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

PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.

1. (1) Staff and Volunteers.

   1. (A) All persons working in a child 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 licensure or within thirty (30) days following employment.

   2. (B) Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/ healthcondiseases/communicable/tuberculosis/tbmanual/pdf/ RiskAssessmentform.pdf. This rule does not incorporate any subsequent amendments or additions. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.

      1. 1. If the person has no documented history of ever

receiving a tuberculin skin test (TST), and elects to receive a TST, then a two- (2-) step TST is required. A history of bacilli Calmette-Guerin vaccination (BCG) shall not exempt a person from receiving a tuberculin test.

1. 2. Persons that have a newly positive tuberculin test(s) shall

not be allowed to work until a medical evaluation is performed to determine if the person has active contagious tuberculosis.

1. 3. Persons with active contagious tuberculosis shall be

excluded from employment until deemed non-infectious by the Missouri Department of Health and Senior Services or the local public health agency. The person may return to work once the above criteria have been met, as long as the person adheres to his/her prescribed treatment regimen.

1. 4. All positive tuberculin tests shall be reported to the

Missouri Department of Health and Senior Services or local public health agency as required by 19 CSR 20-20.020.

1. (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 child care facility for subsequent employment.
2. (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. The Medical Examination Report for Caregivers and Staff form, revised 2021, is incorporated by reference in this rule, as published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms. This rule does not incorporate any subsequent amendments or additions.
3. (E) A child care employee, who is identified as a contact to an active tuberculosis case, shall be evaluated for tuberculosis to determine if the person has active contagious tuberculosis, or be excluded from work.
4. (F) If at any time the department has reason to question the physical or emotional health of any person working or volunteering in the facility, the department shall require a physical or mental examination of these persons.
5. (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

2. (12) months prior to admission. The provider may use the department’s medical assessment form or the provider may use its own form if it contains all the information on the department’s form. The Child Medical Examination Report (Infant/Toddler/Pre-School) form, revised 2021, is incorporated by reference in this rule, as published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms. This rule does not incorporate any subsequent amendments or additions.

   1. (B) The examination report shall determine if a child’s medical history and current state of health is satisfactory for participation in a child care program.
   2. (C) Medical examination requirements shall not apply to any child if the parent(s) files a signed statement of objection based on religious beliefs.
   3. (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.
   4. (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. The School-Age Child Health Report form, revised 2021, is incorporated by reference in this rule, as published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms. This rule does not incorporate any subsequent amendments or additions.

AUTHORITY: section 161.092, RSMo 2016, and section 210.221, RSMo Supp. 2021.* This rule 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. Amended: Filed April 29, 2011, effective Oct. 30, 2011. Moved to 5 CSR 25-500.122, effective Aug. 30, 2021. Amended: Filed Oct. 12, 2021, effective May 30, 2022. *Original authority: 161.092, RSMo 1963, amended 1973, 2002, 2003, 2013, 2014, and 210.221, RSMo 1949, amended 1955, 1987, 1993, 1995, 1999, 2015, 2019, 2020, 2022.