HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/STATE/PENN-AD.ASC

Text File | 1993-01-14 | 54KB | 1,521 lines

/* The PENNSYLVANIA ADMINISTRATIVE CODE deals with long-term
nursing facilities; insurance; education; workplace policies;
reporting; and communicable diseases. */





5.10A. Acquired Immune Deficiency Syndrome (AIDS).

(a)  A school entity shall provide instruction about Acquired
Immune Deficiency Syndrome (AIDS) and related issues to its
students at least once in the elementary grades, at least once in
the middle/junior high school grades and at least once in the
senior high school grades. This instruction shall be included in
the curriculum in the health course and shall be presented in a
series of systematic lessons covering the content outlined in
subsection (c).

(b)  The appropriate time in the school year shall be determined
by each school district individually.

(c)  Educational materials and instruction shall be determined by
the local school district and be appropriate to the age group
being taught. The program of instruction shall include, but need
not be limited to, information about the nature of the disease,
the lack of a cure, the ways the disease is transmitted and how
infection can be prevented. The school district may omit
instruction in the elementary grades on the transmission of the
disease through sexual activity. Programs discussing the transmis
sion of AIDS through sexual activity shall stress that abstinence
from sexual activity is the only completely reliable means of
preventing the sexual transmission of AIDS. The program shall
stress that avoidance of illegal drug use is the only completely
reliable means of preventing transmission of AIDS through shared
drug paraphernalia.

(d)  A school district shall excuse a pupil from AIDS instruction
when this instruction conflicts with the religious beliefs or
moral principles of the pupil or a parent or guardian of the
pupil. A school district shall require written requests for
excusals. Prior to the commencement of instruction, a school
district shall publicize that detailed curriculum outlines and
curricular materials used in conjunction with the instruction
shall be available to parents and guardians during normal school
hours or at teacher/parent conferences. Curricular materials,
where practical, shall be made available by the school district
for home instruction use by a parent or guardian of a student
excused from the district's program of AIDS instruction.



5.13. Educational planning and assessment.

(a)  Once every 5 years, school districts and area vocational-
technical schools shall submit to the Department a LRP according
to criteria established by the Secretary for the plan itself and
the planning process. Once the LRP has been submitted to the
Department, changes to it submitted by a representative of the
school entity shall have the prior approval of the school
entity's board of directors.

(1)  The development of the plan shall include, but not be
limited to, the participation of administrators, school
personnel, teachers, students, parents of school age children and
members of the community.

(2)  The LRP shall include a scheduling plan which will permit a
student's participation in an area vocational technical school
program and be able to meet mandated graduation requirements
under  5.5 (relating to graduation requirements). When
appropriate for the purpose of graduation, this plan should
utilize  5.12 (relating to exceptions).

(3)  The LRP and the curriculum it contains shall be available
for public inspection at the district's central office.

(b)  School districts may participate in the Educational Quality
Assessment program. The Department will provide an opportunity
for the school districts to participate at least once every 5
years.

(c)  The Department will be responsible for coordinating the
scheduling of Educational Quality Assessment participation and
LRP submission dates.

(d)  The LRP shall include evidence that each of the Goals of
Quality Education and their learning objectives are addressed in
the planned courses required and the planned courses offered by
the school entity for all students.

(e)  A separate planned course need not be taken for every goal.
Multiple goals may be integrated in a single planned course. Each
learning objective cited in this section shall be included in
planned courses to be taken by all students at least once at the
elementary, once at the junior/middle and once at the senior high
school levels.

(f)  The following are the Goals of Quality Education. The
learning objectives are presented as subparagraphs under the
goals with which they are typically associated. They may be
linked to other appropriate goals.

(1)  Communication skills. Quality education shall help every
student acquire communication skills of understanding, speaking,
listening, reading and writing. Objectives are:

(i)  Comprehension of oral, written and nonverbal communication.

(ii) Composition of oral and written communication.

(iii)     Interpretation of and facility with language patterns.

(iv) Comprehension and appreciation of literature and arts.

(v)  Use of information sources and research techniques.

(2)  Mathematics. Quality education shall help every student
acquire knowledge, appreciation, and skills in mathematics.
Objectives are:

(i)  Knowledge of numeration and computation.

(ii) Knowledge of geometry and measurement.

(iii)  Knowledge of computer literacy and data management.

(iv)  Development of reasoning, problem solving, and creativity.

(v)  Knowledge of mathematical life skills and applications.

(3)  Science and technology. Quality education shall help every
student acquire the knowledge, understanding, and appreciation of
science and technology. Objectives are:

(i)  Knowledge of basic scientific concepts and processes.

(ii) Understanding of technological applications of scientific
principles.

(iii)  Appreciation of interaction of science, technology, and
society.

(iv)  Opportunity for inquiry and hands-on activity in science
and technology.

(v)  Understanding and use of scientific methodology.

(4)  Citizenship. Quality education shall help every student
learn the history of the United States understand its systems of
government and economics, and acquire the values and attitudes
necessary for responsible citizenship. Objectives are:

(i)  Knowledge of histories: local, State, national and global.

(ii) Understanding of systems of government and law.

(iii)     Understanding of systems of economics.

(iv) Knowledge of individual rights and responsibilities.

(v)  Knowledge of the participatory nature of the democratic
system.

(5)  Arts and the humanities. Quality education shall help every
student acquire knowledge, appreciation and skills in the arts
and the humanities. Objectives are:

(i)  Comprehension of principles and concepts in art, music,
craftsmanship, other discrete arts, and the humanities.

