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

1. (1) Staff and Volunteers.

   1. (A) All adults working in a day care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial 19 CSR 30-62

licensure or within thirty (30) days following employment.

1. (B) 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.
2. (C) Medical examination reports shall be completed not more than twelve (12) months prior to beginning work in the facility and may be transferable to another day care facility for subsequent employment.
3. (D) The medical examination report form shall be supplied by the department or the facility may use its own form if it contains all the information on the department’s form (see 19 CSR 40-61.125).
4. (E) After the initial medical examination, all adults working in a day care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, 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.
5. (F) If at any time the department has reason to question the physical or emotional health of any adult working or volunteering in the facility, the department shall require a physical or mental examination of these persons.
6. (G) Staff or volunteers shall not work when ill if the health or well-being of children is endangered.

1. (2) Children.

   1. (A) The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report 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 admission.
   2. (B) The examination report shall determine if a child's medical history and current state of health is satisfactory participation in a day care program.
   3. (C) Medical examination requirements 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 facility may use its own form if it contains all the information on the department’s form (see 19 CSR 40-61.125).

AUTHORITY: section 210.221.1(3), RSMo Supp. 1993.* This was previously filed as 13 CSR 40-62.110, 13 CSR 40-62.122 and 19 CSR 40-62.122. Original rule filed March 29,1991, effective Oct. 31, 1991. Changed to 19 CSR 40-62.122, 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 30-62.122 July 30, 1998.

*Original authority 1949, amended 1955, 1987, 1993.