Section 390.3220 Medical Care

Section 390

Section 390.3220  Medical

Care

a)

A resident shall be permitted to retain the services of his

or her

own personal physician at his

or her

own expense under an

individual or group plan of health insurance, or under any public or private assistance

program providing such coverage.

(Section 2-104(a) of the Act)

b)

The Department shall not prescribe the course of medical

treatment provided to an individual resident by the resident's physician in a

facility.

(Section 3-201 of the Act)

c)

Every resident shall be permitted to obtain from his

or

her

own physician or the physician attached to the facility complete and current

information concerning his

or her

medical diagnosis, treatment and

prognosis in terms and language the resident can reasonably be expected to

understand.

(Section 2-104(a) of the Act)

d)

Every resident shall be permitted to participate in the

planning of his

or her

total care and medical treatment to the extent that

his

or her

condition permits

. (Section 2-104(a) of the Act)

e)

No resident shall be subjected to experimental research or

treatment without first obtaining his

or her

informed, written consent. The

conduct of any experimental research or treatment shall be authorized and

monitored by an institutional review committee appointed by the administrator

of the facility where such research and treatment is conducted.

(Section

2-104(a) of the Act)

f)

All medical treatment and procedures shall be administered

as ordered by a physician. All new physician orders shall be reviewed by the

facility's director of nursing or charge nurse designee within 24 hours after

such orders have been issued to assure facility compliance with such orders.

(Section

2-104(b) of the Act)

g)

Every woman resident of child-bearing age shall receive

routine obstetrical and gynecological evaluations as well as necessary prenatal

care.

(Section 2-104(b) of the Act) In addition, women residents shall be

referred immediately for diagnosis whenever pregnancy is suspected

rs after

such orders have been issued to assure facility compliance with such orders.

(Section

2-104(b) of the Act)

g)

Every woman resident of child-bearing age shall receive

routine obstetrical and gynecological evaluations as well as necessary prenatal

care.

(Section 2-104(b) of the Act) In addition, women residents shall be

referred immediately for diagnosis whenever pregnancy is suspected.

1)         "Routine obstetrical evaluations" and "necessary

prenatal care" shall include, at a minimum, the following:

A)        Early diagnosis of pregnancy;

B)        A comprehensive health history, including menstrual history, methods

of family planning that the patient has used, a detailed record of past

pregnancies, and data on the current pregnancy that allow the physician to

estimate the date of delivery;

C)        Identification of factors in the current pregnancy that help to

identify the patient at high risk, such as maternal age, vaginal bleeding,

edema, urinary infection, exposure to radiation and chemicals, ingestion of

drugs and alcohol, and use of tobacco;

D)        A comprehensive physical examination, including an evaluation

of nutritional status; determination of height, weight and blood pressure;

examination of the head, breasts, heart, lungs, abdomen, pelvis, rectum, and

extremities;

E)        The following laboratory tests, as early in pregnancy as

possible. Findings obtained from the history and physical examination may

determine the need for additional laboratory evaluations:

i)          Hemoglobin or hematocrit measurement;

ii)         Urinalysis, including microscopic examination or culture;

iii)        Blood group and Rh type determination;

iv)        Antibody screen;

v)         Rubella antibody titer measurement;

vi)        Syphilis screen;

vii)       Cervical cytology; and

viii)      Viral hepatitis (HBsAg) testing;

F)         A risk assessment that, based on the findings of the history

and physical examination, shall indicate any risk factors that may require

special managemen

;

iii)        Blood group and Rh type determination;

iv)        Antibody screen;

v)         Rubella antibody titer measurement;

vi)        Syphilis screen;

vii)       Cervical cytology; and

viii)      Viral hepatitis (HBsAg) testing;

F)         A risk assessment that, based on the findings of the history

and physical examination, shall indicate any risk factors that may require

special management, such as cardiovascular disease, maternal age less than 15

years, neurologic disorder, or congenital abnormalities;

G)        Return visits, the frequency of which will be determined by the

patient's needs and risk factors. A woman with an uncomplicated pregnancy shall

be seen every four weeks for the first 28 weeks of pregnancy, every two to

three weeks until 36 weeks of gestation, and weekly thereafter;

