The amendments and two new rule sections update and clarify the procedures for providing medical care to youth in department facilities and programs.

 

DEPARTMENT OF JUVENILE JUSTICE

Medical

RULE NOS.:RULE TITLES:

63M-2.002Definitions

63M-2.0031Designated Health Authority

63M-2.00315Psychiatry Services

63M-2.0032Role of the Superintendant/Facility Director in Healthcare Services

63M-2.0033Nursing Staff Requirements

63M-2.0035Protocols and Procedures

63M-2.0037Verification of Credentials

63M-2.0038Students or Interns

63M-2.0039Interdisciplinary Risk Reduction/Quality Improvement

63M-2.0041Healthcare Admission Screening

63M-2.0043Routine Notification of the Designated Health Authority Upon Admission

63M-2.0044Tuberculosis (TB) Control and Screening

63M-2.0045Medical Alert System

63M-2.0046Healthcare Orientation of Committed Youth

63M-2.0047Health-Related History (HRH)

63M-2.0048Comprehensive Physical Assessment (CPA)

63M-2.005Consent and Notification Requirements

63M-2.0051Routine Consent - Authority for Evaluation and Treatment (AET)

63M-2.0052Special Consent

63M-2.006Sick Call

63M-2.008Periodic Evaluations

63M-2.009Episodic Care

63M-2.010Girls Gender Responsive Medical Services

63M-2.021Pharmacy Permits and Licenses

63M-2.022Verification and Procurement of Medications Prescribed Prior to Admission

63M-2.023Transfer of Youth's Medications

63M-2.025Inventory and Storage of Sharps

63M-2.026Inventory of Medications

63M-2.030Routine Medication Administration

63M-2.031Youth Self-Administration of Oral Medication Assissted by Trained Non-Licensed Staff

63M-2.032Youth Refusal of Medication

63M-2.033Youth Hoarding of Medication and Swallowing Difficulties

63M-2.034Administration of Parenteral Medications

63M-2.036Adverse Drug Events and Medication Errors

63M-2.037Education of Youth on Medications

63M-2.040Environmental and Exercise Precautions

63M-2.050Infection Control - Regulations and Training

63M-2.052HIV Counseling and Testing

63M-2.061Record Documentation, Development and Maintenance

63M-2.062Core Health Profile

63M-2.063Interdisciplinary Health Record

63M-2.064Storage, Security and Control of the Individual Health Care Record

63M-2.070Health Education

63M-2.081Youth Release to the Community

63M-2.082Transfer from Residential Commitment Program

63M-2.083Youth Released to the Community from Secure Detention

PURPOSE AND EFFECT: The amendments and two new rule sections update and clarify the procedures for providing medical care to youth in department facilities and programs.

SUMMARY: Amendments are made throughout the continuum of care.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The SERC Checklist and current information available to the Department indicates that the statutory threshold for ratification will not be exceeded.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 985.64, F.S.

LAW IMPLEMENTED: 985.64, 985.145, 985.18, F.S.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: Thursday, November 14, 2024 at 10:00 a.m.

PLACE: DJJ Headquarters, 2737 Centerview Dr., General Counsel's Conference Room 3226, Tallahassee, Florida. For information about participation by telephone, contact John Milla at [phone]

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: John Milla, 2737 Centerview Dr., Ste. 3200, Tallahassee, FL 32399-3100, e-mail: [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

63M-2.002 Definitions.

The following definitions shall be used for the department’s acceptable health care treatment services for youth in Detention, Residential and Facility-Based Community Corrections.

(1) Adverse Drug Events: Aan illness or injury resulting from a medical intervention related to a drug.

(2) Assigned Custodian: Individual assigned by the parent/guardian to make healthcare decisions for the youth, as evidenced by a lawful power of attorney under chapter 709, F.S., or a surrogate designation under chapter 765, F.S.

(3)(2) Authority for Evaluation and Treatment (AET): Form HS 002, that when signed by a parent or legal guardian, gives the dDepartment the authority to assume responsibility for the provision of routine mental and physical healthcare to a youth within its physical custody.

(4)(3) Cheeking: Aa term used to describe patients who hide their medications in their cheek or under their tongue to prevent swallowing them.

(5)(4) Chief Probation Officer (CPO): –The department employee who is responsible for managing community-based program operations, including department staff and contracted providers, and staff within each of Florida’s twenty judicial circuits.

(6)(5) Chronic medical condition: Aany illness, disability or condition that is permanent or has persisted persists longer than six months, or has exacerbated within the past six months, causing subsequent treatment/evaluation, apart from with the exception of allergies., This may include uncorrected or uncompensated hearing/speech/visual impairment, but excludes Developmental Disability, or Intellectual Disability Mental Retardation.

(7)(6) Clinical responsibility: Tthe oversight of the medical care of all youth within a department facility. This includes the overall clinical direction, policies, and protocols for the medical services provided.

(8) Community Based Programs: Facility-based non-residential services for youth under prevention services.

(9)(7) Community Provider: Aa Health Care Provider outside of the department commitment system.

(10)(8) Comprehensive Physical Assessment (CPA) (HS 007): Aa comprehensive physical assessment (exam) performed by a physician (MD), osteopathic physician (DO), physician’s assistant (PA), or advanced practice registered nurse (APRN). practitioner (ARNP). The purpose of this assessment is the establishment of a data point, which is used to facilitate the following:

(a) through (d) No change.

(11)(9) Controlled Substances: Aall substances defined as “Controlled” in Chapter Section 893.03, F.S.

(12)(10) Core Health Profile: Aa section of the individual health care record, which contains standardized forms that are filed in designated sub-sections of the Individual Health Care Record (IHCR).

(13)(11) Corrective action: Rrefers to an analysis of the problem’s root cause with a subsequent adjustment in the system in order to prevent future mistakes from taking place.

(14)(12) Designated Health Authority (DHA): The DHA shall be a Physician (MD) who holds an active, unrestricted license under Chapter 458, F.S., or an osteopathic Physician (DO) who holds an active, unrestricted license under Chapter 459, F.S., or an Advanced Practice Registered Nurse (APRN), who has qualifications in Autonomous Practice, who holds an active, unrestricted license under Chapter 464, F.S., and meets all requirements for practice in the State of Florida. The Autonomous APRN may not serve as the DHA of programs with complex medical beds. The Physician must be either Board Certified in Pediatrics, Family Practice, Emergency Medicine, or Internal Medicine (with experience in adolescent health) or Board-Eligible and have prior experience in treating the primary health care needs of adolescents. The Autonomous Practice APRN must have experience with Pediatrics, Emergency Care, Family Practice, or Internal Medicine (with experience in adolescent health). A Psychiatrist who holds an unrestricted license under Chapter 458 or 459, F.S., may serve as the DHA of a facility that provides specialized mental health services, as long as the Psychiatrist has current experience in medically treating the physical health care needs of adolescents. The DHA shall be either a state employed or contracted clinician Physician accountable for ensuring the delivery of administrative, managerial and medical oversight of the facility health care system. Corporate clinicians physicians, who do not perform clinical/administrative duties on-site, shall not be the Designated Health Authority. The DHA shall ultimately be responsible for the provision of necessary and appropriate health care to youth in the care of a detention center or residential commitment program.

(15)(13) Detention Center: Aa temporary hardware-secure state-operated, county or municipal facility for juveniles, which compares to a jail in the adult system.

(16) Electronic Medical Record/Electronic Health Record (EMR/EHR): The EMR and EHR definition can be used interchangeably for this Rule. Electronic Health Record is a department electronic system to maintain and securely access youth(s) Individual Health Care Record to meet federal and state regulations and to allow oversight and confidential access remotely or on site to the youth(s) health information.

(17)(14) Episodic care: Tthe health care component intended to provide medical services in response to unexpected illnesses, accidents or conditions that require immediate attention or an immediate professional assessment to determine their severity. Episodic care also includes responses to those complaints that can result in severe pain or suffering, even if the youth’s life does not appear to be in danger.

(18)(15) Facility: Ffor the purposes of this chapter, a Detention Center or Residential Commitment Program.

(19)(16) Facility Management System (FMS): The computer-based computer based system used by state-operated juvenile detention centers as the primary source of documentation and reporting for facility operations. Forms and reports generated by FMS are considered to be both the official and original documentation for the area concerned.

(20)(17) Facility Operating Procedures: Ffacility/program-specific procedures implemented as guidelines for providing care and oversight to youth.

(21)(18) Facility Superintendent/Major: Tthe person responsible for the operation of a designated regional juvenile detention center.

(22)(19) First Aid: Aany one-time treatment, and follow-up visit for the purpose of observation, of minor injuries such as cuts, scratches, first degree burns and splinters. Ointments, salves, antiseptics, and dressings to minor injuries are considered to be first aid.

(23)(20) Five Rights of Medication Administration: Tthese five rights are specifically defined as:

(a) through (c) No change.

(d) Right Dosage; and

(e) No change.

(24) Focused Note: A chronological progress note in SOAP note (Subjective, Objective, Assessment and Plan) format which documents the review of the prior CPA and documents any discrepancy or changes to the current assessment noted in the CPA and outlines any plan to address the findings when youth return to DJJ programming.

(25)(21) Health-Related History Form (HRH) (HS 014): Tthe form required to document a standardized, comprehensive medical and health-related questionnaire.

(26)(22) Renumbered and no change.

(27)(23) Individual Health Care Record (IHCR): The permanent departmental file containing the unified cumulative electronic and hard-copy collection of clinical records, histories, assessments, treatments, diagnostic tests which relate to a youth’s medical, mental health, substance abuse, Developmental Disability, behavioral health and dental health which have been obtained to facilitate care or document care provided while the youth is in a detention center and residential commitment program.

(28)(24) Juvenile Assessment Center: Chapter Section 985.135, F.S. establishes juvenile justice assessment centers which are designed to serve as a point of intake and screening for juveniles referred to the dDepartment.

(29)(25) Juvenile Justice Information System (JJIS): The department’s electronic information system used to gather and store information on youth youths having contact with the department.

(30)(26) Juvenile Probation Officer (JPO): A person meeting the definition in Chapter Section 985.03(30), F.S., and Chapter Rule 63D-138.001, F.A.C.

(31)(27) Licensed Health Care Professional: Ffor the purposes of this Rule chapter, a Registered Nurse (RN), Licensed Practical Nurse (LPN), and an Advanced Practice Registered Nurse (APRN) Practitioner (ARNP) licensed under Chapter 464, F.S.; a Medical Doctor (MD), and a Physician Assistant (PA) licensed under Chapter 458, F.S.; an Osteopathic Physician (DO) licensed under Chapter 459, F.S.; and a Dentist (DMD, DDS) licensed under by Chapter 466, F.S.

