(a) Permission to administer influenza and pneumococcal vaccine to the residents and influenza vaccine to employees:

1. (1) Is the responsibility of each nursing home; and
2. (2) Must be initiated during admission to the facility.

(c)

1. (1) Consent for vaccination must be:

   1. (A) In writing; and
   2. (B) Signed by either the resident and/or responsible party.
2. (2) The signed consent shall be kept in the resident’s permanent record.
3. (3) Employee consent must also be in writing and placed within the employee’s personnel file.

(d)

1. (1) Nursing homes must:

   1. (A) Maintain a current log or list of residents and employees in their facility; and
   2. (B) Document that each has been immunized.

2. (2) The log must include, at a minimum, the:

   1. (A) Individual’s name;
   2. (B) Date of birth;
   3. (C) Type of vaccine;
   4. (D) Date administered;
   5. (E) Vaccine manufacturer;
   6. (F) Vaccine lot number;
   7. (G) Name of vaccine administrator; and
   8. (H) Date of the vaccine information statement.
3. (3) Additionally, the reason a vaccine was not administered to any resident (including the right to refuse treatment) or employee must be documented on the log or list.
4. (4) A copy of this log must be reported to the Office of Long-Term Care by December 1 of each year.
5. (5) Nursing homes are required to retain a copy of the log for a period of fifteen (15) months after December 1 of the submission year.
6. (6) These log forms may be obtained from the Department of Health by calling 501-537-8969 or 1-800-574-4040.