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Department of Human Services (DHS) Division of Addiction Services (DAS) Information Systems ... - page 5 / 21

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OR

__ b. This level of care is required to complete detoxification and enter into treatment or self-help recovery as evidenced by any of         the following:

1.

Requires medication and has a recent history of detoxification at a less intensive level of care, marked by inability to complete detoxification. And enter into continuing addiction treatment, and continues to have insufficient skills or supports to complete detoxification; OR

2.

Has a recent history of detox at a less intensive level of care, marked by inability to complete detox. And enter into continuing addiction treatment, and continues to have insufficient skills or supports to complete detox.; OR

3.

Comorbid physical, emotional, behavioral or cognitive condition that increases clinical severity of the withdrawal and complicates detox. Is manageable in a Level III.7-D setting.

LEVEL IV-D – MEDICALLY MANAGED INTENSIVE INPATIENT DETOXIFICATION.

Patient must meet (a) or (b);

a.

Risk of severe withdrawal as evidence by any of the following:

1.

Alcohol withdrawal and CIWA-Ar score is 10 or greater. The patient requires: monitoring more often than hourly; intravenous medication or infusions; or close behavioral monitoring due to high levels of agitation, confusion or extremes of vital signs; OR

2.

Alcohol and sedative-hypnotic withdrawal with seizures, delirium tremens or severe, persistent hallucinations; OR

3.

Daily sedative-hypnotic use at more than therapeutic levels for more than 4 weeks, and has accompanying acute mental or physical disorder complicating withdrawal; OR

4.

Daily sedative-hypnotic use for at  least 6 months, in combination with daily alcohol use or regular use of another mind-altering drug known to pose a severe withdrawal syndrome, and accompanying acute mental or physical disorder complicating withdrawal; OR

5.

Severe opiate withdrawal that has not been stabilized or managed at a less intensive level of service; OR

6.

Antagonist medication is to be used in a rapid withdrawal ( as in pharmacological induction and resolution of opiate withdrawal with naloxone in 6 Hours; OR

7.

Stimulant intoxication or withdrawal requires psychiatric or medical monitoring more frequently than hourly because of psychotic impulsive behavior or depressive suicidality; OR

8.

Recent (within 24 hours) serious head trauma or loss of consciousness, with persistent mental status or neurological changes resulting in need for at least close hourly observation; OR

9.

Drug overdose or intoxication has compromised patient’s mental status, cardiac function, or vital signs or functions; OR

10.

Significant acute biomedical disorder poses substantial risk of serious or life-threatening consequences during withdrawal; OR

11.

Drug overdose compromises mental status, cardiac functioning, or other vital signs.

OR

b.

requires medical support and comfort care in this level of care for either of the following reasons:

1. Detoxification regimen or response to the regimen requires monitoring or intervention more frequently than hourly; OR

2. Detoxification or stabilization is required while patient is pregnant until she can be safely treated in a less intensive    level of care.

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