(32)(28) Medical Grade: One of five (5) categories or grades that can be assigned to a youth as part of the medical classification system. The specific Medical Grades are defined as follows:

(a) through (d) No change.

(e) Medical Grade 5: Youth is prescribed any medication for diagnosed mental and/or emotional disorders. This medical grade shall be the only grade assigned in consideration of mental health disorders.

(33)(29) No change.

(34)(30) Non-licensed: For the purposes of this rule, persons who do not hold a medical or nursing licensure recognized as active in the state of Florida from the Division of Health Quality Assurance of the Department of Health but who function in an assistive role to registered nurses or licensed practical nurses in the provision of patient care services through delegated tasks or activities. These delegated tasks or activities shall be provided under the clinical supervision of a Registered Nurse nurse or higher licensure level.

(35) Over-The-Counter medications (OTCs): OTC medications are defined as medications that are safe and effective for use by the general public without seeking treatment by a health professional and can be provided to youth utilizing health care and non-health care protocols within manufacturers recommendations.

(36)(31) Periodic Evaluation: Aa follow-up focused medical evaluation for youth by a physician (MD), osteopathic physician (DO), advanced practice registered nurse (APRN) practitioner (ARNP) or physician’s assistant (PA) for youth with chronic conditions or communicable diseases, at specified time intervals.

(32) Over-The Counter medications (OTCs): Any drug that routinely does not require a prescription.

(37)(33) Perpetual Inventory: A dose-by-dose inventory process for the daily distribution of prescribed over-the-counter medication and sharps. Sharps are to be counted as each sharp is utilized and disposed of.

(38)(34) Practitioner’s Orders: Prescribed and authorized treatments and medications written for implementation by duly licensed practitioners authorized by their respective practice acts to do so. For the purposes of this rule, the term refers to orders written or given verbally by Physicians, Physician Assistants, Advanced Practice Registered Nurses Nurse Practitioners, and Dentists.

(39)(35) Probation: An individualized program in which the freedom of the child is limited and the child is restricted to non-institutional quarters or restricted to the child’s home in lieu of commitment to the custody of the department as per Chapter Rule 63D-138.001, F.A.C.

(40)(36) Program Director/Facility Administrator: The on-site administrator of a Residential Commitment Program, whether state or privately operated, who is accountable for the on-site operation of the program.

(41)(37) Renumbered and no change.

(42)(38) Protective Action Response (PAR)/Right Interaction (RI) – The department approved verbal, physical, and mechanical intervention curriculum used in accordance with Chapter 63H-3, F.A.C. Department-approved verbal and physical intervention techniques and application of mechanical restraints used in accordance with the DJJ Administrative Rules 63H-1.001-1.016, F.A.C., the Protective Action Response Escalation Matrix, and PAR training curricula.

(43) Psychiatric APRN: A licensed advanced practice registered nurse who has a master's degree or a doctorate in psychiatric nursing and two years post-master's clinical experience under the supervision of a physician. A licensed and certified psychiatric Advanced Practice Registered Nurse (APRN) under Chapter 464, F.S., with a master’s degree or doctorate in psychiatric nursing or mental health nursing and two years post-master’s clinical experience in pediatric or adolescent psychiatric treatment under the supervision of a physician would meet this definition as specified in section 394.455, F.S.

(44) Psychiatric Services: Within this rule refers to provision of psychiatric evaluations, prescribing psychotropic medications and monitoring psychotropic medications rendered by a psychiatrist or Psychiatric Advanced Practice Registered Nurse (APRN).

(45) Psychiatrist: A physician licensed pursuant to Chapter 458 or 459, F.S. who is board certified in Child and Adolescent Psychiatry or Psychiatry by the American Board of Psychiatry and Neurology or has completed a training program in Psychiatry approved by the American Board of Psychiatry and Neurology for entrance into its certifying examination. A Psychiatrist, who is board certified in Forensic Psychiatry by the American Board of Psychiatry and Neurology, or the American Board of Forensic Psychiatry, may provide services in DJJ facilities or programs but must have prior experience and training in psychiatric treatment with children or adolescents.

(46) Psychotropic Medication: Medications capable of affecting the mind, emotions and behavior that are used to treat mental illness. The medications, include, but are not limited to the following major categories: antipsychotics, antidepressants, antianxiety drugs, mood stabilizers, and stimulants.

(47)(39) Residential Commitment Program: As defined in Chapter chapter 985, F.S., the level of programming and security provided by programs that service the supervision, custody, care, and treatment needs of committed youth. A low-risk, moderate-risk, high-risk, or maximum-risk residential delinquency program for committed youth.

(48)(40) Restricted Housing: All situations involving segregation, isolation, or separation of a youth for any reason, including disciplinary, medical or mental health reasons. Thus, this term includes disciplinary confinement, room restriction, secure observation, controlled observation, or any other form of housing which separates youth is separate from that of the general population.

(49)(41) No change.

(50)(42) Sharp: Any object routinely used in medical procedures, including but not limited to, hypodermic needles, scalpels, blades, sutures, instruments with or without blunt ends, and broken glass, broken capillary tubes, breakable culture dish, and exposed ends of dental equipment. wires.

(51) Shift-to-Shift Inventory: An inventory of controlled substances that shall be conducted with each shift change, ending shift or new shift, prior to the administration of any controlled substance. It shall be conducted with one oncoming and one off-going staff responsible for the access/administration of controlled substances. If nursing staff shifts do not correspond with other nursing staff, then a non-licensed staff shall observe and witness the counting of all controlled substances in the instance where the nurse comes on shift and when the nurse goes off shift for the day.

(52)(43) No change.

(53)(44) No change.

(54) Subjective, Objective, Assessment, Plan (SOAP): The medical documentation note format nationally recognized as universal documentation for all medical documentation to be used within the Individual Healthcare Record.

(55)(45) Transitional Health Care Planning: Tthe process of planning and information exchange to maintain continuity of care for a youth who is discharged, released to the community from a facility, or transferred between facilities.

(56)(46) Treatment Protocols: Tthe precise and detailed plan for a course of medical treatment developed by the Designated Health Authority/designee that describes a patient's treatment regimen; a detailed plan for the delivery of health care treatment, procedures, tests, medications and dosages. These treatment protocols are limited in scope and responsibility depending upon whether the protocol is written for implementation by licensure level or non-licensed direct care staff.

(57)(47) Working Inventory: Inventory of stock medications, syringes, needles, phlebotomy equipment, suture kits, and other potentially dangerous sharps that is permitted to be kept in an area outside of regular stock for immediate access by nursing and trained non-licensed staff, which is separately tracked for use from the larger quantities stored in a secured area accessible only by licensed staff. including but not limited to, syringes, needles, phlebotomy equipment, suture kits, and all other potentially dangerous sharps and other devices.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended          .

 

63M-2.0031 Designated Health Authority.

(1) The Designated Health Authority (DHA) has the clinical responsibility for all program physical health and medical services occurring within the confines of the facility. Final clinical judgments regarding medical treatment received in the facility shall rest with this single individual.

(2) The role and function of the Designated Health Authority shall be clearly articulated in a written contract or agreement between the provider facility or program and the Designated Health Authority.

(3) The contract shall clearly indicate:

(a) At a minimum, the DHA must be on-site once per week, with a week defined as the seven-day period beginning on Sunday and ending on Saturday. However, at no time will more than nine days pass between onsite visits. This is to allow flexibility for unexpected or emergent situations and should not be the routine process. The DHA must be on-site monthly when the weekly clinical duties have been delegated to a qualified practitioner (with an agreement, for at a minimum, weekly service being provided on site by the qualified practitioner). An Autonomous APRN may not delegate clinical duties and therefore must provide onsite weekly services.

(b) through (e) No Change.

(f) The licensure level of the clinician (APRN, MD, or DO).

(4) The Designated Health Authority, who is an MD or DO only, may delegate clinical duties only to the following clinicians, as defined in Rule 63M-2.002, F.A.C., Designated Health Authority, (which may include the provision of on call coverage if designated in writing by a collaborative agreement):

(a) No change.

(b) An Advanced Practice Registered Nurse (APRN) Practitioner (ARNP), with education, experience and certification in Family Health or Pediatrics, or

(c) No change.

(5) No change.

(6) The Unless the Designated Health Authority is a psychiatrist, the following duties and activities shall not be the responsibility of the Designated Health Authority:

(a) through (c) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended 5-8-17,  .

 

63M-2.00315 Psychiatry Services

(1) Each Detention Center and residential commitment program shall have available, within the facility, written agreements, or contracts with on-site providers, for the provision of Psychiatric Services.

(2) Psychiatry services shall be provided by a Psychiatrist, or by a licensed and certified Psychiatric Advanced Practice Registered Nurse (APRN) under Chapter 464, F.S., who works under the clinical supervision of a Psychiatrist, as specified in the collaborative practice protocol with the supervising Psychiatrist and is maintained at the location where services are provided.

(a) The Psychiatrist or Psychiatric APRN providing psychiatric services in a departmental facility or program must comply with Chapter 63M-2, F.A.C., provisions regarding medication management whenever a youth is considered for, prescribed or receiving psychotropic medication.

(b) The Psychiatrist or Psychiatric APRN shall only prescribe psychotropic medications, which address the youth’s specific diagnoses and target symptoms.

(c) If psychotropic medications are required, the lowest dose of medication necessary to achieve therapeutic effect shall be used bearing in mind potential benefits and risks.

(d) The use of more than one psychotropic medication as part of a mental health treatment regimen requires documented clinical justification for each psychotropic medication utilized by the Psychiatrist or Psychiatric APRN.

(e) Psychotropic medication shall be only one component of the therapeutic program. Additional treatment modalities such as individual, group and family therapy, behavioral therapy, substance abuse counseling and psychosocial skills training shall be utilized in conjunction with the use of psychotropic medication and must comply with Chapter 63N-1, F.A.C.

(f) Psychotropic medication shall not be used as punishment, for staff convenience, discipline, coercion, or retaliation, as a substitute for meaningful psychosocial, rehabilitative services or in quantities that lead to a loss of functional status.

(g) There shall be no pro re nata (PRN) or standing orders for psychotropic medications.

