Rule 59A-4.103 is amended to include provisions for initial and change of ownership applications or the suspension of a current license when licensure fees are returned to the Agency due to insufficient funds. This section also includes specifications regarding the issuance of partial inactive licenses for alternative uses pursuant to section 400.0712, Florida Statutes (F.S.). Other changes to this section include modifications to the licensure application. This rule amendment also eliminates the requirement to report monthly vacant beds and provide quarterly nursing home staffing reports to the Agency. Rule 59A-4.106 is amended to include the provision of a web address for obtaining transfer and discharge forms and deletes a reference to services provided by the Department of Children and Families. This rule amendment includes the requirement for each facility to adopt, implement and maintain policies and procedures for therapeutic services (if offered), updates a reference to the Code of Federal Regulations 483, and provides a specific address to obtain copies of “Health Care Advance Directives.” Rule 59A-4. 107 is amended to allow physician orders to be transmitted by email or electronic records and minor technical changes as needed. Rule 59A-4.1075 is amended to address minor technical changes as needed. Rule 59A-4.108 is amended to establish requirements for requesting the use of licensed nurses to perform licensed nursing and certified nursing assistant duties. The rule is further amended to eliminate the minimum staffing requirements which are cited in section 400.23(3)(a)1, F.S. Rule 59A-4.109 is amended to address minor technical changes. Rule 59A-4.110 is amended to include a requirement for the director of food services to be a certified dietary manager and replaces the outdated references to the Dietary Managers training and certification process. Rule 59A-4.112 is amended to update statutory references and requires nursing homes to only allow licensed staff access to the locked medication room in accordance with state and federal laws. Further, the rule is amended to address the statutory requirement regarding the emergency drug medication kit contents and to address minor technical changes as needed. Rule 59A-4.118 relating to standards for medical records is amended to eliminate the requirement for nursing homes to employ or contract with a person who is eligible for certification as a Registered Record Administrator or an Accredited Record Technician by the American Health Information Management Association of a graduate of a School of Medical Record Science that is accredited jointly by the Council on Medical Education of the American Medical Association and the American Health Information Management Association. The amendment will align this requirement with federal requirements that states a nursing home must maintain clinical records on each resident in accordance with acceptable professional standards and practices that are: complete, accurately documented, readily accessible and systematically organized. Rule 59A-4.122 is amended to define the requirement for comfortable and safe room temperatures and establishes written policies and procedures to maintain the physical plant and overall nursing home environment. Rule 59A-4.123 is amended to remove the requirement to complete the 1-day Adverse Incident Reporting Form and revise the 15-day Adverse Incident Reporting Form and provide for electronic submission of this form. Rule 59A-4.126 is amended to provide language regarding the submission of the emergency management plan, testing of this plan, and procedures and notifications for evacuation, overcapacity and re-occupancy of the nursing home structure during a disaster. Rule 59A-4.128 is amended to remove the statement that noncompliance will be stated as deficiencies measured in terms of scope and severity. Rule 59A-4.1288 is amended to update the references to federal regulations. Rule 59A-4.130 is amended to revise language to conform to code edition changes in the Florida Building Code and retain language not included in the Florida Building Code. Rule 59A-4.133 is amended to provide language to reference the Florida Building Code to conform to statutory changes, and deletes all other requirements. This rule is also amended to change the rule title to “Physical Plant Codes and Standards for Nursing Homes.” Rule 59A-4.134 is amended to update the requirements for construction plan submissions to conform to codes and statutory changes. Rule 59A-4.150 is amended to delete or correct recurring or obsolete definitions and references throughout this section and allows physician assistant and advanced registered nurse practitioner to render services to nursing home residents. Rule 59A-4.165 is amended to replace the reference to a 45-month reporting period in the Nursing Home Guide with language that cites the time period defined in section 400.191, F.S. The amendment includes the new website address for the Nursing Home Guide Methodology. This rule is also amended to include a methodology to obtain a Quality of Care score for current non-federally certified nursing homes that becomes federally certified. Rule 59A-4.202 is amended to include the web address Nursing Home Guide Methodology. Rule 59A-4.204 is amended to remove references to repealed statutory language and includes the methodology used to compute the nursing home turnover and stability rates for Gold Seal Award criteria purposes. Rule 59A-4.206 is amended to include language on termination of the Gold Seal Award designation to a facility or applicant if they no longer meet Gold Seal Award criteria.