PURPOSE: This rule sets forth the requirements for medical examinations for caregivers and children in care.

1. (1) Day Care Provider and Assistants.

   1. (A) The child care provider shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities.
   2. (B) The provider shall have a medical examination report on file at the time of initial licensure.
   3. (C) All assistants shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities.
   4. (D) Assistants who are employed or volunteer more than five (5) hours per week shall have a medical examination report on file within thirty (30) days of beginning work in the home.
   5. (E) Medical examination reports shall include a tuberculin skin test, a chest X ray or appropriate follow-up of a previous examination that indicates the individual is free of contagion.
   6. (F) Medical examination reports shall be signed by a licensed physician or registered nurse who is under the supervision of a licensed physician and completed not more than twelve (12) months prior to beginning work in the home. These reports may be transferable to another day care facility for subsequent employment.
   7. (G) The medical examination report form shall be supplied by the department or the provider may use his/her own form if it contains all the information on the department's form.
   8. (H) After the initial medical examination, the child care provider and all assistants who are employed or volunteer more than five (5) hours per week shall have an annual tuberculin skin test, a chest X ray or appropriate follow-up of a previous examination that indicates the individual is free of contagion.
   9. (I) If at any time the department has reason to question the physical or mental health of a provider or assistant, the department shall require a physical or mental examination of that person.
   10. (J) No individual shall work when ill if the health or well-being of children is endangered.

2. (2) Children.

   1. (A) The provider shall require, within thirty (30) days following the admission of each infant, toddler or preschool child, a medical examination report signed by a licensed physician or registered nurse who is under the supervision of licensed physician and completed not more than twelve (12) months prior to admission.
   2. (B) Examination reports shall determine if a child's medical history and current state of health is satisfactory for participation in a day care program.
   3. (C) Medical examination reports shall not apply to any child if the parent(s) files a signed statement of objection based on religious beliefs.
   4. (D) The parent(s) of a school-age child shall provide a report at the time of enrollment indicating the child's health history, any current health problems and any restrictions necessary for the child's care.
   5. (E) The medical examination report form and the health history report for school-age children shall be supplied by the department or the provider may use his/her own form if it contains all the information on the department's form.

AUTHORITY: section 210.221.1(3), RSMo Supp. 1993.* This rule was previously filed as 13 CSR 40-61.110, 13 CSR 40-61.125 and 19 CSR 40-61.125. Original rule filed March 29, 1991, effective Oct. 31, 1991. Changed to 19 CSR 40-61.125, effective Dec. 9, 1993. Emergency amendment filed Aug. 18, 1993, effective Aug. 28, 1993, expired Dec. 25, 1993. Emergency amendment filed Jan. 4, 1994, effective Jan. 14, 1994, expired May 13, 1994. Amended: Filed Aug. 18, 1993, effective April 9, 1994. Changed to 19 CSR 30-61.125 July 30, 1998. *Original authority: 210.221.1(3), RSMo 1949, amended 1955, 1987, 1993.