(h) There shall be no emergency treatment orders for use of psychotropic medication as a chemical restraint. Chemical restraint means a medication used to control behavior or restrict the youth's freedom of movement and is not a standard treatment for the youth's psychiatric condition.

(i) Injectable psychotropic medications shall require justification and may not be self-administered and may only be administered by a licensed nurse or practitioner.

(3) Each detention center and residential commitment program’s intake screening process must determine whether a youth is taking psychotropic medications. If so, the youth is to be referred for a psychiatric evaluation to be conducted within fourteen days of the youth’s admission. The psychiatric evaluation must be identified as such and documented on the Clinical Psychotropic Progress Note (HS 006), or a form developed by the program which contains all the information required in form HS 006. The Clinical Psychotropic Progress Note (HS 006, October 2014) is incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17126.

(4) Youth who are referred for a new psychiatric evaluation after admission must receive psychiatric evaluation within 30 days of the referral or expedited based on youth needs.

(a) The psychiatric evaluation must be identified as such and documented on the Clinical Psychotropic Progress Note Form (HS 006) or a form developed by the program which contains all the information required in form HS 006.

(b) If the youth’s file contains a psychiatric evaluation which was completed within the past 6 months, the previous psychiatric evaluation may be utilized by the facility’s Psychiatrist or Psychiatric APRN, to conduct an updated psychiatric evaluation. The updated psychiatric evaluation must be identified as such and documented on the Clinical Psychotropic Progress Note Form (HS 006) or a form developed by the program which contains all the information required in form HS 006.

(5) Each youth who is receiving psychotropic medication shall be seen for medication review by the Psychiatrist or Psychiatric APRN, at a minimum, every 30 days. Medication review shall include evaluating and monitoring medication effects and the need for continuing or changing the medication regimen.

(6) Psychotropic medication that is prescribed or significantly changed shall be documented on page 3 of the Clinical Psychotropic Progress Note Form (HS 006). Psychotropic medication that is continued without significant changes shall be documented either on page 3 of form HS 006 or a form developed by the program that contains all the information required on page 3 of form HS 006.

(7) Whenever a new psychotropic medication is prescribed, discontinued, or the drug dosage is significantly changed, parent/guardian/assigned custodian notification and consent must be obtained unless the youth is 18 years of age or older, or is emancipated as provided in Chapter 743, F.S., and is responsible for authorizing his or her own health care, or a physician determines that immediate treatment is needed as set forth in Chapter 985, F.S.

(8) Parent/guardian/assigned custodian consent for psychotropic medication shall be accomplished through the following action:

(a) The Psychiatrist or Psychiatric APRN must attempt to contact the parent or legal guardian by telephone to obtain his or her verbal consent for the psychotropic medication.

(b) The Psychiatrist or Psychiatric APRN must document the parent or guardian’s verbal consent, when obtained, on page 3 of the Clinical Psychotropic Progress Note Form (HS 006), or a form developed by the program that contains all the information required on page 3 of form HS 006. The verbal consent must be witnessed, and the witness will sign on page 3 of the form HS 006 along with the Psychiatrist/Psychiatric APRN’s signature, where indicated.

(c) A copy of the 3rd page of the Clinical Psychotropic Progress Note (HS 006) or a form developed by the program that contains all the information required on page 3 of form HS 006, and the Acknowledgment of Receipt of CPPN or Practitioner Form (Parental Consent for Psychotropic Medication) (HS 001) shall be mailed to the parent/guardian/assigned custodian. The Acknowledgment of Receipt of CPPN or Practitioner Form (Parental Consent for Psychotropic Medication) (HS 001, January 2024) is incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16912.

(d) The parent or legal guardian’s signature on the Acknowledgment of Receipt of CPPN or Practitioner Form (Parental Consent for Psychotropic Medication) (HS 001) provides written consent for the psychotropic medications as recorded on page 3 of the CPPN form HS 001 mailed to the parent, legal guardian, or assigned custodian.

(9) Where parental rights have been terminated and the youth is prescribed psychotropic medications the department or its representatives shall obtain an order of the court authorizing the treatment prior to the treatment being rendered. The department or its representative may ask the Department of Children and Families to assist with this process or confirm authorization has been given in accordance with Chapter 65C-35, F.A.C.

(10) The Psychiatrist or Psychiatric APRN must brief the facility’s treatment team on the psychiatric status of each youth receiving psychiatric services who is scheduled for treatment team review. The briefing may be accomplished through face-to-face interaction or telephonic communication with a representative of the treatment team, or through a detailed progress note submitted by the Psychiatrist or Psychiatric APRN prior to the treatment team meeting.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.601(3)(a), 985.14(3)(a), 985.145(1), 985.18, 985.48(4), 985.64(2) FS. History–New                  .

 

63M-2.0032 Role of Superintendent/Facility Administrator Director in Healthcare Services.

(1) The Facility Superintendent/Major or Facility Administrator/Program Director, with collaborative support from the Office of Health Services, is responsible for:

(a) Ensuring that the Designated Health Authority is clearly informed of all of the department’s health care requirements at the time of the negotiation of the agreement/contract. This responsibility can be delegated to the Facility Superintendent or Program Director Designee and shared with supervisors at the Provider’s Regional level;

(b) through (c) No Change.

(2) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended          .

 

63M-2.0033 Nursing Staff Requirements

(1) Licensed nurses are required to practice within the Florida Nurse Practice Act and the applicable Florida Board of Nursing Rules (Chapter 464, F.S. and Chapter 64B9, F.A.C.).

(2) All detention and residential facilities shall have on-site nursing coverage to be provided by Registered Nurses (RNs) or, at a minimum, Licensed Practical Nurses (LPNs) as outlined by contract.

(3) The licensed healthcare professional that is providing the direction to the LPN is responsible for reviewing all medical cases daily with the LPN, and be available by electronic or telephonic means on-call for consultation for the LPN. Based upon the results of this clinical consultation, on-site assessment and management of medical cases must be provided by the licensed healthcare professional.

(4) Each detention and residential facility shall have practitioner level on-call medical coverage for nights and weekends when no nurse is on-site. There shall be a staff person on every night or weekend shift responsible for accessing medical services or personnel. For specialty facilities and intensive medical facilities, a higher level of nursing coverage may be indicated and shall be clearly articulated per a contractual agreement with the department.

(5) Health care staff shall not be involved in the collection, assembly, or interpretation of, information or laboratory data that will be used in judicial processes to ensure the nurse patient relationship is maintained and establish that the patient advocacy role is clear to the youth receiving care.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.0035 Protocols and Procedures.

(1) Protocols shall adhere to community standards of practice and identify and support the need for maintaining youth privacy during examination and handling of health information. Clinical encounters shall be conducted in private. Escorting, non-health care staff/officers, shall maintain distance from the examination for privacy, however, shall also maintain presence within medical to ensure the safety of medical personnel.

(2)(1) No change.

(3)(2) The facility Designated Health Authority shall review and approve treatment protocols for the on-site licensed nursing staff and non-licensed staff to utilize when administering care in response to commonly encountered complaints. These protocols must be within the scope of practice and level of expertise and training of the staff conducting the evaluation for care. Sick Call process.

(4)(3) No change.

(5)(4) When utilizing treatment protocols, the Designated Health Authority or Physician Designee, PA or APRN ARNP shall be contacted when deemed necessary based upon clinical judgment and when the protocol indicates.

(6)(5) Documentation of the implemented treatment protocol shall be recorded by one of the following:

(a) Within the Electronic Health Record On the treatment protocol copy;

(b) Directly on the Sick Call Request Form (HS 032, February 2010);

(c) For non-licensed staff, the Report of On-Site Health Care by Non-Health Care Staff Form (HS 049, December 20232006), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1693103796 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(d) No change.

(7)(6) The Designated Health Authority, the Psychiatrist, (if applicable), and the Dentist (if services are provided on site applicable), must review, sign and date all of their respective written treatment protocols annually, each time a new protocol is developed and/or when an existing one is changed at a time other than the annual review.

(8)(7) Nursing staff must review, sign and date a cover page, on which all applicable Facility Operating Procedures, treatment protocols, and other procedures are listed, annually. Any changes in these documents that are made during the year must be reviewed, signed, and dated by each nurse on the individual documents or a designated page.

(9)(8) An annual review of all applicable Facility Operating Procedures and treatment protocols is required. This is demonstrated by the signature and date of the DHA and, facility Superintendent/Program Director.

(10)(9) No change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended         .

 

63M-2.0037 Verification of Credentials.

(1) The facility Superintendent, Program Director or designee are responsible for verification of credentials prior to contract execution and at the time of a change in medical provider prior to admittance to the facility/center for all health care providers at that facility.

(2) A copy of the following documentation shall be maintained in the health care provider’s service agreement file at the facility/center and with the contract manager at the respective regional office:

(a) No change.

(b) Curriculum Vitae (for APRN licensure and higher level) Resume; and

(c) No change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended         .

 

63M-2.0038 Students or Interns.

(1) No change.

(2) All student observation experiences must be pursuant to a written agreement with the academic institution and the medical provider, and the agreement must also be on file with the department contract manager.

(3) through (5) No change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.0039 Interdisciplinary Risk Reduction/Quality Improvement.

(1) No Change.

(2) Meetings shall be held and documented no less than quarterly, whereby all disciplines that provide or oversee the provision of physical and mental health care, programming/operations and behavior management are represented. Additional meetings shall be held as needed when an adverse or sentinel event occurs or the potential for such an event is recognized.

(3) Simple Root Cause Analysis or another problem-solving methodology shall be conducted for review of actual adverse or sentinel events and reviewed during such meetings.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.0041 Healthcare Admission Screening.

(1) Each facility shall screen every youth upon admission to determine if the youth has an acute injury, illness, chronic medical condition, physical impairment (e.g., speech, hearing, visual), mental disability, or developmental disability that requires medical or mental health evaluation and treatment, and/or medication needs to be met.

(a) An oral screening shall be on the Oral Health Assessment Form (HS 050, February 2007), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03797 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize a form of their choice as long as the form includes all information required on the Oral Health Assessment Form that is incorporated by reference into Chapter 63M-2, F.A.C.

(b) All youth shall be screened for possible Sexually Transmitted Diseases by completing the Sexually Transmitted Infections Screening Form (HS 029, October 2006), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03798 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize a form of their choice as long as the form includes all information required on the Sexually Transmitted Disease Screening Form that is incorporated by reference into Chapter 63M-2, F.A.C.