(ii) Understanding of the influence of literature, philosophy,
and tradition in shaping our heritage.

(iii)  Development of analytic and performing skills in the arts
and the humanities.

(iv)  Application of objective and aesthetic criteria to decision-
making.

(v)  Participation in intellectual and creative experiences in
the arts and humanities.

(6)  Analytical thinking. Quality education shall help every
student develop analytical thinking. Objectives are:

(i)  Development of information management skills.

(ii)  Development of logical thinking skills.

(iii)     Development of problem solving skills.

(iv) Development of decision making skills.

(v)  Family living. Quality education shall help every student
acquire the knowledge, skills and attitudes necessary for
successful personal and family living. Objectives are:

(i)  Development of personal and family relationships.

(ii)  Selection, management, and maintenance of personal and
family resources.

(iii)  Understanding of economics of family life.

(iv)  Development of consumer skills.

(8)  Work.  Quality education shall help every student acquire
the knowledge, skills, and attitudes necessary to become a self-
supporting member of society. Objectives are:

(i)  Development of career awareness.

(ii) Development of personal career planning skills.

(iii)   Development of job seeking, job getting,  and job keeping
skills.

(iv)  Development of entry level occupational skills.

(v)  Development of an awareness of the dignity of work.

(vi) Development of current labor market skills to foster
economic development.

(9)  Health.  Quality education shall help every student acquire
knowledge and develop practices necessary to maintain physical
and emotional well-being. Objectives are:

(i)  Development of personal and physical health.

(ii)  Knowledge of community health, disease prevention and con
trol including knowledge from instruction about Acquired Immune
Deficiency Syndrome (AIDS), as required by  5.10a (relating to
Acquired Immune Deficiency Syndrome (AIDS)).

(iii)  Knowledge of human growth, development, and good nutri
tion.

(iv)  Awareness of the dangers of tobacco, alcohol, and other
drugs.

(v)  Knowledge of safety and first aid skills.

(vi)  Development of family and consumer health.

(10) Environment. Quality education shall help every student
acquire the knowledge and attitudes necessary to maintain the
quality of life in a balanced environment. Objectives are:

(i)  Knowledge of natural and human resources.

(ii)  Understanding of geographic environments: local, regional,
global.

(iii)  Knowledge of interrelationships and interdependence of
natural and human systems.

(iv)  Development of personal environmental attitudes and values.

(v)  Development of environmental problem solving and management
skills.

(vi)  Knowledge of and appropriate uses of energy.

(11)  Self-esteem. Quality education shall help every student
develop

self-understanding and a feeling of self-worth. Objectives are:

(i)  Understanding of personal strengths and limitations.

(ii) Recognition of one's personal abilities, interests and accom
plishments.

(iii)     Awareness of one's personal beliefs and opinions.

(iv) Development of self-confidence.

(v)  Development of personal adaptability to change.

(12) Understanding others. Quality education shall help every stu
dent acquire knowledge of different cultures and an appreciation
of the equal worth and rights of all people to include the active
roles and contributions of women, minority racial and ethnic
groups. Objectives are:

(i)  Knowledge of cultural similarity and diversity.

(ii) Knowledge of individual similarity and diversity.

(iii)  Development of interpersonal relationship skills.

(iv)  Understanding of human interdependence.

(v)  Knowledge of roles and contributions of racial and ethnic
groups and women.



Ch. 7     MISCELLANEOUS PROVISIONS

Subchapter FF. AIDS WORK PLACE POLICY

Sec.

7.431.    Overall AIDS work place policy.

7.432.    Detailed provisions of the AIDS work place policy.

7.433.    Agency AIDS policies.



7.431. Overall AIDS work place policy.

It is the policy of this administration to provide a concerned
and nondiscriminatory environment for individuals with AIDS or
HIV infection. A person with AIDS or HIV infection is to be
treated with respect and dignity and not to be denied government
service due to him. State employees and persons served by the
Commonwealth will not be discriminated against on the basis of
their AIDS or HIV status. Specific aspects of this policy related
to State employment are set forth in this subchapter.



7.432. Detailed provisions of the AIDS work place policy.

(a)  Individuals and State employees with AIDS or HIV infection,
or those perceived to have these conditions, may not be
discriminated against with regard to appointment, transfer,
promotion or other employment action. The Pennsylvania Human
Relations Act (43 P. 5.  951-962.2) prohibits the discrimination,
as does section 504 of the Rehabilitation Act of 1973 (29
U.S.C.A.  794), the Civil Rights Restoration Act of 1987 (Pub. L.
No. 100-259) (102 Stat. 28) and recent court decisions.

(b)  No current or prospective State employee may be required to
receive an AIDS or HIV antibody test as a condition of
employment.

(c)  State employees with AIDS or HIV infection shall continue in
their current jobs and work assignments as long as their health
permits. If an employee is unable physically to carry out his job
duties, the employee shall be afforded the same considerations as
another employee whose illness prevents him from performing job
duties.

(d)  Because of the episodic nature of the secondary illnesses
which afflict persons with AIDS, employees may request reasonable
accommodations which will allow them to continue to work with
their handicap. These requests should be honored to the extent
practicable. State employees with AIDS or HIV infection who
request a transfer because of their medical condition should have
these transfers considered, consistent with agency needs.

