PURPOSE: This rule prescribes general medical and health care requirements for community residential facilities with fewer than four residents as required by 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 and special studies when the index of suspicion is high, vision and hearing tests, 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 also applies 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) For residents who are mentally retarded or developmentally disabled, 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) 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. 1. 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.

1. 2. Standing orders for the entire facility

shall not be allowed.

1. 3. PRN orders for nonprescription drugs

and treatment may be utilized for individual residents if the order indicated specific drugs and specific drug dosage or specific treatments for specific indications.

1. 4. Physician’s orders for regular and

PRN nonprescription medication, except nonprescription topical medication, must be reviewed at least every ninety (90) days. 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.

1. 5. In an emergency, the physician may

give or change an order by telephone, but the order must be signed within forty-eight (48) hours.

1. 6. Medical treatment and medications

shall be administered in accordance with the physician’s orders and directions on the label of medication containers.

1. 7. The same person who prepares med-

ication shall also administer it and chart it at the time it is administered.

1. 8. 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.

1. 9. 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.

1. 10. 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.

1. (D) Immunizations shall be kept current in accordance with the recommendations of the Missouri Department of Health.

1. (3) The head of the facility immediately shall report any unusual occurrences of infectious or contagious diseases, epidemic outbreaks, poisoning or other occurrences which threaten the welfare, safety or health of any resident to the department, the licensing office and local health authority. The facility shall furnish other information relative to the occurrences as required by the department.
2. (4) 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 isolation within the facility is not possible, the head of the facility shall contact the department for removal of the resident. AUTHORITY: sections 630.050 and 630.215, RSMo (1994).* 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 630.215, RSMo (1980), amended 1983.