(c) All youth shall be screened for possible communicable diseases by utilizing the Infectious and Communicable Disease Form (HS 018). The Infectious and Communicable Disease Form (HS 018, October 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03799 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(a)(d) In detention facilities, a Medical and Mental Health Admission Screening must be conducted by detention staff and documented in the Facility Management System (FMS).

(b)(e) In residential commitment programs, the Facility Entry Physical Health Screening document (HS 010) shall be utilized. The Facility Entry Physical Health Screening form (HS 010, March 2024 May 2007) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1691703800 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(c)(f) In a Juvenile Assessment Center, the Probation Medical and Mental Health Clearance Form (HS 051) shall be utilized when law enforcement delivers a youth to the department for screening or for youth who are self-surrendering without law enforcement present upon apprehension. The Probation Medical and Mental Health Clearance Form (HS 051, July 2010) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03801 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(2) A licensed nurse, advanced practice registered nurse (APRN), practitioner (ARNP), physician assistant (PA) or physician (MD or DO) shall review the admission screening within 24 hours of a youth’s admission to a detention center or residential commitment program if the screening was not conducted by a licensed nurse. The following screenings are to be completed after the completion or review of the Facility Entry Physical Health Screening or the Medical and Mental Health Admission Screening:

(a) An oral screening shall be on the Oral Health Assessment Form (HS 050, April 2024), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-16932. The facility may utilize a form of their choice as long as the form includes all information required on the Oral Health Assessment Form that is incorporated by reference into Chapter 63M-2, F.A.C.

(b) All youth shall be screened for possible Sexually Transmitted Diseases by completing the Sexually Transmitted Infections Screening Form (HS 029, April 2024), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-16927. The facility may utilize a form of their choice as long as the form includes all information required on the Sexually Transmitted Disease Screening Form that is incorporated by reference into Chapter 63M-2, F.A.C.

(c) All youth shall be screened for possible communicable diseases by utilizing screening instruments and documentation on the Infectious and Communicable Disease Form (HS 018, March 2024). The Infectious and Communicable Disease Form (HS 018,) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-16922.

(3) Youth are to be re-screened utilizing the Medical & Mental Health Screening Tool for Detention or Facility Entry Physical Health Screening (HS 010) by the receiving facility whenever they are moved from one facility to another with an anticipated stay of 24 hours or more to include transfers within detention.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended         .

 

63M-2.0043 Routine Notification of the Designated Health Authority upon Admission.

(1) In situations where a youth does not require immediate emergency transfer, the Designated Health Authority or designee must be notified of all youth admitted with a medical condition, illness, or injury documented at the time of screening. This notification may be by telephone, electronically, or verbally with documented confirmation, in accordance with state and federal privacy regulations.

(2) No change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.0044 Tuberculosis (TB) Control and Screening.

(1) All facilities shall implement routine screening for all youth for latent and active tuberculosis, upon within 72 hours of admission, as well as environmental controls in the case of a youth with active Tuberculosis, in accordance with the Florida Department of Health Centers for Disease Control and Prevention recommendations.

(2) After the initial screening, a TB test shall be completed within 7 days of admission, if there is no documentation of a current (within one year) TB test on file.

(3)(2) Renumbered and no change.

(4)(3) The Designated Health Authority or designee shall be responsible for the reporting of all youth with confirmed TB disease to the Department of Health.

(5)(4) Renumbered and no change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended       .

 

63M-2.0045 Medical Alert System.

(1) through (3) No Change.

(4) All youth with Medical Grades of 23-5 shall be placed on the facility’s Medical Alert System.

(5) The following medical conditions and issues warrant placement of a youth on Medical Alert:

(a) through (f) No Change.

(g) Developmental disability or intellectual disability mental retardation; and

(h) Medication side effects; and

(i) Immunocompromised.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended         .

 

63M-2.0046 Healthcare Orientation of Committed Youth.

(1) No Change.

(2) The healthcare orientation shall be provided by a nurse, or at a minimum, by a non-licensed staff knowledgeable with the health care delivery system, and shall include at a minimum: access to care, sick call vs episodic/emergency care, medication process, right to refuse care, what to do in the case of a sexual assault or attempted sexual assault; the non-disciplinary role of the health care providers and general infection control/hygiene.

(3) through (5) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.0047 Health-Related History (HRH).

(1) The HRH Health Related History (HS 014) shall be completed no later than seven (7) calendar days following the date of admission and prior to the youth engaging in strenuous exercise or being subjected to extreme outdoor weather conditions including, but not limited to, high heat indices and frigid temperatures. The HRH Health Related History (HS 014, March 2024 August 2009) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1692003802 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(2) The HRH Health Related History shall be conducted or reviewed by a nurse through interview of the youth and then made available to the Designated Health Authority or Physician Designee, PA, or APRN ARNP, prior to conducting or reviewing the Comprehensive Physical Assessment (CPA).

(3) When a youth re-enters the department’s custody or is placed in a another residential facility, a nurse, together with the youth shall review the HRH Health-Related History. Corrections and revisions shall be made at this time and documented on the section page reserved for this purpose. Review of health information shall be documented by signature and date on the HRH at the time of review.

(4) Nursing assessments, including a summary of the health-related issues of the youth shall be documented. Medical Alerts based on the history are to be implemented or corrected as applicable.

(5) The HRH can be reviewed a total of six (6) times before a new HRH will need to be completed. A new HRH shall be completed annually.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.0048 Comprehensive Physical Assessment (CPA).

(1) The Comprehensive Physical Assessment (HS 007) shall be completed no later than seven (7) calendar days following the date of admission and prior to the youth engaging in strenuous exercise or being subjected to extreme outdoor weather conditions including, but not limited to, high heat indices and frigid temperatures. For youth with a Comprehensive Physical Assessment completed prior to admission, see subsection 63M-2.0048(98), F.A.C.

(2) The DHA/designee may place the youth on a 72-hour observation with no contact sports or extensive exercise regimen. Attempts shall be made to interview the parent/legal guardian/assigned custodian to determine any current physical activity restrictions in effect prior to admission to detention. Youth shall be screened for chronic health conditions that may potentially prevent participation in strenuous physical activity. Youth who are re-admitted to detention will be screened for history of known physical activity restrictions post practitioner assessment during the prior admission. If there are no symptoms that would warrant concern for participation in activity during the 72 hours, the activity restriction may be lifted after consulting with the practitioner or at the completion of the CPA.

(3)(2) No change.

(4)(3) The standard Comprehensive Physical Assessment (CPA) form shall be used by all practitioners. The Comprehensive Physical Assessment (HS 007, February 2024 October 2007) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1691403803 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. When a community practitioner completes the CPA, (physician, PA, or APRN ARNP), all efforts shall be made to provide them with the approved form for documentation. If this cannot be done, the DHA, his/her physician designee, PA or ARNP shall augment that assessment to ensure that all of the CPA’s required components are clearly documented on the alternate form.

(5)(4) A new CPA, or a focused medical examination documented in the chronological progress notes, shall be completed as clinically indicated when a youth’s condition warrants.

(a) At a minimum, a focused note must be completed with each additional admission and completion of the Additional Reviews to Comprehensive Physical Assessment form (HS 052).

(b) All screening components (i.e., vital signs, vision, height, weight, Body Mass Index (BMI)) shall be completed at the initial CPA and at the time of the focused note.

(6)(5) No change.

(7)(6) Registered Nurses and Licensed Practical Nurses may only increase a Medical Grade; they are not permitted to decrease grades. These changes shall be documented in the progress notes as well as the Problem List (HS 026), Medication Administration Record (HS 019) and Practitioner’s Orders. The Problem List (HS 026, April 2024 October 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1692503804 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(8)(7) No change.

(9)(8) A Comprehensive Physical Assessment completed prior to the youth’s current admission may be used as follows:

(a) A current CPA with no changes in the youth’s medical condition. The current CPA shall be reviewed as the youth is examined and signed off as reviewed by the physician, PA, or APRN ARNP.

(b) The CPA shall only be reviewed with the completion of a focused note, up to six times, before a new CPA shall be initiated to avoid confusion on the youth’s condition and to ensure clear documentation of the current condition. A current CPA with a change in the youth’s medical condition. The clinician shall conduct a focused medical evaluation of the youth and document in the progress notes of the Individual Health Care Record.

(10)(9) No change.

(11) A visual acuity (without correction) of 20/40 (both eyes) will require referral for visual examination by a licensed optometrist or ophthalmologist within 60 days of screening.

(12) A BMI of less than 18 or greater than 29.9, shall have a periodic evaluation and initiate a plan of care by the DHA/designee. After the DHA completes the physical assessment, the DHA may document justification if a plan of care is not needed for obesity (i.e., large muscle mass).

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.005 Consent and Notification Requirements.

The following are the requirements for the authorization of health care services to youth in the physical custody of the department.

(1) The Authority for Evaluation and Treatment (AET) is the means by which the department obtains the consent of the parent, or guardian, or assigned custodian for basic health and mental health evaluation and treatment. Covered services and exclusions are described on the form. The AET is not required for emergency services. Under no circumstances shall emergency services be withheld pending provision of a signed AET. The AET (HS 002, January 2024 February 2010) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1691303805 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.(a) The department’s Juvenile Probation Officer (JPO) or Facility Superintendent is responsible for ensuring that the AET is signed and dated by the parent or guardian at the first available opportunity.

(2) The AET remains valid for as long as the youth is in custody or under supervision. It becomes invalid if youth is on abscond status for greater than 1 year. The abscond status for greater than one year would then warrant a new AET to be completed., or for one year after signing, whichever comes later

(a) The AET is no longer in effect once a youth turns 18 years of age or shows proof of legal emancipation by a court order.

(b) When a youth with developmental disabilities turns 18 years of age while in department custody, the regional counsel must be consulted to determine that the party authorized to provide consent has been identified and shall proceed as in Chapter subparagraph 63E-7.001(3)(a)5., F.A.C.

(3) The AET may be revoked by the parent/guardian/assigned custodian in whole or in part. Revocation or modification shall be documented as follows:

(a) The JPO must ensure that the original or a legible copy of the signed and witnessed AET is provided for inclusion in the youth’s Individual Health Care Record (IHCR) and EHR. It is the final responsibility of the JPO supervisor to ensure the legible signed and witnessed copy of the AET is included in the completed commitment packet prior to approving the packet.

(b) If a subsequent AET is obtained, it shall be filed directly on top of the prior AET in the IHCR and uploaded to the department’s electronic system. The JPO shall maintain a copy of the AET.