(e)  Managers and supervisors should be given a point of contact
within their agency where they can obtain further information on
AIDS-related situations which arise in their work units.

(f)  Agencies will  provide ongoing education  and  information
to employees on AIDS and HIV in order to increase knowledge about
the disease. Effective education should result in better services
to the public and should be ongoing to reinforce earlier efforts
and to reflect new information.

(g)  Federal guidelines for protection against exposure to blood
and blood by-products should be adopted by Commonwealth agencies.
These guidelines are issued by the United States Public Health
Service, Centers for Disease Control (CDC). Agencies are to
insure that staff who have the potential to be exposed to blood
or blood by-products follow specific CDC guidelines, which are
available from the Department of Health.

(h)  State employees wanting more information on AIDS should
contact their personnel office or other official designated as
responsible for handling AIDS questions. Additional information
can be obtained from the Department of Health hotline, local
State Health Centers and local AIDS support groups.

(i)  State employees wanting an AIDS or HIV antibody test should
be referred to the Department of Health's testing centers. If a
test is desired because of a documented incident in the work
place, the test can be conducted during paid work hours and costs
will be reimbursed by the Commonwealth.

(j)  AIDS-related  information  on State employees,  dependents
and clients should be handled with strict confidentiality by
agencies. Records should not be filed in the Official Personnel
Folder. Supervisory and management employees shall assure
confidentiality when handling AIDS-related employee information.



7.433. Agency AIDS policies.

State agencies that develop individualized AIDS work place
policies should insure that their issuances are consistent with
this Commonwealth policy and with policies found in other State
agencies. Agency policies shall be approved, in writing, by the
Department of Health and the Office of Administration before
issuance.



CHAPTER 27. COMMUNICABLE AND NONCOMMUNICABLE DISEASES

Subchap                          Sec.
A.   GENERAL PROVISIONS          27.1
B.   REPORTING OF DISEASES       27.21
C.   QUARANTINE AND ISOLATION    27.61
D.   VENEREAL DISEASE,
  TUBERCULOSIS AND OTHER
  COMMUNICABLE DISEASES          27.81
E.   PROCEDURE FOR TREATING EACH
  REPORTABLE DISEASE             27.101
F.   MISCELLANEOUS PROVISIONS    27.181



Subchapter A. GENERAL PROVISIONS

Sec.

27.1.     Definitions.

27.2.     Reportable diseases.

27.3.     Unusual or ill-defined diseases, illnesses or
outbreaks.

27.4.     Noncommunicable diseases and conditions.

27.5.     Cancer Registry.



 27.1. Definitions.

The following words and terms, when used in this chapter, have
the following meanings, unless the context clearly indicates
otherwise:

Act - Disease Prevention and Control Law of 1955 (35 P.S. 521.1-
521.21).

Board-The Advisory Health Board of the Department.

Carrier-A person who, without any apparent symptoms of
communicable disease, harbors a specific infectious agent and may
serve as a source of infection.

Communicable disease-An illness due to an infectious agent or its
toxic products which is transmitted, directly or indirectly, to a
susceptible host from an infected person, animal or arthropod, or
through the agency of an intermediate host, or a vector or
through the inanimate environment.

Communicable period-The time during which the etiologic agent may
be transferred directly or indirectly from an infected person to
another person, or from an infected animal to a person.

Contact-A person or animal known to have been in association with
an infected person or animal as to have had an opportunity of
acquiring the infection.

County morbidity reporting area-A county so designated by the
Board wherein initial reports for communicable and
noncommunicable diseases are to be reported to the State health
center of the Department.

Department-The Department of Health of the Commonwealth.

Isolation-The separation for the period of communicability of
infected persons or animals from other persons or animals, in
places and under conditions that prevents the direct or indirect
transmission of the infectious agent from infected persons or
animals to other persons or animals who are susceptible or who
may spread the disease to others.

Local board-The board of health or the department of public
health of a municipality of the first class, a county department
of health or a joint county or joint municipal department of
health.

Local health authority-The appropriate local health officer,
local board or district director of the area.

Local health officer-The head of a local board.

Municipality-A city, borough, incorporated town or township.

Placarding-The posting on a home or other building of a sign or
notice warning of the presence of communicable disease within and
the danger of infection therefrom.

Quarantine-The limitation of freedom of movement of persons or
animals who have been exposed to a communicable disease, for a
period of time equal to the longest usual incubation period of
the disease, in such manner as to prevent effective contact with
those not exposed. A quarantine may be complete or one of the
following types:

(i)  Segregation-The separation for special control or
observation of one or more persons or animals from other persons
or animals to facilitate the control of a communicable disease.

(ii) Modified quarantine-A selected, partial limitation of
freedom of movement determined on the basis of differences in
susceptibility or danger of disease transmission which is
designed to meet particular situations. Modified quarantine
includes, but is not limited to, the exclusion of children from
school and the prohibition, or the    restriction, of those
exposed to a communicable disease from engaging  in particular
occupations.

(iii)  Surveillance-The close supervision of persons and animals
exposed to a communicable disease without restricting their
movement.

Regulation-A rule or regulation issued by the Board or an
ordinance, rule or regulation enacted or issued by a local board.

Reportable disease-A communicable disease declared reportable by
regulation; an unusual or group expression of illness which, in
the opinion of the Department, may be a public health emergency;
 noncommunicable diseases and conditions for which the Department
may authorize reporting to provide data and information which, in
the  opinion of the Board, are needed in order to effectively
carry out those programs of the Department designed to protect
and promote the health of the people of this Commonwealth, or to
determine the need for the establishment of the programs.

