1. (1) If a child in out-of-home care appears to be suffering from illness or injury requiring medical intervention, the child welfare professional, upon notification, or the out-of-home caregiver shall take the child to the child’s health care provider for a health care screening or treatment. If there is a medical emergency or an urgent need for medical attention, the child shall be taken to the nearest available health care provider or hospital.

2. (2) Ongoing health care and treatment shall include physical, dental and vision examinations as required by Rule Chapter 59G-4, F.A.C., “Medicaid Services.”

   1. (a) If a child is Medicaid eligible, these services shall be sought first through Medicaid providers. If a child is not Medicaid eligible, or if a Medicaid provider is not available or appropriate, then necessary services shall be obtained using other providers.
   2. (b) If the child welfare professional responsible for the case receives a notice for a scheduled child health check-up, he or she shall immediately send copies to the child’s custodial parent, the child’s licensed out-of-home caregiver or relative or non-relative caregiver. Information pertaining to the child’s health check-up shall be documented in FSFN by the child welfare professional responsible for the case within 48 hours of notification of completion of the medical appointment.
3. (3) The parents shall remain financially responsible for the medical care and treatment of a child in out-of-home care when that medical care and treatment is not covered by Medicaid. For children who are not covered by Medicaid but have private insurance coverage, the child welfare professional and the out-of-home caregiver shall cooperate with the child’s health insurance provider in identifying medical providers that will accept the insurance coverage. Unless the child is Medicaid eligible, the parent is responsible for payment in all situations in which the child receives a medical examination or treatment, irrespective of the parent’s consent to such examination or treatment. However, the inability or failure of the parent to meet this payment responsibility shall not delay the receipt of a medical exam or treatment. The financial responsibility of the parent ends when parental rights are terminated.
4. (4) The child welfare professional and licensed caregivers shall receive training in regard to and comply with the federal Health Insurance Portability and Accountability Act which provides procedures regarding the management and protection of personal health information. The child welfare professional shall inform relative and non-relative caregivers regarding the requirements of HIPAA.
5. (5) Required Actions to Gain Medical Consent at Time of the Shelter Hearing. The Children’s Legal Services attorney shall request a blanket court order authorizing the custodian, as named in the order, to give consent for ordinary medical treatment and medication on an ongoing basis. No consent is needed for treatment or medication rendered in the event of an emergency as documented by the attending physician.

6. (6) Consent for Medical Care of Children in Out-of-Home Care When Parental Rights Have Not Been Terminated. There are three types of medical care and treatment, each of which requires its own method to obtain consent for medical treatment. This may include a relative or non-relative who has been granted custody by the court. The attending physician shall determine the type of care needed.

   1. (a) Ordinary Medical Care and Treatment. After a child is adjudicated dependent, the contracted service provider may delegate authority to consent to ordinary medical care and treatment to the out-of-home caregiver if the child remains in the custody of the Department. Children’s Legal Services shall request the court order placing the child in out-of-home care specify individuals who are authorized to consent to ordinary medical care and treatment for the child.

   2. (b) Extraordinary Medical Care and Treatment. If the health care provider determines that an illness or injury requires medical treatment beyond ordinary medical care and treatment, but is not an emergency, the express and informed consent of the child’s parent for the treatment shall be sought. If a parent provides express and informed consent for any extraordinary medical procedure, the form and content of the consent shall be as directed by the prescribing health care professional.

      1. If the parent is unavailable, unwilling or unable to provide informed consent for the proposed medical care, the child welfare professional shall consult with the medical provider to determine if the treatment should be required. If consultation with the medical provider results in a determination that the treatment should be required, the child welfare professional shall seek and obtain an order of the court authorizing the treatment prior to the treatment being rendered. In cases when the child is prescribed psychotropic medications, the procedures established in Section 39.407(3), F.S., will be followed.

      2. If a court order is required to obtain authorization for any extraordinary medical procedure, the following information shall be included in the request for a court order:

      a. Present diagnosis and known past medical interventions for the treatment of this condition,

      b. A statement that the prescribing health care professional has reviewed all medical information concerning the child that has been provided,

      c. The name and requested administration range for any medication requested,

      d. A statement recommending the proposed procedure signed by the attending physician,

      e. An analysis of the risks and benefits of the prescribed treatment for the particular child,

      f. Alternatives to the treatment being recommended and the rationale for selecting the particular treatment recommended; and,

      g. Interventions other than the extraordinary medical care and treatment that are or shall be ongoing in conjunction with the care and treatment.

   3. (c) Emergency Medical Care and Treatment. Although parents shall be involved whenever possible, obtaining consent is not required for emergency care and treatment. If the emergency care and treatment is provided without parental consent, the child welfare professional shall ensure the parent and the guardian ad litem, if appointed, are notified no later than 48 hours from the time the child welfare professional was notified of the care and treatment. The child’s case file shall contain a statement signed by the attending physician that the situation was an emergency and the care was needed to ensure the child’s health or physical well-being. The case file shall also contain documentation that the parent and guardian ad litem, if appointed, were notified after the treatment was administered. If the parents are unable to be located all attempts to locate and notify parents shall be documented in the child’s case file.

7. (7) Consent for Medical Care for Children in the Custody of the Department when Parental Rights Have Been Terminated.

   1. (a) Ordinary and Emergency Medical Care and Treatment. When a child is placed in the custody of the Department following the termination of parental rights, the Department or contracted service provider shall provide consent for ordinary medical care or emergency care of the child. The child welfare professional responsible for the case shall provide documentation of the consent for the ordinary medical care or emergency care and document in FSFN.
   2. (b) Extraordinary Medical Care and Treatment. When a child is placed in the custody of the Department following the termination of parental rights, the Department or contracted service provider shall not provide consent for extraordinary medical care or treatment. Authorization for the extraordinary medical care or treatment shall be obtained by the Department or contracted service provider from the court.

8. (8) Required Documentation for Medical Care and Treatment.

   1. (a) During the initial removal or no later than the first court proceeding thereafter, the child welfare professional responsible for the case shall request the following information from the child’s parents, family members, other caregivers, or health care providers: medical history of the child; medical history of the child’s family and medical consents from the child’s parent or guardian. This information shall be placed in the Child’s Resource Record.
   2. (b) All actions taken to obtain medical history and parental consent for medical screening, treatment, medications or immunizations shall be documented in FSFN and a copy provided to the out-of-home caregiver for placement in the Child’s Resource Record. If parental consent is received, a copy of the “Consent for Treatment and Release of Medical Information,” CF-FSP 4006, Oct 2005, which is incorporated by reference and available at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-06738"
      http://www.flrules.org/Gateway/reference.asp?No=Ref-06738, shall be placed in the child’s case file and a copy provided to the caregiver for placement in the Child’s Resource Record, as defined in Rule 65C-30.001, F.A.C.
   3. (c) A copy of any court orders authorizing treatment shall be documented in FSFN, and a copy provided to the out-of-home caregiver for placement in the Child’s Resource Record.
   4. (d) Any notification provided to parents or others regarding a child’s medical treatment shall be documented in FSFN.
9. (9) Notification of parents. The child welfare professional shall ensure that the child’s parent is notified of any medical treatment of the child where the parent was not involved in providing consent for the treatment within 48 hours from the time the child welfare professional was notified of the treatment.

Rulemaking Authority 39.012, 39.0121(6), (12), (13), 39.407(1), 743.0645 FS. Law Implemented 39.407, 743.064 FS. History–New 5-4-06, Amended 5-8-16.