PURPOSE: This rule prescribes general medical and health care requirements for certain community residential facilities as required in section 630.710, RSMo.

1. (1) Annually, the facility shall have each resident given a physical examination by a licensed physician and a dental examination by a licensed dentist.

   1. (A) Annual physical examinations shall include a complete blood count, tuberculin control test, urinalysis, special studies when the index of suspicion is high; vision and hearing tests and routine screening laboratory examinations, including medication levels, as recommended by the physician; and, at the discretion of the physician, female residents shall have an annual pelvic examination.
   2. (B) The dental examination requirement applies also to residents who have dentures unless the dentist gives written notification that less frequent checkups are adequate but the requirement does not apply to residents under age three (3) nor to edentulous residents unless recommended by a physician.

2. (2) The facility shall have available to each resident the services of a licensed dentist and of a licensed physician who has admitting privileges at a hospital.

   1. (A) The facility shall have formal written arrangements with a community hospital for the treatment and hospitalization of residents.
   2. (B) The facility shall arrange prompt medical and dental treatment when required by a resident injury or illness.
   3. (C) Immunizations shall be kept current in accordance with the recommendation of the Missouri Department of Health.
3. (3) The head of the facility shall immediately report any unusual occurrences of infections or contagious diseases, epidemic outbreaks, poisoning or other occurrences which threaten the welfare, safety or health of any resident to the supervising regional center, the licensing office and local health authority. The facility shall furnish other information relative to the occurrences as required by the department.

4. (4) The head of the facility shall not permit any resident to be provided medical treatment, drugs or topical medications other than by written order of a licensed physician. This rule does not apply to nonprescription topical applications.

   1. (A) Physician’s orders shall be limited to ninety (90) days for prescription drugs. Pro re nata (PRN) orders for prescription drugs shall be reviewed every thirty (30) days.
   2. (B) Standing orders for the entire facility shall not be allowed.
   3. (C) PRN orders for nonprescription drugs and treatment may be utilized for individual residents if the order indicates specific drugs and specific drug dosage or specific treatments for specific indications.
   4. (D) In an emergency, the physician may give or change an order by telephone but the order must be signed within forty-eight (48) hours.
   5. (E) Physician’s orders for regular and PRN nonprescription medication, except nonprescription topical medication, must be reviewed at least every ninety (90) days.
   6. (F) Stock supplies of nonprescription medications are permitted. Nonprescription medication shall not be used after the expiration date on the medication container and shall be disposed of properly.
   7. (G) When a resident is under the care of several physicians at the same time, all doctor’s orders should be kept together and available for review every ninety (90) days. When a resident goes to a consulting physician, his/her chart should accompany him/her.
   8. (H) It is not necessary that the physician’s orders be rewritten each time if there are no changes. The physician’s signature and date is sufficient.

5. (5) The following rules shall regulate the storage and administration of drugs and medications:

   1. (A) Medications shall be properly and clearly labeled in accordance with Missouri statutes and shall be stored under lock and key. Schedule II controlled substances as defined under section 195.017, RSMo, shall be stored under double lock. Internal and external medication shall be kept separate;
   2. (B) The head of the facility shall assume responsibility for the proper administration of medications from a well-lighted central supply cabinet which shall be locked when not in use;
   3. (C) Self-administration of medication shall be allowed as written in the resident’s individualized habilitation or treatment plan and as approved by the physician. Self-administration of medication or treatment shall be supervised by a staff person trained in medication administration;
   4. (D) Errors in administering or in selfadministration of medications shall be reported immediately to the physician and regional center or placement office;
   5. (E) Unused, discontinued, outdated or deteriorated drugs shall be properly disposed of by destruction at the facility or returned to the pharmacist. Destruction of drugs shall be recorded on a medication sheet by two (2) persons, one (1) of whom is a pharmacist, a physician or a licensed nurse;
   6. (F) If a prescription medication does not have an expiration date, the medication should be evaluated every ninety (90) days through a consultation with the pharmacist. It is the responsibility of the head of the day program/residential facility to contact the pharmacist and record his/her advice;
   7. (G) Medical treatment and medications shall be administered in accordance with the physician’s orders and directions on the label of medication containers. The same person who prepares medication shall also administer it and chart it at the same time it is administered; and
   8. (H) First-aid supplies needed to treat simple medical emergencies shall be available at the facility.
6. (6) If a facility has medical and nursing equipment, the head of the facility shall maintain them in operable condition, store them so they are reasonably accessible and use the equipment only for the purpose for which it was intended.
7. (7) If the attending physician recommends that a resident with a contagious or infectious disease be placed in isolation, the head of the facility shall immediately implement the physician’s recommendation. If the isolation within the facility is not possible, the head of 9 CSR 40-5

the facility shall contact the regional center for removal of the resident.

AUTHORITY: sections 630.050 and 630.705, RSMo (1994).* Emergency rule filed Sept. 20, 1983, effective Oct. 1, 1983, expired Jan. 15, 1984. Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed March 14, 1984, effective Aug. 15, 1984. Amended: Filed July 15, 1985, effective Feb. 1, 1986. Amended: Filed Jan. 2, 1990, effective June 11, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. *Original authority: 630.050, RSMo (1980), amended 1993, 1995 and 630.705, RSMo (1980), amended 1982, 1984, 1985, 1990.