How to Bring an Annex into Compliance in Mexico: The Guide Based on the CONASAMA 2025 Certificate

To regularize an annex or residential addiction treatment center in Mexico, you must comply with the criteria of the CONASAMA 2025 Supervision Form (V. 5.2), obtain the operating license from the State Health Services (SESA), and demonstrate compliance in 6 evaluated areas: infrastructure, food, organization, human resources, care process, and user satisfaction. The maximum score is 292 points distributed across these areas.

Introduction

Most annex owners in Mexico know they need to "regularize," but they don't know exactly what supervisors will review when they arrive.

That information gap is the problem. It's not a lack of willingness — it's a lack of access to the correct document.

This guide is based directly on the Supervision Form for Residential Establishments with a Mixed Care Model, 2025 version (V. 5.2), the official CONASAMA instrument that supervisors carry during each visit. If your center complies with what is described here, you are in a position to regularize.

What is CONASAMA and Who Supervises Your Center?

CONASAMA (National Commission for Mental Health and Addictions) is the federal agency that certifies and supervises residential addiction treatment establishments in Mexico.

At the state level, supervision is carried out by the CESMA (State Commission against Addictions), which in some states operates under the name CECA (State Commission of Care Centers).

The recognition process has two main stages:

• 1st Recognition Visit: Initial evaluation at your establishment
• Re-coding: Review of evidence for criteria not met in the first visit

The 6 Areas Evaluated by the CONASAMA Form (and their Weight)

Area	Maximum Points	% of Total
1. Infrastructure	95	33%
2. Food Service	12	4%
3. Establishment Organization	34	12%
4. Human Resources	23	8%
5. Care Process	124	42%
6. User Satisfaction	4	1%
TOTAL	292	100%

The Care Process is the area with the highest weight (42%). It is also the one where most centers fail, because it requires complete and well-documented clinical records.

Area 1: Infrastructure (33% — 95 points)

This is the second heaviest area. Supervisors physically tour each space.

Mandatory Spaces

Criteria marked as mandatory (value 3) in the form include:

• Equipped medical office: sink, examination table, sphygmomanometer, stethoscope, scale with altimeter, thermometer, prescription pad, diagnostic kit (ophthalmoscope + otoscope), hazardous biological waste bins, emergency first aid kit
• Exclusive individual counseling area (ensures confidentiality, no recording)
• Group therapy / multi-purpose area
• Archive with clinical records with restricted access
• Exclusive dormitories, signposted and separated by sex
• Sufficient beds for installed capacity
• Medication storage area with lock and access only for staff
• Current first aid kit (minimum 2 antiseptics + 2 wound care materials)

Key Technical Specifications

• One restroom for every 8 people
• One shower for every 8 people
• Restrooms and showers separated and signposted by sex
• Beds with a minimum of 60 cm separation between them
• Current fire extinguishers: one for every 300 m² of surface, 1.5 m high
• Evacuation route signs, safety areas, and tobacco-free zones
• Printed and visible architectural plan, updated with extinguisher locations

Physical Condition of the Establishment

Supervisors rate from 0 to 3 (Poor / Regular / Good / Very Good) in 4 dimensions: Functionality, Cleanliness, Ventilation, and Free of harmful fauna in 12 specific areas.

Area 2: Food Service (4% — 12 points)

Although it is the area with the least weight, its criteria are visually verified on the day of the visit.

What they review:

• Balanced weekly menus signed and endorsed by a nutritionist (with name, signature, and professional license)
• That the day's food matches the menu
• Clean and functional utensils
• Food in good condition, not expired
• Food stored on shelves or pallets, off the floor
• Refrigerator in working order with temperature regulator

Area 3: Establishment Organization (12% — 34 points)

This area contains the highest priority mandatory documents. Any deficiency here is a red flag for supervisors.

