Other levels of care and support can and will be recommended as indicated through the ASAM multidimensional assessment. This includes ASAM 3.1, SUD case management, and peer services available within Anderson and Associates. If an individual is assessed as needing care not available in-house, referrals and coordination with community partners will be facilitated including to ASAM levels of care not available at Anderson and Associates. Urine drug screens and breathalyzer is utilized as a tool for accountability and determining progress with treatment goals. In general, 3 positive screens for illicit substance use or alcohol use will result in an evaluation for referral to a higher level of care. Screens will be discussed by the clinician one on one with each individual and documented in the client record. If an individual exits ASAM 2.5 due to continued positive screens, they will not be admitted back into this level of care without completion of a higher level of care or 30 days out of services. Psychiatric and medical consultation is available within 8 hours by telephone and/or 48 hours in person/telemedicine via the contracted psychiatric nurse practitioner. Determination for the need for consultation will be made based on the results of Dimension 2 and 3 of the ASAM multidimensional assessment framework. On-going medical and psychiatric care will be provided through referral into the community for primary and speciality medical care. For individuals with co-occurring SUD and mental health conditions or who may be tri-morbid with physical health conditions as well, SUD case management services can be utilized to support referral and coordination of care. Medication assisted treatment can be offered through the Anderson and Associates OBOT or coordinated with an OBOT/OTP for which the individual is already engaged. All individuals will be asked about screening for infectious disease over the last 12 months, specifically about HIV, Hepatitis B and C as well as tuberculosis. Individuals will be encouraged to get screened and care for treatment will be coordinated as part of their care. Completion of treatment will be based on individualized assessment of the individual’s functioning and condition throughout the course of treatment and will be clinically determined. Anderson and Associates makes available to individuals in this level of care access to a 24-hour on-call number which can be utilized to address emergencies related to an individual’s substance use disorder during their treatment.