Virginia Law

A. The provider shall require each individual to undergo an initial medical examination. The initial medical examination is comprised of two parts:

1. A screening examination to ensure that the individual meets the criteria for admission in accordance with 12VAC35-105-935 and that there are no contraindications to treatment with MOUD; and

2. A full health history and examination, including a physical examination, to determine the individual's broader health status, with lab testing as determined by an appropriately licensed practitioner. An individual's refusal to undergo lab testing for co-occurring physical health conditions should not preclude access to treatment, provided such refusal does not have the potential to negatively impact treatment with medications. The individual's full health history and examination shall be completed within 14 days of admission.

B. Both the screening examination and the full health history and examination shall be completed by an appropriately licensed practitioner. When the initial medical examination is performed outside of the provider's service:

1. The written results, narrative of the initial medical examination, and available lab testing results must be transmitted, consistent with applicable privacy laws, to the provider and verified by an opioid treatment practitioner; and

2. If the original screening examination was not conducted by an opioid treatment practitioner, the screening shall occur not more than seven days prior to admission to the provider's service.

C. The provider shall maintain the report of the individual's initial medical examination in the individual's service record.

D. The provider shall have a policy to ensure that coordination of care is in place with any prescribing physician.

E. The provider shall coordinate treatment services for individuals who are prescribed benzodiazepines and prescription narcotics with the treating physician. The coordination shall be the responsibility of the provider's physician and shall be documented.

F. Serology testing and other testing as deemed medically appropriate by the provider's physician based on the screening and full health history and examination, drawn not more than 30 days prior to admission to the provider's service, may form part of the initial medical examination.

G. An evaluation of an individual for treatment shall occur in person or use audio-visual telemedicine platforms. When not available, a provider may use audio-only devices, but only when the individual is in the presence of a licensed practitioner who is registered to prescribe and dispense controlled medications. The licensed practitioner shall document being physically present during the audio-only evaluation through signature in the individual's record. The provider's physician shall review the initial medical examination results and order MOUD as indicated.

H. Qualified personnel shall review a consent-to-treatment form with the patient and shall document informed written consent prior to the individual receiving the first dose of MOUD.

I. Assuming no contraindications, an individual may begin MOUD treatment after the screening examination is completed.