Mandatory Documents (Value 3 in the form)

• Operating license and/or sanitary license (with establishment address)
• Sanitary Responsible Notice (name and professional license of the health professional)
• Constitutive act or Legal Responsible document
• CLUNI (civil organizations) or CLUES (public)
• RFC of the establishment
• Procedure Manual endorsed by CESMA — includes: pre-admission, admission, evaluation, treatment, discharge, referral, and follow-up
• Official internal regulations (prohibiting abuse, foul language, establishing visiting hours)
• Monthly notifications to SISVEA (private establishments only)

Necessary Documents (Value 2 and 1)

• Organization Manual (mission, vision, organizational chart, staff functions)
• Staff directory visible to the public
• User rights poster in admission area
• Visible referral and inclusion criteria
• Civil Protection Program validated by competent authority
• Current fumigation certificate (no older than 3 months) + schedule

Area 4: Human Resources (8% — 23 points)

This area is critical for centers where staff are in recovery.

Staff in Recovery

If the director or any counselor/sponsor has a history of substance use, the form requires:

• Negative urine or saliva drug tests, for 5 elements, performed every 6 months during the last 2 years
• Laboratory tests from an institution belonging to the Ministry of Health

This is mandatory (value 3). Without these tests, it does not comply.

Medical Staff

• Doctor available 8 hours daily, Monday to Friday (40 hours per week)
• Must perform admission assessments, follow-up consultations, and continuous care

Psychology Staff

• At least one weekly individual psychotherapy session per user
• The number of psychologists must be proportional to the installed capacity (example: 40 beds = 40 hrs/week of psychology)

Counseling Staff

• At least one weekly individual counseling session of a minimum of 45 minutes per user
• Same proportion as psychology: installed capacity = weekly counseling hours

Documented Training

• Professional staff: 2 official documents attesting to addiction training in the last 3 years (degree, professional license, diploma, specialty, etc.)
• Counselors and sponsors: 2 documents from CESMA, universities, or health institutions in the last 3 years
• Civil Protection Responsible with current certificate (last year)
• Certificate of training in fire extinguisher handling

Area 5: Care Process (42% — 124 points)

This is the heart of regularization. It represents almost half of the total score and evaluates the clinical records of each user.

5.1 Pre-Admission

Each record must contain:

• Initial interview with: general data, substance use, readiness for change, family, free time, mental health, physical health (aligned with NOM-004)
• Screening instrument: ASSIST or other validated instrument to assess risk level
• Instruments for dual disorder:
  • Beck Anxiety Inventory (or equivalent valid)
  • Beck Depression Inventory (or equivalent valid)
  • SCL-90R for psychosis (or equivalent valid)
• Individual assessment note: prepared by medicine, psychology, and social work

5.2 Admission

Mandatory documents in record:

• Admission log (date, general data, type of admission, responsible family member, contact phone)
• Medical admission note: physical examination, diagnostic impression, treatment plan, doctor's signature and professional license (within the first 48 hours)
• Printed CURP, beneficiary card or non-beneficiary letter
• Socioeconomic study performed by social worker
• Voluntary informed consent with user's signature + director + 2 witnesses
• Paragraph in consent guaranteeing:
  • Continuity of medical treatment
  • Protection of personal data (Federal Law)
  • Prohibition of recording without authorization
• Cost transparency form with clause prohibiting retention of user for non-payment
• Payment control/receipts

For emergency admissions, additionally required:

• Written medical indication
• Notification to the Public Ministry within less than 24 hours after admission

5.3 During Evaluation

• Complete clinical history (first 48 hours)
• Minimum laboratory tests: complete blood count, blood chemistry, urine, electrocardiogram, and liver function (minimum 3 out of 5)
• All medication prescribed by doctor with prescription
• Medication administration log with user's signature

5.4 Therapeutic Process

• Daily schedule printed and visible with specific times and responsible staff
• Personalized treatment plan per record (with short, medium, and long-term goals)
• Weekly psychological evolution notes per user
• Medical and social work evolution notes
• Therapeutic program including documented components of:
  • Relapse prevention
  • Life plan
  • Free time management
  • Physical exercise
  • Social reintegration
  • Family participation
  • Life skills (social, cognitive, and emotional)
  • Spirituality (for counseling/sponsorship model)
• Clinical Practice Guidelines available: COPD, liver failure, esophageal varices, acute pancreatitis, alcohol intoxication, opioids, and benzodiazepines
• Individual and group counseling sessions at least once a week

5.5 Discharge

• Final counseling report: number of sessions, goal achievement, reason and type of discharge, prognosis, and follow-up plan
• Medical discharge note with ICD-11 or DSM-5-TR diagnosis, signatures of doctor, psychologist, and director
• Life satisfaction questionnaire
• Service satisfaction questionnaire