Secretary-The Secretary of the Department of Health.

State health center-The official headquarters of the Department
in each county other than those organized as county departments
of health.



27.2.     Reportable diseases.

The Board declares the following communicable diseases, unusual
outbreaks of illness, noncommunicable diseases and conditions to
be reportable:

AIDS (Acquired Immune Deficiency Syndrome).

Amebiasis.

Animal bite.

Anthrax.

Botulism.

Brucellosis.

Campylobacteriosis.

Cancer.

Chlamydia trachomatis infections.

Cholera.

Diphtheria.

Encephalitis.

Food poisoning.

Giardiasis.

Gonococcal infections.

Guillain-Barre syndrome.

Haemophilus influenzae type b disease.

Hepatitis non-A non-B.

Hepatitis, viral, including Type A and Type B.

Histoplasmosis.

Kawasaki disease.

Legionnaires' disease.

Leptospirosis.

Lyme disease.

Lymphogranuloma venereum.

Malaria.

Measles.

Meningitis-all types.

Meningococcal disease.

Mumps.

Pertussis (whooping cough).

Plague.

Poliomyelitis.

Psittacosis (Ornithosis).

Rabies.

Reye's syndrome.

Rickettsial diseases including Rocky Mountain Spotted Fever.

Rubella (German Measles) and congenital rubella syndrome.

Salmonellosis.

Shigellosis.

Syphilis-all stages.

Tetanus.

Toxic shock syndrome.

Toxoplasmosis.

Trichinosis.

Tuberculosis-all forms.

Tularemia.

Typhoid.

Yellow Fever.



 27.24. Reports by heads of institutions.

(a)  Superintendents of hospitals or other persons in charge of
an institution for the treatment of disease or of an institution
maintaining dormitories and living rooms or of an orphanage shall
notify the local health authorities having jurisdiction over the
area in which the institution is located and the district
director or county health officer upon the occurrence in or
admission to the institution of a patient with a reportable
disease and shall thereafter follow the advice and instructions
of the health authorities for controlling the disease, but the
notification may not relieve physicians of their duty to report
in the manner set forth in  27.21 (relating to physicians who
treat patients with reportable diseases including tuberculosis),
cases which they may treat or examine in any such institution.

(b)  Persons in charge of hospitals shall report cases of AIDS
under  27.32 (relating to reporting AIDS).



 27.25. Reports by other licensed health practitioners.

A chiropractor, dentist, nurse, optometrist, podiatrist or other
licensed health practitioner having knowledge or suspicion of a
reportable disease or condition, except cancer and AIDS, shall
report promptly to the local board.



27.26. Reporting by householders and others.

A householder; proprietor of a hotel, rooming, lodging or
boarding house; or other person having knowledge or suspicion of
a reportable disease or condition, except cancer and AIDS, shall
report this knowledge or suspicion promptly to the local board.



27.27. Revision of diagnosis by attending physician.

No diagnosis of a disease for which isolation or quarantine is
required may be revised without the concurrence of the county
health officer or the designated representative of the Department
or the medical member of the local board.



27.28. Reporting unusual or ill-defined diseases or illnesses.

A person having knowledge of the occurrence of an unusual disease
or group expression of illness which may be of public concern,
whether or not it is known to be of a communicable nature, shall
report it promptly to the local health officer; reports shall be
made to the representative of the Department district director.



27.32. Reporting AIDS.

(a)  Physicians and hospitals shall report cases of AIDS promptly
to the Department of Health, Division of Acute Infectious Disease
Epidemiology, Post Office Box 90, Harrisburg, Pennsylvania 17108,
or to the local health department in the counties of Allegheny,
Bucks, Chester, Erie and Philadelphia and in the cities of
Allentown, Bethlehem and York when the individual who is the
subject of the report is a resident of the county or city.

(b)  Local health authorities receiving reports of AIDS cases
shall forward completed case report forms to the Department of
Health in a timely manner. Completed forms shall provide
identifying information, including but not limited to, the name
of the case, the individual's address and telephone number, the
name of the individual's medical provider and the reporting
source.



REPORTS BY LOCAL HEALTH OFFICERS

27.41. Individual case reports.

A health officer of a municipality shall report weekly to the
appropriate county health authorities on the prescribed form each
individual case of reportable disease or condition which has been
reported to him during the week.



Subchapter E. PROCEDURE FOR TREATING EACH REPORTABLE DISEASE

Sec.

27.101.   General.

27. 101a.  Acquired Immune Deficiency Syndrome (AIDS).

27.102.   Amebiasis (amebic dysentery).

27.103.   Animal bites.

27.104.   Anthrax.

27.105.   Botulism.

27.106.   Brucellosis.

27. 106a.  Campylobacteriosis.

27.107.   Cholera.

27.108.   Diphtheria.

27.109.   Encephalitis.

27.110.   Food poisoning.

27.111.   Giardiasis.

27.112.   Gonococcal infections.

27.113a.  Haemophilus influzenae Type b Disease.

27.113.   Guillain-Barre Syndrome.



27.101. General.

This subchapter contains the names of reportable diseases in
alphabetical order and prescribes, in each case, the general
requirements for the control of the infected individual, his
contacts and his environment.

