Both residential and outpatient facilities must have medical staff bylaws, along with written medical policies developed by the medical director in conjunction with the medical staff. The written medical policies and bylaws must include, but need not be limited to, the following:

1. A plan for medical staff meetings that are documented by minutes;
2. A procedure for reviewing credentials and delineating qualifications of medical staff, appointments and reappointments, evaluation of medical care and the granting, denial, curtailment, suspension, or revocation of medical staff privileges;
3. Specifications for verbal and telephone orders, including the identification of the licensed medical staff authorized to give and receive verbal and telephone orders;
4. A system for completion of entries in client clinical records by members of the medical staff, including specification of a time limit for completion of the clinical record, which must not exceed 30 days following a client's last treatment or discharge; and
5. For those facilities serving women and dependent children, a plan for ensuring that the needs of the children, as well as the mothers, are adequately assessed and met during treatment.

Outpatient facilities must also have written medical policies and bylaws that cover the identification of the program's quality assurance plan for medical and nursing services and medical staffing patterns.

Facilities with pharmacies must have specific written policies and procedures concerning the provision of those services. The written documents must specify the qualifications and responsibilities of the pharmacist, including individuals who serve as a pharmacist on a consultant basis. Such procedures must be included in a written affiliation agreement between the facility and the pharmacist. The pharmacy-related policies should include documented inspections of all areas of the facility where medications are dispensed, administered, or stored, and education of clients and staff concerning medications including self-administration.

Regardless of whether the facility provides its own pharmaceutical services, facilities must have written policies and procedures dealing with the administration of medication. The written policies and procedures must be designed to ensure that medication in the correct strength and dosage and at the correct time intervals is administered to the correct client through the prescribed route of administration. Facilities are required to keep medications in locked storage areas and in a secured area when not in use.

Both residential and outpatient facilities' policies and procedures must ensure a method of tracking the line of possession of the medications while in the facility and describe the facilities' plan to ensure the adequate maintenance of supplies, including at least the following:

1. Methods for procuring medications on a routine basis, in emergencies and in the event of disaster;
2. Stocking and maintenance of emergency kits and carts, including:
3. Acceptable methods for ordering medications must be consistent with the following:
1. Orders shall be in writing and specify the name and strength of the medication, dose, frequency and route of administration;
2. Orders shall be signed and dated by the prescriber;
3. Verbal orders and telephone orders shall be written and countersigned by authorized medical personnel issuing the verbal order or telephone within 72 hours of the original order; and
4. Special requirements for prescribing or dispensing controlled drugs shall be noted on the prescription and in the client's clinical record;
4. Administration of medication, including establishment of the times for administration of medication prescribed;
5. When self-administration is permitted at the facility, the self-administration process must include:
1. A prohibition on self-administration of medication, except upon a written order of the prescriber;
2. Storage and labeling of medications, including directions for use and appropriate cautionary and/or warning messages;
3. Methods for documenting self-administration of medication in the client's clinical record and medication administration record along with signature and date of staff observing self-administration;
4. Individualized client medication administration record;
5. Training and education of clients and staff in self-administration and the safe use of medications including procedures for self-administration off-site (examples include field trips, outings away from the facility, etc.);
6. Identification of staff trained and authorized to observe self-administration; and
7. Establishment of precautions against clients sharing their medications with one another;
6. Procedures for documenting and reporting adverse medication reactions, medication errors, and medication defects;
7. Discontinuation of medication orders, including:
1. The length of time medication orders may be in effect for medications and solutions that are not specifically limited as to duration of use or number of doses when ordered;
2. A process for notifying the prescriber prior to the expiration of a medication order to ensure that the medication for the specific client is discontinued if no specific renewal is ordered; and
3. Removal of discontinued medications within 30 days of the client's discharge;
8. Standards for the purchase, storage, safeguarding, accountability, use and disposal of medications;
9. Standards for the procurement, storage, use and disposal of needles and syringes in accordance with state laws;
10. Standards for the control of medications consistent with applicable federal and state laws, including:
1. Provisions for a verifiable record system for controlled medication;
2. Procedures to be followed when inventories of controlled medications cannot be verified, medications are lost, contaminated, unintentionally wasted or destroyed, including a written report of the incident signed and dated by the individuals involved and any witnesses; and
3. Procedures for the intentional wasting of controlled medications, including the disposal of partial doses, including written documentation of the event signed by the individual responsible for the intentional wasting of the medication and an individual assigned to witness the event;
11. Maintenance of a record of each onsite prescriber's federal Drug Enforcement Administration ("DEA") numbers and state Controlled Dangerous Substance registration numbers; and
12. Data to be maintained on each medical unit, including:
1. A list of abbreviations, metric conversion charts and chemical symbols, subject to approval by the medication staff;
2. Specific information on medications and other drugs, including indications, contraindications, actions, reactions, interactions, cautions, precautions that should be taken, toxicity, and dosages; and
3. Antidote information and the telephone number of the state Poison Information and Education System Center 1-800-POISON-1.

Facilities providing medical and/or nursing services must establish policies and procedures regarding verbal and telephone orders from physicians or other licensed practitioners to include the following:

1. Specifications of the circumstances under which verbal and telephone orders may be given and received;
2. Limitations on verbal and telephone orders to emergency situations; and
3. Written documentation of verbal and telephone orders shall be entered into the client's clinical record by medical staff authorized medical to receive such orders, and countersigned within 72 hours of the original order by the physician or medical staff issuing the verbal or telephone order.

In addition, there are numerous requirements applicable to medication-assisted treatment, as discussed in the section dedicated to that subject matter below.