that justification is recorded in the patient’s case record for reducing the frequency of service visits for observed drug ingesting and providing additional take-home medication under exceptional circumstances or when there is physical disability, as well as when any medication is prescribed for physical health or psychiatric problems.

DHS 75.59(10)(c)10.10. Ensuring the correct amount of medication is administered or dispensed, and for recording, signing and dating each change in the dosage schedule in a patient’s case record.

DHS 75.59(10)(c)11.11. Ensuring that all physician orders are executed by the date given in the order or, if no date is specified, within 24 hours of the order being written.

DHS 75.59(10)(c)12.12. Having a valid DEA registration for prescribing, administering, or dispensing controlled substances, and having a DEA waiver if they or any other healthcare professional they supervise prescribes, administers, or dispenses partial opioid agonists.

DHS 75.59(10)(d)(d) Service physician responsibilities. A service physician is responsible for all of the following:

DHS 75.59(10)(d)1.1. Determining the amount of the medication to be administered or dispensed and recording, signing and dating each change in a patient’s dosage schedule in the patient’s case record.

DHS 75.59(10)(d)2.2. Approving, by signature and date, any request for an exception to the requirements under sub. (13) relating to take-home medications.

DHS 75.59(10)(d)3.3. Detoxification of a patient from narcotic drugs and administering the narcotic drug or authorizing an agent to administer it under physician supervision and physician orders in a manner that prevents the onset of withdrawal symptoms.

DHS 75.59(10)(d)4.4. A history and physical examination of the patient determining that the patient is a suitable candidate for admission to an OTP.

DHS 75.59(11)(a)(a) Dose determination. The dose determination for a patient is a matter of clinical judgment by a physician in consultation with the patient and appropriate clinical staff.

DHS 75.59(11)(b)(b) Verbal orders. The service physician shall determine, on the basis of clinical judgment, the appropriate medication dose for the patient and may also use verbal orders pursuant to state, accreditation, and federal rules. Upon receiving the service physician’s order, the receiver shall record the order in the patient’s record, and then shall read back the written order to the issuing professional to assure that the order is understood clearly. Orders made orally or telephonically must be documented as such and staff recording must sign their name and title. Oral or telephone orders must be countersigned by the service physician no later than 72 hours after being given.

DHS 75.59(11)(c)(c) Patient sanctioning. Any dose adjustment to sanction the patient, to reinforce the patient’s behavior, or for purposes of treatment contracting, is prohibited.

DHS 75.59(11)(d)(d) Patients under the influence. The service shall delay administration of an FDA-approved medication for the treatment of an opioid use disorder to a patient under the influence of illicit drugs or alcohol until diminution of intoxication symptoms can be observed and documented, or the patient shall be readmitted for observation for withdrawal symptoms while augmenting the patient’s daily dose in a controlled, observable fashion.

DHS 75.59(11)(e)(e) Sufficient dosing. The FDA-approved medication dose that a service provides to a patient shall be sufficient to produce the desired response in the patient for the desired duration of time.

DHS 75.59(11)(f)(f) Initial methadone dose. A patient’s initial dose shall be based on the service physician’s evaluation of the history and present condition of the patient. The initial dose of methadone may not exceed 30 milligrams except that the total dose for the first day may not exceed 40 milligrams.

DHS 75.59(11)(g)(g) Withdrawal planning. A service shall incorporate withdrawal planning as a goal in a patient’s initial treatment plan and all subsequent treatment plans. A service physician shall determine the rate of withdrawal to prevent relapse or withdrawal symptoms.

DHS 75.59(12)(a)(a) Emergency termination.

DHS 75.59(12)(a)1.1. The service may terminate a patient immediately, prior to a fair hearing and without provision for medically supervised withdrawal, when either of the following occurs:

DHS 75.59(12)(a)1.a.a. The clinic director reasonably determines and documents that the patient’s continuance in the service presents an immediate and substantial threat of physical harm to other clients, service personnel or property.