5.6 Referrals and Follow-up

• Current emergency directory, validated by CESMA
• Operational guide for referral and counter-referral
• Referral sheets completed for emergency cases, intoxication, opioids
• Follow-up at 1, 3, 6, and 12 months post-treatment, documented in the record

Area 6: User Satisfaction (1% — 4 points)

• Complaint box visible to users and families
• Monthly opening system managed by an external body to the center
• Complaint follow-up log with at least one year of records

Mandatory Items: Those You Cannot Fail

The form explicitly identifies mandatory criteria. Failing any of these is a serious signal. The most critical include:

Infrastructure: equipped office, exclusive individual and group counseling area, signposted dormitories, sufficient beds, restricted access medication storage, current first aid kit.

Organization: operating license, sanitary responsible, legal responsible, CLUNI, RFC, procedure manual, internal regulations, SISVEA notifications.

Human Resources: abstinence tests for director and counselors, sufficient medical staff, weekly psychotherapy and counseling session.

Care Process: initial interview, admission log, admission note, informed consent, clinical history within 48 hours, laboratory tests, schedule, psychological evolution notes, counseling sessions, discharge note, emergency directory.

Frequently Asked Questions (FAQ)

What is the CONASAMA Supervision Form?
It is the official instrument (2025 V. 5.2 version) that CONASAMA and CESMA supervisors use to evaluate residential addiction treatment establishments. It evaluates 292 points across 6 areas.

What is the most important area of the form?
The Care Process represents 42% of the total score (124 points). It is the most demanding section because it evaluates the clinical records of each admitted user.

Does the annex director need to present drug tests?
Yes, if the director has or had a substance use disorder, they must present negative drug tests for 5 elements, performed every 6 months during the last 2 years.

What evaluation instruments does the form accept?
It accepts the ASSIST for screening, the Beck Inventory for anxiety and depression, the SCL-90R for psychosis, or any equivalent validated and reliable instrument. It does not require unique instruments.

Does an annex need a doctor?
Yes. The form requires medical staff available 8 hours daily Monday to Friday (40 hours weekly). This is a mandatory criterion with maximum value in the scoring.

What is SISVEA and what is it for?
It is the Epidemiological Surveillance System for Addictions. Private establishments must send monthly notifications of cases attended, with stamp and signature of receipt. Applies only to private ones.

What happens if I fail mandatory criteria in the first visit?
You have the opportunity to present evidence during the re-coding process. The form allows up to 3 evidence reviews per criterion. However, failing mandatory criteria significantly lowers your total score.

Do records need to follow any specific standard?
Yes. The form specifies that all clinical notes must comply with NOM-004-SSA3-2012, which regulates clinical records in Mexico.

What is the Procedure Manual and who endorses it?
It is the written document that describes the treatment model and all center procedures (pre-admission to follow-up). It must be endorsed by the CESMA of your state.

Can a mutual aid center (12-step model) obtain CONASAMA recognition?
Yes. The form applies to establishments with a "mixed care model," which includes centers with a counseling, sponsorship, and spiritual component, provided they meet documented and staffing standards.

Related Readings

• Read our guide on the clinical record in addiction centers: NOM-004 applied to understand the requirements of each note
• Learn more about the evaluation instruments accepted in the CONASAMA form and how to apply them correctly

For Directors Who Want to Prepare Their Center Before the Visit

The CONASAMA form leaves no room for improvisation. 42% of the score depends on your clinical records being well-constructed from the first day of admission.

This means having the correct forms for: initial interview, admission note, informed consent, treatment plan, evolution notes, counseling notes, follow-up plan, and discharge note — all aligned with NOM-004.

The Essential Manual of Addiction Counseling from ConsejeroEnAdicciones.com includes clinical forms and intervention guides specifically designed for centers in Mexico, aligned with the standards that CONASAMA and CESMA supervisors verify in the field.

Learn about the Essential Manual →

Content prepared by Juan José López, addiction counselor with over 10 years of clinical experience in Mexico and the United States. Director at Baja Rehab. Founder of ConsejeroEnAdicciones.com. Based on the Supervision Form for Residential Establishments with a Mixed Care Model, CONASAMA 2025 V. 5.2.