(4) No change.

(5) When emergency medical services are provided, the facility superintendent, program director or designee must immediately attempt to notify the parent, or guardian, or assigned custodian once the need for necessary treatment is established. The contact attempts will be documented in the chronological progress notes and in accordance with assigned permissions in the EHR.

(6) In situations where the parent/legal guardian/assigned custodian is unable to make a face to face appearance for authorization and witnessed signature of the AET, a verbal, witnessed authorization may be obtained and documented on the Limited Consent for Evaluation and Treatment (HS 057), until such time the parent/legal guardian/assigned custodian is able to make a face to face appearance and provide a witnessed signature, in order to ensure necessary medical care is provided on site at a detention facility.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.0051 Routine Consent – Authority for Evaluation and Treatment (AET).

(1) Because a signed AET is essential to providing routine health services to youth, an effort must be made to obtain a signed AET as early as possible during the youth’s intake and stay. the following procedure shall be employed to obtain this critical authorization:

(2) Department staff shall obtain routine consent for health services, either through a signed AET or a referenced alternative, under the following procedure:

(a) If the parent, or guardian, or assigned custodian is available at the detention screening a JPO/designee or during the youth’s detention stay, the assigned JPO or staff at the detention center must explain the AET and obtain the required signature. If the parent, guardian, or assigned custodian is available during the youth’s detention stay the detention representative/medical provider must explain the AET and obtain the required signature.

(b) If the parent, or guardian, or assigned custodian is not available during the detention screening, an the assigned JPO shall schedule an intake conference with the parent, or guardian, or assigned custodian for the purpose of completing the AET at the earliest possible time and within 7 days of admission.

(c) If the parent, guardian, or assigned custodian has expressed objection to signing the department AET, a JPO/designee will work with DJJ counsel to assist in obtaining a court order for medical services. The department representative introducing the AET to the parent or guardian must review the basic components of the document with the parent or guardian.

(d) If a youth arrives at a detention center or residential commitment program without a signed AET, the facility administrator or designee must immediately contact the respective Chief Probation Officer or designee for assistance with the parent, guardian or assigned custodian.

(e) For detained youth who have not been committed to the department, and for whom an AET has not yet been obtained, the detention superintendent or the person in charge of the detention center or facility, or his or her designee, shall authorize a Healthcare Admission Screening as per Rule 63M-2.0041, F.A.C., to determine if the youth is in need of medical care or isolation via the execution of the Limited Consent for Evaluation and Treatment form. The Limited Consent for Evaluation and Treatment (HS 057, May 2024) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-16934. For additional, non-emergency care and treatment, consent shall be obtained as follows:

1. Authorization for additional examination and treatment, including the continued provision of currently prescribed medication, standard vaccinations, specified over-the-counter medications, and other routine services shall be provided as authorized by the youth’s parent, or guardian, or assigned custodian in a signed Authority for Evaluation and Treatment (HS 002, February 2010).

2. Where a signed AET has not been obtained, and the person with the power to consent to examination or treatment cannot be contacted after a diligent search, and has not expressly objected to consent, the Detention Facility Superintendent or Assistant Facility Superintendent may consent to ordinary and necessary medical treatment, including immunizations, and dental examination and treatment as set forth in Section 743.0645, F.S. The assigned JPO shall conduct the diligent search as set forth in the form Affidavit of Diligent Effort (HS 056, January 2012), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03806 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The assigned JPO shall complete the Affidavit of Diligent Effort and attach to the youth’s Limited Consent for Evaluation and Treatment (HS 057, December 2013), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03807 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The Facility Superintendent providing the consent for the youth shall sign the Limited Consent for Evaluation and Treatment.

3. Where the youth is in the dependency system and is served by the Department of Children and Families, the following process applies:

a. Where the youth has not been removed from the parent’s home, the JPO shall obtain the parent’s consent to ordinary medical treatment by executing the Limited Consent for Evaluation and Treatment (HS 057, December 2013).

a.b. Where parental rights have not been terminated and the youth is in out-of-home care, such as a foster home, group home, or unlicensed caregiver, the parent shall be contacted to sign the AET. the JPO shall contact the Department of Children and Families or its contracted service provider to locate the parent to consent to ordinary medical treatment by executing the Limited Consent for Evaluation and Treatment (HS 057, December 2013).

b. Parental consent is not required where the court order placing the youth in out-of-home care specifically gives authority to consent to ordinary medical treatment to the Department of Children and Families or the out-of-home caregiver. Where these circumstances exist, either the Department of Children and Families or the court assigned out-of-home caregiver may consent to ordinary medical treatment by executing the Limited Consent for Evaluation and Treatment (HS 057, December 2013).

c. Where parental rights have been terminated and the youth is in the custody of the Department of Children and Families, the Department of Children and Families or its contracted service provider may consent to ordinary medical treatment by executing the Limited Consent for Evaluation and Treatment (HS 057, December 2013).

d. Where parental rights have been terminated and the youth is prescribed psychotropic medications refer to subsection 63M-2.00315(9), F.A.C.

(f) For youth committed to the department; prior to admission to a residential commitment program of a youth under 18 years of age or a youth 18 years of age or older who is incapacitated as defined in Section 744.102(12), F.S., the youth’s JPO shall provide the residential commitment program with an original or a legible copy of the signed AET or a court order addressing the provision of routine physical and mental healthcare. The Limited Consent for Evaluation and Treatment (HS 057) is not applicable for use in residential commitment programs. However, when a youth is 18 years of age or older and not incapacitated, or otherwise emancipated as provided in Section 743.01 or 743.015, F.S., no AET or court order is required since the youth is responsible for authorizing his or her own physical and mental health care.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended         .

 

63M-2.0052 Special Consent.

(1) Additional consent is required in special circumstances through the Parental Notification of Health Related Care: General (HS 020, January 2014) and is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03808 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. Informed consent is required for the following:

(a) through (b) No change.

(c) Pelvic Examinations as defined in section 456.51, F.S. Dental services other than evaluations;

(d) Any procedure or service of an invasive nature including dental fillings, crowns and anesthesia;

(e) through (f) No change.

(2) Newly prescribed New medications, or a significant change to medications (including OTCs), excluding psychotropic medications, require parental notification consent through the Parental Notification of Health-Related Care: Medication Management Medications (HS 021 April 2024 January 2014) and is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1692303809 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. Reasonable attempts shall be made to contact the parent/guardian/assigned custodian verbally/by telephone prior to making the changes in order to explain the medications.

(3) New Vaccinations and Immunizations shall be provided in accordance with 64D-3 F.A.C. and informed consent obtained and documented by utilizing require parental consent through the Parental Notification of Health Related Care: Vaccinations/Immunizations (HS 022, February 2010) which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03810 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(4) When the person authorized to consent withholds, revokes or limits consent for any recommended treatment, the program’s Designated Health Authority, based on his or her clinical judgment, shall determine whether failure to provide the treatment will potentially result in serious or significant health consequences for the youth or threaten his or her life or jeopardize the health of other youth and staff in the program. If the Designated Health Authority so determines, the program director shall explain the situation to the person withholding, revoking or limiting consent, encouraging him or her to consent to the needed treatment; however, if consent is still denied, the program director shall contact the department’s regional general counsel to request assistance to that he or she obtain a court order authorizing the treatment.

(5) No change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 6-20-14, Amended         .

 

63M-2.006 Sick Call.

(1) No change.

(2) Sick Call shall be regularly scheduled in each facility and conducted by a licensed health care provider within 24 hours of placing the sick call request.

(3) No change.

(4) Review and triage of Sick Call requests shall be conducted as follows:

(a) No change.

(b) When a licensed health care professional is not on site, the shift supervisor shall review all Ssick Ccall requests as soon as possible, within four (4) hours after the request is submitted. Issues requiring attention prior to the next scheduled Sick Call shall be addressed as per Rule 63M-2.009, F.A.C.

(5)1. Renumbered and no change.

(6)2. If a facility utilizes a Licensed Practical Nurse (LPN) without the presence of a Registered Nurse, the LPN shall conduct the Sick Call. The LPN shall review all sick call requests daily, which is defined as seven days a week, including Holidays, (either telephonically or in person) with someone at the level of a Registered Nurse or a higher licensure level.

(7)(5) After appropriate evaluation of the Sick Call requests have has been completed:

(a) No change.

(b) For detention facilities, the staff shall utilize the department’s electronic system JJIS and FMS to enter the Sick Call requests generated by the youth. This entry must then generate a notice to the nurse for his/her timely review. Every facility shall have a backup method for notification to the nurse in situations where the computerized system is unavailable.

(8)(6) Youth identified as having the same complaint and seen by the nurse three times within a two-week period shall be referred to the Physician, APRN ARNP or PA. Episodic encounters must be taken into account when determining the frequency of care provided for the same complaint.

(9)(7) A youth who has received medical evaluation and treatment by the APRN ARNP or P.A. more than once for the same complaint that has demonstrated no improvement after two medical evaluations shall be referred immediately to a physician (on-site, off-site or Emergency Room).

(10)(8) The RN, APRN, ARNP or P.A. shall immediately notify the DHA (physician) when he or she cannot determine the nature and/or severity of a youth’s medical or clinical condition. The Designated Health Authority has the final authority for determining the next medical course of action.

(11)(9) When a non-licensed staff person has a concern regarding a youth’s need to be seen as early as possible in Sick Call, whether or not the youth has made a Sick Call Request, the staff shall notify the nurse and the youth shall be seen and triaged for sick call or episodic care as early as possible. When no nursing staff are on site the DHA/designee shall be contacted regarding the youth(s) immediate need for care. as soon as possible.

(12)(10) The Sick Call documentation shall be as follows:

(a) Youth in Residential Commitment Programs shall complete the Sick Call Request Form (HS 032). The Sick Call Request Form (HS 032, April 2024 February 2010) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1693003811 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. When an electronic format of this form is used, all components of the sick call shall be incorporated and completed at the time of the completion of the sick call.

(b) For youth who need assistance initiating completing the Sick Call Request form, a staff person shall be available. The staff person must communicate to the youth that this then gives them access to the youth’s personal information. The staff person shall maintain the youth’s confidentiality.

(c) The completed Sick Call Request forms shall be placed in a secure location inaccessible to youth to be provided to the nurse or provided electronically to medical staff.

(d) No change.

(e) Detention facilities shall utilize the department’s established electronic system Facility Management System (FMS) and the Juvenile Justice Information System (JJIS) to coordinate and document Sick Call. A copy of the completed electronic Sick Call Request form shall be placed in the youth’s Individual Health Care Record and maintained in the EMR/EHR.