Detailed requirements for reporting diseases are prescribed in
Subchapter B (relating to reporting of diseases) and requirements
for isolation and quarantine are prescribed in Subchapter C
(relating to quarantine and isolation).



27.101a. Acquired Immune Deficiency Syndrome (AIDS).

(a)  Reporting. Reports of AIDS cases shall be made to the
Division of Acute Infectious Disease Epidemiology, Department of
Health, or to the local health department, as specified in  27.32
(relating to reporting AIDS).

(b)  Isolation, Observe blood/body fluid precautions. Observe
precautions appropriate for other specific infections that occur
in AIDS patients.

(c)  Concurrent disinfection. Equipment contaminated with blood
or semen shall be disinfected.

(d)  Terminal disinfection. Thorough cleaning of the patient's
environment is required upon the patient's discharge from a
hospital room.

(e)  Quarantine. No quarantine is required.

(f)  Restrictions on infectious individuals. Restrictions on body
fluid and organ donations shall conform to the following:

(1)  AIDS cases, human immunodeficiency virus (HIV) infected

persons and HIV antibody positive persons may not donate blood,

plasma, semen, organs or other body tissues.

(2)  Blood banks, sperm banks and hospitals may not accept for
human use blood, plasma, semen, organs or other body tissues
without obtaining prior evidence that the donor is HIV antibody
negative. Transplants may be performed prior to receiving HIV
test results if delay, due to performance of the test, would
threaten the recipient's survival.



CHAPTER 90c. INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY

 90c.5. Underwriting questions.

(a)  Information.

(1)   Information asked of the applicant to underwrite the
coverage is in the form of a single direct question, not a
compound question or declaratory statement, and permits a direct
response of known fact. This complies with  89.12(d) (relating to
application forms).

(2)   Additional information obtained by a telephone interview
conducted after the application has been submitted to the company
is not used to contest coverage, unless the additional
information is agreed to in writing by the applicant.

(b)  "Good health" question.

(1)   An adult application does or does not contain a "good
health" question if the application contains extensive health
underwriting questions.

(2)   An adult application does not contain a "good health"
question if the application does not contain extensive health
underwriting questions. Extensive health underwriting questions
means questions concerning at least the common dread diseases and
a broad range of common nonlife threatening health conditions.

(3)   A juvenile application does or does not contain a "good
health" question.

(c)  Serious health condition.

(1)   An adult application does or does not contain either of the
following questions, or a similar question, if the application
contains extensive health underwriting questions:

(i) "Had or been treated for any serious health condition?"

(ii)    "Do you have any other impairment?"

(2)   A juvenile application does or does not contain either of
these questions, or a similar question, without extensive health
underwriting questions.

(d)  Alcohol and drug use.

(1)   An application contains alcohol and drug use or dependency
questions if the application clearly defines words such as
"excessive," "dependency," "habitual," "abuse," "regular," and
the like. An application does not contain these questions if the
application does not clearly define "excessive," "dependency,"
"habitual," "abuse," "regular," and the like. In relation to
alcohol, these words are defined in terms of number of drinks
consumed per day or some similar measure. In relation to drugs,
they are defined in terms of being treated by a doctor for drug
use or dependency.

(2)   Underwriting questions concerning treatment for alcohol or
drug use or dependency are worded to permit responses of known
fact.

(3)          The following alcohol or drug questions do or do not
appear:

(i)   Have  you  been  medically treated for  or  been  medically
advised  to  have  treatment  for  alcoholism  or  drug  use   or
dependency?

(ii) Have you been treated for alcohol or drug use or dependency?

(iii)   Have  you  joined  a  treatment organization  because  of
alcohol or drug use or dependency?

 (iv)   Have  you  ever sought medical treatment for  alcohol  or
drug use or dependency?

(v)             Have  you  ever  been hospitalized  for  drug  or
alcohol use or dependency?

(e)  Subsequent application. If an application is taken
subsequent to the taking of an original application, it does not
contain questions that require the applicant to agree that his
health on the date of the application is the same as it was when
the original application was taken, unless the applicant has a
copy of the original application. In addition, a subsequent
application that refers to the original application is not used
more than 180 days after the original application.

(f)   AIDS questions. The following AIDS questions do or  do  not
appear:

(1)  Have you ever been treated for or ever had Acquired Immune
Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC)?

(2)          Have  you  ever  had  a  condition  which  you  were
medically advised is related to AIDS?

(3)         Have you ever tested positively for HIV, AIDS or ARC?

NOTE:  The Department considers valid testing to be the  HTLV-III
test.  A  company uses a positive response to require  additional
testing to confirm AIDS. The additional testing includes the HTLV-
III  test  twice and the Western Blot Test on the same sample  of
blood. The company does not deny coverage or rate the coverage on
incomplete testing.

(4)  Have you ever had an immune deficiency disorder or disease
of the lymphatic system or immune mechanism? This appears only if
the question in paragraph (1) or (2) or a similar question
appears on the  application.

(g)  Additional AIDS questions. The following AIDS questions do
not appear:

(1)  Have you received counseling for, or advice concerning,
AIDS?

   NOTE:  Questioning a proposed insured's history of  counseling
concerning  AIDS  is  an  invasion of  the  applicant's  privacy.
Counseling by itself would not reveal anything pertinent  to  the
underwriting process.

(2)  Are you homosexual?

NOTE:     Questioning a proposed insured's life style is an
invasion of the proposed insured's privacy.

(3)  Have you ever had a known indication or symptom of AIDS or
ARC or other health condition?

