a) Prior to the initiation of the ASAM assessment, or, in the case of an impaired patient, as soon as stabilization permits, the following information shall be provided to the patient and obtained from the patient:

1. 1) Collection of all required demographics, as specified in Section 2060.370(d)(9);
2. 2) The hours and days of operation when services are available;
3. 3) Identification of any third-party payment benefits;
4. 4) Collection of income verification, if applicable;
5. 5) A fee schedule in accordance with the requirements in Section 2060.345 that also identifies any cost to the patient that may not be covered by third party insurance including Medicaid and Medicare; and
6. 6) The admission and exclusionary criteria applicable to the individual's conduct or care or that may prohibit a person from receiving necessary services from the licensed organization.