(f) When the youth is evaluated and treated by the facility’s Physician, PA or APRN, ARNP, the Chronological Progress note section shall be utilized to provide documentation for the Individual Health Care Record and EMR/EHR. The documentation shall include subjective findings, objective findings, the medical assessment of the youth, and the plan of care for treatment of the youth.

(g) Sick Call complaints shall be listed on The Sick Call Index form (HS 030), and maintained filed in the section reserved for the Core Health Profile in the Individual Health Care Record/EHR. The Sick Call Index (HS 030, April 2024 October 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1692803812 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(13)(11) An aggregate Sick Call/Referral Log (HS 031) or electronically generated form must be utilized at each residential program. The Sick Call/Referral Log (HS 031, January 2024 October 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1692903813 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize a form of their choice if as long as the form includes all information required on the Sick Call/Referral Log.

(14)(12) Detention facilities shall utilize the sick call log generated by the department’s electronic JJIS system.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 6-20-14, Amended       .

 

63M-2.008 Periodic Evaluations.

(1) A periodic evaluation and plan of care by a Physician, PA or APRN ARNP shall be conducted for youth in a facility who:

(a) through (c) No change.

(2) Periodic evaluations shall be conducted, at a minimum, once every three (3) months except for situations of prescribed epinephrine auto injectors and OTC’s which can be evaluated and prescribed every 6 months in accordance with community standards.

(3) through (6) No change.

(7) Periodic evaluations conducted off-site shall be documented on the Summary of Off-Site Care Form (HS 033), and filed in the Individual Health Care Record in the chronological progress notes, in reverse chronological order, along with any records from the off-site provider and uploaded to the department’s EMR/EHR, where applicable. The Summary of Off-Site Care Form (HS 033, October 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03814 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.009 Episodic Care.

(1) Medical issues that require immediate attention shall be determined defined by the DHA or physician designee.

(2) Any complaint of severe pain, including dental pain, shall be treated as an emergency with immediate referral to the on-site nursing staff, APRN ARNP, PA or Physician.

(3) No change.

(4) If a program utilizes a Licensed Practical Nurse (LPN) without the presence of a Registered Nurse on-site, then the LPN shall review all episodic or emergency cases daily, which is defined as seven days a week, including Holidays, (either electronically, telephonically or in person) with either the Registered Nurse or a higher licensure level health care staff.

(5) through (6) No change.

(7) Episodic care provided by a non-licensed staff person, or that requires off site care, must have a follow-up evaluation/assessment by a licensed health care professional the next time this person is on-site, or sooner, if warranted.

(8) The Designated Health Authority or physician designee shall be notified when a youth requires emergency transfer off-site for evaluation, treatment and/or hospitalization. The DHA/Designee shall perform a physician evaluation and review of records at the first available opportunity.

(9) Non-licensed staff members who provide first aid and/or emergency care are authorized to provide care only within their training and maintain required certifications as per Chapter 63H-32, F.A.C.

(10) First aid supplies shall be kept and maintained on-site as determined by the Designated Health Authority. First aid kits for vehicles shall be stored in a cool environment to protect contents from heat exposure and checked out prior to use of the vehicle to transport youth.

(11) No change.

(12) Training records and proof of staff certifications shall be maintained per Chapter Division 63H-3, F.A.C.

(13) Emergency drills, both announced or unannounced, shall be conducted for each shift, on a quarterly basis at a minimum, and simulate an episodic care event that calls for immediate need of First Aid and/or administration of CPR techniques and the initiation of the emergency procedures to follow when a life-threatening emergency does occur. Documentation of these drills shall also be maintained per facility. CPR and AED techniques shall be demonstrated at least annually. All staff from all shifts with direct contact on a day-to-day basis must participate in at least one emergency drill annually which demonstrates CPR/AED.

(14) No change.

(15) Episodic care subsequent to a Protective Action Response (PAR) shall be conducted pursuant to Chapter paragraph 63H-31.007(2)(d), F.A.C.

(16) All episodic care provided by licensed healthcare staff shall be documented in SOAP format in the chronological progress notes in the Individual Health Care Record. Episodic care provided by non-licensed staff may be recorded on the Report of On-Site Health Care by Non-Health Care Staff Form (HS 049, December 2006), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03815 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(17) All episodic care provided shall be documented on the Episodic Care (First Aid/Emergency) Care Log (HS 009, February 2024 October 2006) The Episodic (First Aid/Emergency) Care Log is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1691603816 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize a form of their choice if as long as the form includes all information required on the Episodic Care (First Aid/Emergency) Care Log that is incorporated by reference into Chapter 63M-2, F.A.C.

(18) Routine or emergency care conducted off-site shall be documented on the Summary of Off-Site Care form (HS 033, October 2006), and filed in the Individual Health Care Record, in reverse chronological order along with any records from the off-site provider and uploaded to the department’s EMR/EHR where applicable.

(19)(18) No change.

(20)(19) PAR/RI Medical Review documentation is as follows:

(a) The Post-PAR/RI interview and PAR Medical Review shall be documented on a the progress note in the youth’s Individual Health Care Record. The individual performing the Post-PAR interview will also sign and date the PAR Report.

(b) If an off-site medical review is conducted, the relevant sections of the youth’s Individual Health Care Record and Medication Administration Record shall accompany the youth to the review as well as a Summary of Off-Site Care form indicating the type of examination needed. After the off-site medical review, the documents will then be placed in reverse chronological order in the designated section of the youth’s Individual Health Care Record.

(c) After an off-site medical review, the top of each page returned by the reviewer must be dated and labeled with “PAR Medical Review.” The documents will then be placed in reverse chronological order in the Progress Notes in the youth’s Individual Health Care Record.

(c)(d) The facility Superintendent or Program Director shall have access to the medical Post-PAR/RI documentation for review. review the PAR Incident report, Post-PAR interview and the PAR Medical Review.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended             .

 

63M-2.010 Girls Gender Responsive Medical Services.

(1) The Designated Health Authority or physician designee, PA or APRN ARNP shall be responsible for the management of appropriate girls’ medical gender responsive and age-related health care and services in addition to routine medical care and services.

(2) Girls’ Gender responsive medical care shall include all of the following conditions:

(a) through (i) No Change.

(3) through (4) No Change.

(5) Any female youth that identifies her menstrual cycle as more than two weeks late shall have a urine or blood pregnancy test performed with consent.

(6) Once a youth is identified as being pregnant, the Designated Health Authority or physician designee, PA or APRNARNP shall be immediately notified, and medication held until explicit instructions are given regarding continuation of the current medication regimen.

(7) through (9) No Change.

(10) All staff working in facilities and programs which serve girls shall be provided education and training on gender specific health care issues of the adolescent female. A licensed nurse shall provide in-service education on girls’ health care, at a minimum, on an annual basis to all non-licensed staff.

(11) The Designated Health Authority or Physician Designee shall be responsible for the medical management oversight for neonatal medical care for the infant. Collaboration with community health care providers shall be utilized when necessary to obtain neonatal specialized health care services.

(12) The Provider shall provide daycare services for these infants. By providing daycare services, the Provider is responsible for complying with all Florida Statutes and regulations concerning the care of infants in this setting. The Provider shall comply with all Florida Statutes with regards to the transportation of infants.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.021 Pharmacy Permits and Licenses.

(1) No change.

(2) A Pharmacy and Therapeutics Committee (PTC) shall be established and meet at least quarterly in facilities as defined in Chapter Rule 64B16-27.300, F.A.C., Standards of Practice – Continuous Quality Improvement Program. Each facility shall identify the Pharmacy and Therapeutics Committee members in the facility’s medication management operating procedures, based upon the requirements as stated in Rule 64B16-27.300, F.A.C.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended         .

 

63M-2.022 Verification and Procurement of Medications Prescribed Prior to Admission.

(1) Facility and/or Program staff must continue all currently prescribed and verified medications to youth prior to entering the department’s custody.

(2) A duly licensed Physician, PA or APRN ARNP must make all changes in medication regimens subsequent to an appropriate assessment. Under no circumstances may staff in a facility discontinue an appropriately prescribed medication that the youth is receiving upon admission.

(3) Upon admission to a facility, the youth and parent or guardian/assigned custodian (if available), shall be interviewed about the youth’s current medications. Refer to required forms HS 051 (Probation Medical and Mental Health Clearance Form for Detention Centers) or HS 010 (Facility Entry Physical Health Screening for Residential Commitment Programs).

(4) No change.

(5) Only medications from a licensed pharmacy, with a current, patient-specific label intact on the original medication container may be accepted into a dDepartment facility.

(6) Medications may not be administered unless all of the following have been met:

(a) No change.

(b) Either the youth or the parent/guardian/assigned custodian has brought the valid, patient-specific medication container to the facility, or can be verified by contacting the current provider or dispensing pharmacy;

(c) through (d) No Change.

(7) After medication verification, the Medication Receipt, Transfer, & Disposition Form (HS 053, October 2023 September 2010) shall be completed, with copy of the form provided to the parent/guardian/assigned custodian (when parent/guardian/assigned custodian is available). The Medication Receipt, Transfer & Disposition Form (HS 053, September 2010) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1693303817 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The original form shall be a part of the Individual Health Care Record.

(8) If the prescription medication cannot be verified as authentic, the prescription and contents shall be verified by:

(a) Calling the pharmacy that dispensed the medication; or

(b) Calling the outside provider who prescribed the medication.

(8)(9) Further medication verification requires DHA or physician designee, PA, or APRN ARNP notification and a medical evaluation of the youth completed, with documentation in the Chronological Progress Notes.

(9)(10) A Practitioner’s Order from the DHA or Physician Designee, PA or APRN ARNP is required to resume the specified medications. The Practitioner’s Orders Form (HS 024, October 2006) shall be utilized, is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03818 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize a form of their choice as long as the form includes all information required on the Practitioner’s Order Form that is incorporated by reference into Chapter 63M-2, F.A.C.

(10)(11) Renumbered and no change.

(11)(12) The Designated Health Authority or physician designee, PA or APRN ARNP shall be notified within 24 hours when a youth with a medication has been admitted into the facility. within 24 hours.

(12)(13) Any contact made with the youth’s prescribing community practitioner(s) prior to admission shall be documented on a chronological progress note and filed in the youth's Individual Health Care Record. This documentation shall include, at a minimum, the effectiveness of the currently prescribed medications, and side effects and/or precautions.

