1. (a) Within fourteen (14) calendar days from the date of the primary counselor's knowledge that the patient may be pregnant, as documented in the patient's record, the medical director shall review, sign, and date a confirmation of pregnancy. Also within this time frame, the medical director shall document his or her:

   1. (1) Acceptance of medical responsibility for the patient's prenatal care; or
   2. (2) Verification that the patient is under the care of a physician, physician assistant, or nurse practitioner licensed by the State of California and trained in obstetrics and/or gynecology, or a licensed midwife or certified nurse midwife licensed by the State of California.

2. (b) The medical director shall document a medical order and his or her rationale for determining LAAM to be the best choice of therapy for the patient prior to:

   1. (1) Placing a pregnant applicant on LAAM therapy; or
   2. (2) Continuing LAAM therapy after confirmation of a patient's pregnancy. The medical director shall conduct a physical examination of this patient, as specified in Section 10270(a)(3), prior to documenting a medical order to continue LAAM therapy.

3. (c) Within fourteen (14) calendar days from the date the medical director confirmed the pregnancy, the primary counselor shall update the patient's treatment plan in accordance with Section 10305. The nature of prenatal support reflected in subsequent updated treatment plans shall include at least the following services:

   1. (1) Periodic face-to-face consultation at least monthly with the medical director or physician extender designated by the medical director.
   2. (2) Collection of patient body specimens at least once each calendar week in accordance with collection procedures specified in Section 10310.
   3. (3) Prenatal instruction as specified in subsection (d) of this section.

4. (d) The medical director or licensed health personnel designated by the medical director shall document completion of instruction on each of the following prenatal topics:

   1. (1) Risks to the patient and unborn child from continued use of both illicit and legal drugs, including premature birth.
   2. (2) Benefits of replacement narcotic therapy and risks of abrupt withdrawal from opioids, including premature birth.
   3. (3) Importance of attending all prenatal care visits.
   4. (4) Need for evaluation for the opioid addiction-related care of both the patient and the newborn following the birth.
   5. (5) Signs and symptoms of opioid withdrawal in the newborn child and warning that the patient not share take-home medication with the newborn child who appears to be in withdrawal.
   6. (6) Current understanding related to the risks and benefits of breast-feeding while on medications used in replacement narcotic therapy.
   7. (7) Phenomenon of postpartum depression.
   8. (8) Family planning and contraception.

   9. (9) Basic prenatal care for those patients not referred to another health care provider, which shall include instruction on at least the following:

      1. (A) Nutrition and prenatal vitamins.
      2. (B) Child pediatric care, immunization, handling, health, and safety.
   10. (10) Evidence-based practices for managing neonatal abstinence syndrome.
5. (e) If a patient repeatedly refuses referrals offered by the program for prenatal care or refuses direct prenatal services offered by the program, the medical director shall document in the patient's record these repeated refusals and have the patient acknowledge in writing that she has refused these treatment services.

6. (f) Within fourteen (14) calendar days after the date of birth and/or termination of the pregnancy, the medical director shall document in the patient's record the following information:

   1. (1) The hospital's or attending physician's summary of the delivery and treatment outcome for the patient and offspring; or
   2. (2) Evidence that a request for information as specified in subsection (f)(1) of this section was made, but no response was received.
7. (g) Within fourteen (14) calendar days from the date of the birth and/or termination of the pregnancy, the primary counselor shall update the patient's treatment plan in accordance with Section 10305. The nature of pediatric care and child immunization shall be reflected in subsequent updated treatment plans until the child is at least three (3) years of age.

Note: Authority cited: Sections 11750, 11755, 11835, 11839.3 and 11839.20, Health and Safety Code. Reference: Sections 11839.3 and 11839.20, Health and Safety Code.

History

1. New section filed 6-23-97 as an emergency; operative 7-1-97 (Register 97, No. 26). Pursuant to Health and Safety Code section 11758.42, a Certificate of Compliance must be transmitted to OAL by 12-28-97 or emergency language will be repealed by operation of law on the following day. For prior history, see Register 97, No. 24.

2. Editorial correction of subsections (b)(1), (d)(2) and (d)(5) and History 1 (Register 98, No. 1).

3. Repealed by operation of Government Code section 11346.1(f) (Register 98, No. 1).

4. New section filed 12-31-97 as an emergency; operative 12-31-97 (Register 98, No. 1). A Certificate of Compliance must be transmitted to OAL by 4-30-98 or emergency language will be repealed by operation of law on the following day.

5. New section refiled 4-27-98 as an emergency, including amendment of subsection (f)(2); operative 4-30-98 (Register 98, No. 18). A Certificate of Compliance must be transmitted to OAL by 8-28-98 or emergency language will be repealed by operation of law on the following day.

6. Certificate of Compliance as to 4-27-98 order, including amendment of subsections (a)(1)-(2) and (e), transmitted to OAL 6-1-98 and filed 6-29-98 (Register 98, No. 27).

7. Change without regulatory effect amending Note filed 4-19-2006 pursuant to section 100, title 1, California Code of Regulations (Register 2006, No. 16).

8. Amendment of subsections (a)(2), (c)(3), (d)(2) and (d)(4)-(5), new subsection (d)(10), amendment of subsection (f)(2) and amendment of Note filed 5-7-2020; operative 7-1-2020 (Register 2020, No. 19).