NOTE:Questions about whether a proposed insured has had a known
indication or symptom do not appear on an application. Unless a
condition has been previously diagnosed or treated, this question
places the applicant in the position of making a self-diagnosis.
Also, it is difficult to define what constitutes a "known
indication or symptom of."

(4)  Have you ever had an AIDS related condition?

NOTE:"AIDS"/"AIDS Related Complex" is definitive. Conversely, "related
conditions" is vague and not in compliance with  89.12(d).

(5)  Have you ever had an AIDS Related Complex?

NOTE:"AIDS"/"AIDS Related Complex" is definitive. Conversely, "any
AIDS related complex" erroneously suggests that there is more
than one AIDS Related Complex.

(6) Have you ever had an AIDS related blood test?

NOTE:"AIDS related blood test" is vague and not in compliance with
89.12.

(h)  Specific AIDS questions. The following questions do or do
not appear with or without specific AIDS questions:

(1)  Have you ever had, experienced, been tested for, treated for
or told you had any of the following: Kaposi's Sarcoma,
infections from Pneumocystis Carinii, Cytomegalovirus (CMV),
enlargement of lymph nodes or glands, chronic diarrhea, unusual
or persistent skin lesions, unexplained infections or chronic
fatigue?

(2)  Have you ever had major surgery that necessitated a blood
transfusion?

(i)  Blood transfusion. The following question does not appear:
Have you ever had major surgery that necessitated, or may have
necessitated, a blood transfusion?

(j)  Medical consultation. An application does or does not
contain a general question about a medical consultation or a
visit to a physician, for example, "Have you within the past 10
years had a consultation?" or "When did you last see a
physician?" If it does, the company certifies in writing that
information obtained on the application about a medical
consultation or informational visit concerning AIDS or ARC, as
opposed to the diagnosis or treatment of AIDS or ARC, will never
be used to underwrite coverage on a proposed insured.

(k)  Church affiliation. An application does not contain a
question    ( about the applicant's church affiliation. The
agent's report does or does not contain a question concerning the
applicant's church affiliation. If it does, the company certifies
that the information is not used for underwriting purposes.

(1)  Smoker or nonsmoker. Underwriting questions for the purpose
of assigning a smoker or nonsmoker rating in determining the cash
values of a fixed premium policy or rider and the cost of
insurance rates of a flexible premium universal life policy or
rider are limited to questions about the proposed insured's
tobacco use habits. With respect to the cost of insurance rates,
this does not prevent the company from classifying a proposed
insured, not an existing insured, who does not smoke a
substandard nonsmoker based on medical history.

(m)  Medical exam report. When using another company's medical
exam report the following apply:

(1) The report is provided to the new company only by the
applicant or with specific authorization in writing from the
applicant.

(2) The new application that incorporates the other company's
medical exam report provides for the applicant to state that the
medical condition as stated in the medical exam report is
unchanged only if the applicant has a copy of the report.

(3) The medical exam is no older than 180 days.



 90c.25. AIDS.

Insurer practices that comply with the following are acceptable:

(1)  For underwriting purposes, AIDS is considered to be the same
as other medical conditions, such as cancer or heart disease.

(2)  Information obtained through the underwriting process is
confidential.

(3)  Proposed insureds who are determined to have AIDS or ARC are
insured at standard premiums, at higher than standard premiums,
or rejected as insureds based on underwriting and any complete
test results.

(4)  An individual life insurance policy or annuity contract does
not include a provision applicable to all life insureds or
annuitants that excludes claims from any specific condition, such
as AIDS.



CHAPTER 211. PROGRAM STANDARDS FOR LONG TERM CARE NURSING
FACILITIES

  211.1. Infection control.

(a)  The facility shall establish an active Infection Control
Committee composed of members of the medical and nursing staffs,
administration, and dietetic, pharmacy, housekeeping, maintenance
and other services charged with responsibility for overall
infection control.

           (b)   The  Infection Control Committee shall establish
           written  policies  and procedures  for  investigating,
           controlling   and   preventing   infections   in   the
           facility,   and   for   identifying   patients    with
           reportable diseases.

 (c)     The  written  policies  and procedures  in  aseptic  and
isolation  techniques  shall be followed  by  personnel.  If  the
facility  does  not have the capability of caring for  a  patient
with  an  infectious disease, the written policies shall  include
provisions for handling isolation cases until arrangements can be
made  to  have the patient transferred to a facility  capable  of
caring  for  the  patient and the needs related to  the  specific
organism.

(d)       The  Infection  Control Committee shall  monitor  staff
performance to ensure that policies and procedures are executed.

(e)        Procedures   shall  be  reviewed   and   revised   for
effectiveness   and  improvement  at  least  annually   or   more
frequently as necessary.

(f)      Minutes shall be maintained for Committee meetings.

(g)  A patient who develops a communicable disease after
admission shall be medically isolated from other patients if
ordered by the physician. If the patient cannot or should not be
managed in the facility, arrangements shall be made by the
attending physician for the transfer of the patient to an
appropriate facility at the earliest practical time.

