Section 164.124 - Staffing Pattern(A) The licensee shall designate a physician as Medical Director who shall be responsible for administering all medical services performed by the program. The Medical Director shall have, at a minimum, six months' clinical experience with alcohol and other drug-dependent persons or 40 hours of documented continuing education credit in treating addicted persons within the first 12 months of employment. The Medical Director shall be responsible for: (1) Ensuring that each patient receives a complete physical examination including a medical history;(2) Ensuring that appropriate laboratory studies have been performed; and,(3) Signing all medical orders.(B) The licensee shall establish a staffing pattern in sufficient numbers and positions necessary for the level of care provided. Staffing pattern shall include the following positions: (1) Senior Clinician among direct service staff, who shall be responsible for the clinical/ educational operation of the substance abuse service;(2) Licensed psychiatrist or licensed psychologist on staff or available through Qualified Service Organization Agreements;(3) Registered nurse, nurse practitioner, or physician assistant on staff and on site during hours of operation of the service;(4) Licensed practical nurse, case aides and case management staff;(5) If serving pregnant women, an obstetrician/gynecologist available on staff or through a Qualified Service Organization Agreement; and(6) Sufficient staff to ensure coverage on all shifts.(C)Supervision: In addition to supervision requirements set forth in 105 CMR 164.044 Training and Supervision, the licensee shall ensure that supervision of nursing staff is overseen by a registered nurse.(D) The licensee shall ensure that a qualified physician is available during all hours when service is provided, either on site or through a Qualified Service Organization Agreement, to provide consultation to staff. If services are to be available through an agreement, this agreement shall be reaffirmed every two years.