H)        Determinations of blood pressure, measured fundal height, fetal

heart rate, and, in later months, fetal presentation, and urinalysis for

albumin and glucose. Hemoglobin or hematocrit level shall be measured again

early in the third trimester;

I)         Evaluation and monitoring of nutritional status and habits;

J)         Education for health promotion and maintenance;

K)        Counseling concerning exercise and child birth education

programs;

L)        Postpartum review and evaluation four to eight weeks after

delivery, including determination of weight and blood pressure and assessment

of status of breasts, abdomen, and external and internal genitalia

nd monitoring of nutritional status and habits;

J)         Education for health promotion and maintenance;

K)        Counseling concerning exercise and child birth education

programs;

L)        Postpartum review and evaluation four to eight weeks after

delivery, including determination of weight and blood pressure and assessment

of status of breasts, abdomen, and external and internal genitalia.

2)         "Routine gynecological evaluations" shall include, at

a minimum, the following:

A)        An initial examination, the basic components of which are:

i)          History; any present illnesses; menstrual, reproductive,

medical, surgical, emotional, social, family, and sexual history; medications;

allergies; family planning; and systems review;

ii)         Physical examination, including height, weight, nutritional

status, and blood pressure; head and neck, including thyroid gland; heart;

lungs; breasts; abdomen; pelvis, including external and internal genitalia;

rectum; extremities, including signs of abuse; lymph nodes; and

iii)        Laboratory tests, including urine screen; hemoglobin or

hematocrit determination and, if indicated, complete blood cell count; cervical

cytology; rubella titer.

B)        Annual updates, including, but not limited to:

i)          History, including the purpose of the visit; menstrual

history; interval history, including systems review; emotional history;

ii)         Physical examination, including weight, nutritional status

and blood pressure; thyroid gland; breasts; abdomen; pelvis, including external

and internal genitalia; rectum; other areas as indicated by the interval

history;

iii)        Laboratory, including urine screen; cervical cytology, unless

not indicated; hemoglobin or hematocrit determinations; and

iv)        Additional laboratory tests, such as screening for sexually

transmitted disease, as warranted by the history, physical findings, and risk

factors

is, including external

and internal genitalia; rectum; other areas as indicated by the interval

history;

iii)        Laboratory, including urine screen; cervical cytology, unless

not indicated; hemoglobin or hematocrit determinations; and

iv)        Additional laboratory tests, such as screening for sexually

transmitted disease, as warranted by the history, physical findings, and risk

factors.

3)         When a resident is referred for a diagnosis of pregnancy

and/or for prenatal care, the facility shall send the health care provider a

copy of the resident's medical record, including a list of prescription

medications taken by the resident; the resident's use of alcohol, tobacco and

illicit drugs, and any exposure of the resident to radiation or chemicals

during the preceding three months.

h)         Cancer

screening.  Cancer screening for women shall include the following:

1)         A

periodic Pap test.  The frequency and administration of Pap tests shall be

according to the guidelines set forth in the Guidelines for Women's Health

Care, published by the American College of Obstetricians and Gynecologists; and

2)         Mammography.

The frequency and administration of mammograms shall be according to the

guidelines set forth in the Guidelines for Women's Health Care.

i)

Every resident shall be permitted to refuse medical

treatment and to know the consequences of such action, unless such refusal

would be harmful to the health and safety of others and such harm is documented

by a physician in the resident's clinical record.

(Section 2-104(c) of the

Act) (B)

j)

Every resident, resident's guardian, or parent if the

resident is a minor shall be permitted to inspect and copy all of the

the

resident's

clinical and other records concerning

the resident's

care

and maintenance kept by the facility or by

the resident's

physician

(Section 2-104 (d) of the Act).

k)

A resident shall be permitted respect and privacy in his

or

her

medical and personal care program

very resident, resident's guardian, or parent if the

resident is a minor shall be permitted to inspect and copy all of the

the

resident's

clinical and other records concerning

the resident's

care

and maintenance kept by the facility or by

the resident's

physician

(Section 2-104 (d) of the Act).

k)

A resident shall be permitted respect and privacy in his

or

her

medical and personal care program. Every resident's case discussion,

consultation, examination and treatment shall be confidential and shall be

conducted discreetly, and those persons not directly involved in the resident's

care must have his

or her

permission to be present.

(Section 2-105

of the Act)