(h)  When a patient develops a reportable disease, the
administrator shall report the information to the appropriate
health agencies and Long Term Care Field Office. Reportable
diseases and conditions are:

     Acquired Immune Deficiency Syndrome
     Amebiasis
     Animal bites
     Anthrax
     Botulism
     Brucellosis
     Campylobacteriosis
     Cancer
     Cholera
     Diphtheria
     Encephalitis
     Food Poisoning
     Giardiasis
     Gonococcal Infections
     Guillain-Barre Syndrome
     Haemophilus influenzae type b disease
     Hepatitis, Viral, including Type A and Type B
     Hepatitis, non-A and non-B
     Histoplasmosis
     Kawasaki disease
     Legionnaires' disease
     Leptospirosis
     Lyme disease
     Lymphogranuloma venereum
     Malaria
     Measles
     Meningitis-all types
     Meningococcal Disease
     Mumps
     Pertussis (whooping cough)
     Plague
     Poliomyelitis
     Psittacosis (ornithosis)
     Rabies
     Reye's syndrome
     Rickettsial diseases, including Rocky Mounted Spotted Fever
     Rubella (German measles) and congenital rubella syndrome
     Salmonellosis
     Shigellosis
     Syphilis, all stages

     Tetanus
     Toxic Shock Syndrome
     Toxoplasmosis
     Trichinosis
     Tuberculosis, all forms
     Tularemia
     Typhoid
     Yellow Fever

(i)  The following conditions shall be reported when diagnosis is
confirmed by laboratory findings:

Amebiasis

Anthrax

Botulism

Brucellosis

Campylobacteriosis

Cholera

Diphtheria infections

Giardiasis

Gonococcal infections

Haemophilus influenzae type b disease

Hepatitis, viral, including types A and B

Hypothroidism in infant up to 24 months

Histoplasmosis

Lead poisoning

Legionnaires' disease

Leptospirosis

Lyme disease

Lymphogranuloma venereum

Malaria

Meningococcal isolations

Phenylketonuria

Plague

Psittacosis (ornithosis)

Rabies

Rickettsial infections including Rocky Mountain Spotted Fever

Salmonella isolations

Shigella isolations

Syphilis

Trichinosis

Tuberculosis

Tularemia

Typhoid isolations

Viral infections

Vaccine-preventable diseases

Arboviruses

Respiratory viruses

(j)  If a communicable disease develops, adequate steps shall be
taken to determine the source and degree of dissemination of the
disease.

(k)  Cases of scabies and lice shall be reported to the Long Term
Care Field Office.



  211.2. Medical services.

(a)  The facility shall have or make provisions for a physician
who shall be responsible for attending to the medical needs of
the patients.

(b)  A patient shall be under the current care of a physician. A
skilled care patient shall be seen by the attending physician at
least every 30 days and an intermediate care patient at least
every 60 days, or more often as necessary.

(c)  A patient's total program of care, including medications,
care and treatments, shall be reviewed during a visit by the
attending physician at least once every 30 days for a skilled
care patient and every 60 days for an intermediate care patient.
Revisions shall be made as necessary. The physician shall
indicate on the patient's medical record that the review has been
made. Entries made by the physician on the medical record shall
be dated and signed with the original signature of the physician.
A physician's orders shall be renewed at least once every 30 days
for skilled care patients and every 60 days for intermediate care
patients.

(d)  The facility shall have written procedures available at each
nurses station that provide for a physician to be available to
furnish necessary medical care in case of emergency. The
procedures shall be reviewed periodically to determine their
effectiveness.

(e)  The attending physician shall be responsible for the medical
evaluation of the patient and shall prescribe a planned regimen
of total patient care. This regimen shall incorporate all of the
components of the patient's care and shall designate the
patient's appropriate level of care.

(f)  The facility shall have available, prior to or at the time
of admission, patient information which includes current medical
findings, diagnoses and orders from a physician for immediate
care of the patient. Information shall also be available at the
time of admission or within 48 hours thereafter, on the patient's
rehabilitation potential and a summary of the course of prior
treatment.

(g)  The admission requirements shall include a report of
physical examination, chest X-ray, complete blood count and
urinalysis. These shall be done within 1 week prior to, or within
48 hours after admission. A chest X-ray taken within 60 days
prior to admission will fulfill the admission requirement for a
chest X-ray. When the patient is admitted to the facility
directly from a hospital, the hospital report of these
examinations and tests accompanying the patient shall be
considered to meet this requirement, if the attending physician
in the facility documents, in the patient record, that these
reports are acceptable. When a patient is admitted to another
level of care within a facility, or to another licensed nursing
facility, the medical reports transferred with the patient shall
be considered to meet this requirement, if the attending
physician in the facility documents, in the patient's record,
that these reports are acceptable.

(h)  Annually thereafter, there shall be a physical examination,
complete blood count and urinalysis completed for each patient.
The results of the tests shall be available on the patient chart.

(i)  A progress note shall be written or typed and signed and
dated by the physician on the day the patient is seen.

 (j)  A physician's orders shall be dated and signed with the
 original signature of the physician.

(k)  A facility shall have a medical director who is licensed as
a physician in this Commonwealth and who is responsible for the
overall coordination of the medical care in the facility to
ensure the adequacy and -appropriateness of the medical services
provided to the patients. The medical director may serve on a
full- or part-time basis depending on the needs of the patients
and the facility and may be designated for single or multiple
facilities. There shall be a written agreement between the
physician and the facility.

(l)  The medical director's responsibilities shall include at
least the following:

(1)  Coordination of care of patients provided by attending physi
cians and ensurance of compliance with the facility's written
bylaws and rules which delineate responsibilities.