(13)(14) Any medication that is not successfully verified will be destroyed and documented as such per Rule 63M-2.027, F.A.C., or returned to the parent/legal guardian/assigned custodian.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended       .

 

63M-2.023 Transfer of Youth’s Medications.

(1) Medication Acceptance (to be utilized when youth is being transported):

For youth being transported through the Statewide Transportation and Relocation System Offender Program, there shall be, at a minimum, a 7-day supply of medications for transport to accompany the youth. A medication pack card shall be utilized when available for transport with the youth that includes the remaining doses of medication.

(2) When nursing staff are not on site, medication verification shall be completed by trained non-licensed staff for those youth who arrive from home for transport. This shall be completed by review of medication labels, determining last dose(s) provided, (by verifying with the parent/guardian/assigned custodian when available), and determining if medication is scheduled to be taken during the transport of the youth. The Non-Licensed Staff Medication Record (HS 054, September 2010) shall be utilized to document when the non-licensed staff delivers medication to the youth during transport. The Non-Licensed Staff Medication Record (HS 054, September 2010) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03819 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(3) The residential commitment program shall provide a transport packet to detention center staff when a youth is delivered to the detention center for transport. The transport packet must include:

(a) No change.

(b) Face Expanded face sheet;

(c) through (e) No Change.

(f) Medication Administration Record (current medication order when if applicable);

(g) No change.

(h) Most recent Current Health Related History and Comprehensive Physical Assessment;

(i) No change.

(j) Youth Transport Card (HS 055, September 2010), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03820 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399; and

(k) The completed Medication Receipt, Transfer & Disposition Form (HS 053, September 2010) for transfers from one Residential Commitment Program to another.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.025 Inventory and Storage of Sharps.

(1) Sharps shall have a perpetual inventory, be securely stored and inventory checked weekly. A week is defined as a seven-day period beginning on Sunday and ending on Saturday.

(2) through (3) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended-     .

 

63M-2.026 Inventory of Medications.

(1) Medication inventory shall include, at a minimum, the following components:

(1)(a) A perpetual inventory with clear descriptions shall be maintained for all stock and over the counter medications with documented weekly checks by a licensed health care staff. A week is defined as a seven-day period beginning on Sunday and ending on Saturday daily running inventory of medication utilization for all stock prescription medications.

(2)(b) Controlled substances must be counted with a witness daily, which is defined as seven days a week, including Holidays. During shifts when a controlled substance is provided, the count must be completed prior to, and after, the administration/delivery of the medication. Shift-to-shift inventory counting of controlled substances shall be conducted under the supervision of a licensed nurse. Non-health When no controlled substances are provided, a shift-to-shift count is not required. Supervisory level non-health care staff trained in the delivery and oversight of medication self-administration are allowed to assist the licensed nurse with conducting the count. Only when a licensed nurse is not on-site is the trained non-health care staff permitted to conduct the count without a licensed nurse. This process shall be included in the facility’s operating procedure regarding medication management. Each dosage and shift-to-shift inventory of a controlled substance administered to a youth, shall be documented on the youth’s Controlled Medication Inventory Record (HS 008). The completed Controlled Medication Inventory Record (HS 008) shall be filed in the youth’s Individual Health Care Record. The Controlled Medication Inventory Record (HS 008, May 2023) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1691503821 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize a pre-printed pharmacy-controlled medication record if the form includes all information required on the Controlled Medication Inventory Record (HS 008) that is incorporated by reference into 63M-2, F.A.C.

(3)(c) Reporting criteria and methods of managing and investigating inventory discrepancies, including unexplained losses of controlled substances. Facilities shall notify the appropriate department branch regional staff of the unexplained loss. The DHA or Physician Designee, and Superintendent or Program Director shall be notified immediately for any discrepancies with the daily controlled substance inventory count.

(2) Each dosage of a controlled substance administered to a youth, shall be documented on the youth’s Controlled Medication Inventory Record (HS 008). The shift-to-shift inventory count of each controlled substance shall also be documented on the youth’s Controlled Medication Inventory Record (HS 008). The completed Controlled Medication Inventory Record (HS 008) shall be filed in the youth’s Individual Health Care Record. The Controlled Medication Inventory Record (HS 008, April 2010) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03821 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize a pre-printed pharmacy controlled medication record as long as the form includes all information required on the Controlled Medication Inventory Record that is incorporated by reference into Chapter 63M-2, F.A.C.

(3) The DHA or Physician Designee, and Superintendent or Program Director shall be notified immediately for any discrepancies with the daily controlled substance inventory count.

(4) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.030 Routine Medication Administration.

(1) No change.

(2) Medication delivery, including the security and control of the medications shall be the sole responsibility of the licensed nursing staff during the administration of the medications and shall be delivered in a secure environment for the protection of the nurse or staff providing the medications.

(3) A prescription medication shall not be removed from its original prescription package packaging or prescription container and placed in another container for subsequent administration until the time of medication administration for each youth.

(4) The same staff member shall prepare and administer/deliver the medications.

(5) No change.

(6) Documentation of each individual dosage of medication administered to youth shall be maintained on the youth’s Medication Administration Record (MAR) (HS Form 019). The Medication Administration Record (HS 019, October 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03822 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399. The facility may utilize their Pharmacy vendor pre-printed Medication Administration Record if as long as the form includes all information required on the Medication Administration Record that is incorporated by reference into Chapter 63M-2, F.A.C.

(7) through (13) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended       .

 

63M-2.031 Youth Self-Administration of Oral Medication Assisted by Trained Non-Licensed Staff.

(1) through (4) No Change.

(5) The Registered Nurse that completed the training must supervise the trained staff member, at a minimum annually, by periodically performing direct observation of skills, inspecting the Medication Administration Record(s) and the required documentation assigned to the staff member. In the event, the Registered Nurse that completed the training is no longer employed by the facility, the staff member must be re-trained by another Registered Nurse that shall determine the staff member’s competency and perform direct observation of skills and inspection of the MAR and required documentation, at a minimum, annually.

(6) through (7) No Change.

(8) Self-administration of medications by non-licensed staff shall include, at a minimum, the following:

(a) through (g) No Change.

(h) Confirm the allergy status of the youth and question the youth about any possible side effects or adverse reactions to the medication.

(i) through (k) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended-     .

 

63M-2.032 Youth Refusal of Medication.

(1) A youth’s refusal to take a dosage of a prescribed medication shall be documented in the Individual Health Care Record Chronological Progress Note section, in addition to “R” for Refusal (as indicated on the MAR form).

(2) The staff youth shall initial the MAR indicating refusal of medication. The youth shall sign the Refusal of Treatment form (HS 027). If the youth refuses to sign, a witness shall sign, as indicated on the form. The Refusal of Treatment form (HS 027, April 2024) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-16926. If the youth will not initial the refusal notation, this shall be included in the Chronological Progress Notes.

(3) through (4) No Change.

(5) Each facility shall conduct a review of medication refusals that required DHA or prescribing physician notification. The review shall be conducted by the Designated Health Authority, or physician designee, PA or ARNP and when applicable, the prescribing psychiatric practitioner.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended       .

 

63M-2.033 Youth Hoarding of Medication and Swallowing Difficulties.

(1) No change.

(2) Licensed health care professional staff shall notify the DHA/Psychiatrist DMHA when a youth is found to be “cheeking” or not swallowing his or her medication(s).

(3) A practitioner’s order or general authorization must be provided by the Designated Health Authority or physician designee in order for a youth’s medications to be crushed and sprinkled or mixed with food.

(4) Licensed Health Care professional staff is responsible for notifying the Designated Health Authority or physician designee, PA or APRN ARNP of a youth with swallowing difficulties or developmental disabilities, to obtain an order for an alternate method of providing oral medications. The alternate method shall be noted on the MAR.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended       .

 

63M-2.034 Administration of Parenteral Medications.

(1) No change.

(2) A non-licensed staff person may administer a percutaneous injection of a pre-packaged medication to a youth to prevent or treat an allergic reaction. The staff member must be trained by a licensed medical professional with a licensure of RN or above in the use of this product in order to be permitted to administer the medication.

(3) Approval from the facility Superintendent or Program Director and the Designated Health Authority or Physician Designee is required for any youth to self-administers his/her own parenteral medication(s). Self-administration of parenteral medication by the youth shall only be under the supervision of the licensed health care professional trained staff member who has control of the vial of medication. The Designated Health Authority shall approve all procedures for self-administration under these circumstances with a practitioner order.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended     .

 

63M-2.036 Adverse Drug Events and Medication Errors.

(1) through (2) No Change.

(3) Licensed health care professional staff shall monitor each youth daily, prior to administering medications, for potential medication side effects. For instances where licensed health care professional staff are not on-site and non-licensed staff members assist youth with medication administration, see paragraph 63M-2.031(8)(h), F.A.C.

(4) through (5) No Change.

(6) The Designated Health Authority or physician designee, and the facility superintendent or Program Director shall review the medication error reports at least every two weeks. These findings shall be reviewed and summarized during the quarterly Pharmacy and Therapeutics Committee CQI meetings as per Chapter Rule 64B16-27.300, F.A.C.

(7) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended      .

 

63M-2.037 Education of Youth with Chronic Medical Conditions and Prescribed on Medications.

(1) All youth with a diagnosed chronic medical condition who are prescribed medications shall receive instructions and education related to those chronic medical conditions and prescribed medications.

(2) Education Medication education for a youth by an on-site licensed health care professional shall be recorded in the Individual Health Care Record.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.040 Environmental and Exercise Precautions.

(1) through (2) No Change.

(3) The Designated Health Authority or physician designee, PA or APRN ARNP shall determine whether the facility’s full exercise regimen is appropriate for a youth with a chronic medical condition.

(4) No postpartum female shall participate in physical exercise until six (6) weeks postpartum with clearance by the youth’s facility OB/GYN or Nurse Midwife.

(5) through (6) No Change.

(7)(8) The Designated Health Authority or Physician designee, PA or APRN ARNP shall inform the Superintendent or Program Director of youth who may be medically compromised by adverse environmental and exercise conditions.

(9) through (10) are redesignated (8) through (9) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.050 Infection Control ‒ Regulations and Training.

(1) through (6) No Change.

(7) All youth shall receive infection control training, to include the prevention of blood-borne pathogens, within seven days of admission into the Juvenile Detention/Residential system. The youth training shall be documented in the Individual Health Care Record.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended-     .

