All hospitals in Baltimore City must complete this form to achieve certification in one of the three Levels of Care for treating overdose and opioid use disorder. The Baltimore City Health Department expects that every emergency department in Baltimore City will earn at least a level 3 designation. Please complete this form, indicating whether your organization fulfills each criterion for the selected certification level. Provide a description and required documentation to demonstrate organizational compliance for each criterion. Documentation should be specific and reflect how your organization meets the requirements. Applications will be reviewed by a leadership team led by the Baltimore City Health Department (BCHD) and Behavioral Health System Baltimore (BHSB).