63M-2.052 HIV Counseling and Testing.

(1) No Change.

(2) The facility shall provide or facilitate the HIV counseling and testing according to Chapter 65D-2, F.A.C. and pursuant to section 381.004, F.S. If the facility cannot provide the counseling and testing, the facility shall collaborate with the local County Health Department or other community providers for these services.

(3) HIV counseling shall only be conducted by a certified HIV counselor.

(3)(4) Pursuant to Chapter Sections 381.004(3) and 384.30, F.S., any test for the detection of HIV requires cannot be ordered without an informed consent from the individual being tested. The youth’s consent may be obtained and recorded on the Human Immunodeficiency (HIV) Antibody Virus Youth Consent fForm (HS 015, May 2023 April 2010) which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1692103823or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(5) The facility shall facilitate confirmation of positive HIV test results when indicated, and provide medical follow-up.

(6) through (7) redesignated (4) through (5) No Change.

(6) Requested HIV testing shall be completed within 30 days of the request or by the next available testing, whichever comes first for all youth with identified risk factors.

(8) All pregnant youth shall be provided an HIV test unless, after counseling by the Physician, PA or ARNP as to the risks of transmission of HIV to the fetus, she refuses testing. When this occurs, she must sign a waiver (refusal) to decline the test. This shall be filed in the IHCR.

(7)(9) HIV results shall be sealed in an envelope marked “confidential” and filed/documented in the Individual Health Care Record and uploaded where available, to the departments EMR/EHR indicating confidential information.

(8)(10) No change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.061 Record Documentation, Development and Maintenance.

(1) through (2) No Change.

(3) A youth’s official case file shall include all health care records along with the management file at the time of release/discharge or transfer pursuant to Chapter 63E-7, F.A.C.

(4) All handwritten documentation in the Individual Health Care Record shall be recorded legibly in blue or black ink. No correction fluid or erasure will be used in the IHCR. Corrections shall be made by crossing through with a single line and the deleted section initialed. The department’s Electronic Medical Record shall be used where available. All hand-written records shall also be uploaded to the EMR/EHR where available.

(5) Health care documents shall be filed in reverse chronological order a chronological organized manner. All chronological progress notes shall be in SOAP note format, or at a minimum, narrative format that includes all components of the SOAP note format. Incidental notes shall be used where there is no patient contact and in narrative format.

(6) through (9) No change.

(10) Each facility/center shall maintain an Individual Health Care Record for each youth.

(11) The IHCR shall be maintained intact with the original documentation except:

(a) When off-site off site providers retain the original notes in their files;

(b) When Medicaid is billed for services and requires the original records for billing;

In these situations, original, clean, legible copies are acceptable and shall be retained in the record as if they were the originals. “COPY” shall be written or stamped on the document in an area that does not obscure any necessary information.

(b)(c) No change.

(12) The entire IHCR shall be transported with the youth between department facilities. and shall be documented on the Custody of Health Care Record. The Custody of Health Care Record (HS 005, October 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03824 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended       .

 

63M-2.062 Core Health Profile.

The Core Health Profile shall include the following forms and be organized in the order in which the forms are listed below:

(1) Individual Health Care Record Checklist and Internal Quality Control (HS 017, October 2006), which is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03825 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399;

(1)(2) Personal and Health-Related Information (HS 023, January 2024 October 2006), which is incorporated into this Rulerule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1692403826 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399;

(3) through (6) redesignated (2) through (5) No Change.

(6)(7) The Immunization Tracking Record (HS 016, October 2006), or the Immunization Record as per the Florida State Health Online Tracking System (Florida SHOTS) through the Department of Health Bureau of Immunization, as authorized by Chapter Section 381.003, F.S. The Immunization Tracking Record (HS 016, October 2006), is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-03827 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399;

(7)(8) Facility Entry Physical Health Screening (HS 010) for residential or the Medical and Mental Health Screening form for detention;

(9) through (12) redesignated (8) through (11) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended       .

 

63M-2.063 Interdisciplinary Health Record.

This section of the IHCR shall include the forms listed below and organized in this order:

(1) No change.

(2) Chronological Progress Notes includes but not limited to: all health encounters (sick call, episodic and emergency care, report of health care by non-health care staff, chronological progress notes for nursing and practitioners as well as incidental notes in reverse chronological order);

(3) No change.

(4) Medication Administration Record(s) (MAR) (HS 019);

(5) through (9) No Change.

(10) Dental Care and consents for dental care.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.064 Storage, Security and Control of the Individual Health Care Record.

(1) through (2) No Change.

(3) The Designated Health Authority or physician designee, Facility Superintendent, or Program Director shall provide delegated access to Individual Health Care Records.

(4) through (9) No Change.

(10) Parents or legal guardians have the right to request and review copies of the Individual Health Care Records for their child, utilizing the process for Public Records requests, with the following exceptions:

(a) through (b) No Change.

(c) If there is any question, the office or area receiving the request shall refer the issue to the General Counsel’s Office.

If there is any question, the issue shall be referred to the Regional General Counsel’s Office.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended       .

 

63M-2.070 Health Education.

(1) Health education programs shall pertain to health issues of adolescents. These topics shall include, at a minimum, the following, and shall be completed prior to or in conjunction with the HRH or review of the HRH:

(a) through (g) No Change.

(h) Review of iImmunizations;

(i) through (o) No Change.

(2) Documentation of health education shall be made on the Health Education Record (HS 013) or the Chronological Progress Notes. The Health Education Record (HS 013, October 2023 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1691903828 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended          .

 

63M-2.081 Youth Release to the Community from a Residential Commitment Program.

(1) The assigned JPO, facility nursing staff, and the facility case manager shall work together to ensure that all medical information requiring parental follow-up is communicated to the responsible parent/guardian/assigned custodian prior to the youth’s exit from the facility.

(2) The youth’s Juvenile Probation Officer, parent/guardian/assigned custodian, the facility case manager and conditional release provider as applicable shall be notified regarding pending or unresolved health care issues upon the youth’s release to the community.

(3) For youth who will not be in the physical custody of the department, the parent or guardian/assigned custodian is responsible for arranging the youth’s health care services upon release.

(4) No Change.

(5) A Parental Notification of Health-Related Care form (HS 020) shall be sent in advance to the parent or guardian/assigned custodian by the facility with any information on upcoming appointments.

(6) Fourteen (14) days prior to discharge, the residential commitment program shall again review the need for any upcoming appointments and notify the parent or guardian/assigned custodian.

(7) Final medical follow-up information shall be provided to the parent or guardian/assigned custodian on the Health Discharge Summary Transfer Note (HS 012, March 2024 October 2006) when the youth is released. The Health Discharge Summary Transfer Note (HS 012, March 2024 October 2006) is incorporated into this rule and is available electronically at http://www.flrules.org/Gateway/reference.asp?No=Ref-1691803829 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(8) through (10) No Change.

(11) The youth’s medication shall be provided to the youth’s parent or guardian/assigned custodian youth and parents or guardians at the time of release from the program. The medication must be in an individually labeled, youth-specific, prescription container generated by a pharmacy vendor.

(12) Prescription medications shall not be released solely to the youth unless the youth is at least 18 years of age or legally emancipated.

(13) Verification of the parents or guardian/assigned custodian’s acceptance of the youth’s medication shall be documented in the Individual Health Care Record utilizing the Medication Receipt, Transfer, and Disposition (Discharge) form (HS 053).

(14) The youth’s parent or guardian/assigned custodian shall be provided with a 30-day paper prescription from the facility DHA/, designee, PA, or Psychiatrist/designee ARNP for any medication(s) non-narcotic medications that a youth will continue after release.

(15) through (16) No Change.

(17) A summary of health-related needs shall be included in the residential program’s exit conference for the youth.

(18) through (19) No Change.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended         .

 

63M-2.082 Transfer from a Detention Center or Residential Commitment Program.

(1) No change.

(2) Upon transfer to another detention center or residential commitment program or facility, the youth shall be informed of current health care needs and required medical follow-up.

(3) Duplication of screenings, risk assessments, and laboratory tests at the receiving detention or residential commitment facility, or program shall be avoided unless clinically indicated, with the exception of the Medical and Mental Health Admission Screening in detention or the Facility Entry Physical Health Screening (HS 010) in the residential commitment program.

(4) Youth transferred between detention centers or to a residential program shall have the following documents accompany them on the transport: All medications and MAR’s shall be transferred with youth to the subsequent residential commitment program.

(a) Entire paper version of the Individual Health Care Record

(b) Youth Transport Card (HS 055)

(c) Prescribed medication(s)

(d) If medications are prescribed, the Medication Receipt, Transfer, & Disposition (Discharge) form (HS 053)

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14, Amended        .

 

63M-2.083 Youth Released to the Community from Secure Detention.

(1) The assigned JPO and detention center nursing staff shall work together to ensure that all medical information requiring parental follow-up is communicated to the responsible parent/legal guardian/assigned custodian prior to the youth’s release from the facility.

(2) Statutorily protected health-related information shall not be provided to parents unless the youth has given permission.

(3) Medical conditions reportable as per state regulations require instructions to the youth and parent for medical follow-up with the local county health department.

(4) Efforts to make medical appointments with community providers shall be documented in the Individual Health Care Record and communicated to the parent/legal guardian/assigned custodian.

(5) The youth’s parent or guardian/assigned custodian shall be provided with the remainder of any home medications brought into the detention center on admission that a youth will continue after release. If new medications have been prescribed during the youth’s stay in detention or previously prescribed medication doses have been changed, provider medical staff will ensure that the youth’s medication is released to the parent/legal guardian/assigned custodian or arrangements are made to provide a prescription for those medications upon release. The youth’s parent or guardian/assigned custodian shall be provided with a 30-day prescription from the facility DHA/designee or Psychiatrist/designee for any medication(s) that a youth will continue after release. Medication obtained from a pharmacy vendor during the youth’s admission to secure detention must be in an individually labeled, youth-specific, prescription container.

(6) Final medical follow-up information shall be provided to the parent or legal guardian/assigned custodian on the Health Discharge Summary Transfer Note (HS 012) when the youth is released. Verification of the parents or guardian/assigned custodian’s acceptance of the youth’s medication shall be documented in the Individual Health Care Record utilizing the Medication Receipt, Transfer, and Disposition (Discharge) form (HS 053).

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New     .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Michelle Hall, Director of Nursing Services

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Eric Hall, Secretary

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 13, 2024

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 13, 2024