(2)  Review of incidents and accidents that occur on the premises
and addressing the health and safety hazards of the facility. The
administrator shall be given appropriate information from the
medical director to help insure a safe and sanitary environment
for patients and personnel.

(3)  Execution of patient care policies as they relate to the
patient's total plan of care.

(4)  Development of written policies which are approved by the
governing body that delineate the responsibilities of attending
physicians.

(m)  The requirement for a medical director may be waived by the
Department for an appropriate period of time depending on the
following:

(1)  The facility is located in an area where the supply of
physicians is not sufficient to permit compliance with this
requirement without seriously reducing the availability of
physician services within the area.

(2)   The  facility has made continuous efforts in good faith  to
recruit  a  medical  director but has not been  able  to  hire  a
physician due to the unavailability of physicians.



211.3. Oral and telephone orders.

(a)  A physician's oral and telephone orders shall be given to a
licensed nurse, physician or other individual authorized by
appropriate statutes and the State Boards in the Bureau of
Professional and Occupational Affairs and shall immediately be
recorded on the patient's medical record by the person receiving
the order. The entry shall be signed and dated by the person
receiving the order.

(b)  A physician's oral and telephone orders for care and
treatments, exclusive of medication orders-see  211.9(h)
(relating to pharmaceutical services)-shall be dated and
countersigned with the original signature of the physician within
7 days of receipt of the order. If the physician is not the
attending physician, he shall be authorized and the facility so
informed by the attending physician and shall be knowledgeable
about the patient's condition.



211.4. Procedure in event of death.

(a)  The patient's physician or the physician's designee shall be
notified immediately of the apparent death of a patient.
Documentation shall be on the patient's medical record of this
notification or attempt to notify the physician.

(b)  Written and dated documentation by the physician shall be on
the patient's medical record that death has occurred.

(c)  Death certificates shall be completed and signed by the
physician under Article V of the Vital Statistics Law of 1953 (35
P.S.  450.50l-450.5(6).

(d)  Written postmortem procedures shall be available at each
nursing station.

(e)  Documentation shall be on the patient's medical record that
the next of kin, guardian or responsible party has been notified
of the patient's death. The name of the notified party shall be
written on the patient's medical record.



    211.5.  Medical records.

                  (a)  The facility shall maintain, in
                  accordance with accepted professional
                  standards and practices, an organized patient
                  record system. These records shall be
                  available to professional and other staff
                  directly involved with the patient and to
                  authorized representatives of the State and
                  Federal government. Records shall be available
                  to, but not be limited to, representatives of
                  Department of Aging Ombudsman Program.

(b)  The medical record service shall have sufficient staff,
facilities and equipment to provide medical records that are
documented completely and accurately, readily accessible and
systematically organized to facilitate retrieving and compiling
information.

(c)  Information contained in the patient's record shall be
privileged and confidential. Written consent of the patient, or
of a designated responsible agent acting on the patient's behalf,
is required for release of information. Written consent is not
necessary for authorized representatives of the State and Federal
government during the conduct of their official duties.

(d)  The facility shall provide the patient or the patient
designee, upon request, access to information contained in the
patient's medical records unless medically contraindicated. If
the patient or patient designee wants a copy of the medical
record, the facility shall provide the copy and may charge a
reasonable fee for reproducing copies.

(e)  If requested, after the death of a patient, the facility
shall make the patient's medical record available to the deceased
patient's executor or administrator of the decedent's estate or
to the person who is responsible for the disposition of the body.
If a copy of the medical record is requested, the facility shall
provide one copy and may charge a reasonable fee for reproducing
copies.

(f)  Records shall be adequately safeguarded against destruction,
fire, loss or unauthorized use.

(g)  The facility shall maintain adequate facilities and
equipment, which  are conveniently located, in order to provide
efficient processing of medical records.

(h)  Records shall be retained for a minimum of 7 years following
a patient's discharge or death.

(i)  Medical records of discharged patients shall be completed
within 30 days of discharge. Clinical information pertaining to a
patient's stay shall be centralized in the patient's medical
record.

(j)    When a facility closes, patient medical records may be
transferred with the patient if the patient is transferred to
another health care facility. Otherwise, the owners of the
facility shall make provisions for the safekeeping and
confidentiality of medical records and shall notify the
Department of how the records may be obtained.

(k)  At a minimum, the patient record shall include physicians'
orders, observation and progress notes, nurses' notes, medical
and nursing history and physical examination reports;
identification information, admission data, documented evidence
of assessment of patient's needs, establishment of an appropriate
treatment plan and plans of care and services provided; hospital
diagnoses authentication-discharge summary, report from attending
physician, or transfer form-diagnostic and therapeutic orders,
reports of treatments, clinical findings, medication records and
discharge summary including final diagnosis and prognosis or
cause of death. The information contained in the record shall be
sufficient to justify the diagnosis and treatment, identify the
patient and show accurately documented information.

(1)  Symptoms and other indications of illness or injury,
including the date, time and action taken shall be recorded.

(m)  Each professional discipline shall enter the appropriate
historical and progress notes in a timely fashion in accordance
with the individual needs of a patient.

(n)  Overall supervisory responsibility for the medical record
service shall be assigned to a full-time employee of the
facility. If the person is not a qualified medical records
administrator, this person functions with consultation from a
person so qualified. The facility shall also employ sufficient
supportive personnel competent to carry out the functions of the
medical record service.

(o)  The following information shall be incorporated by members
of the nursing staff into the nurses' notes section of the
medical record:

(1)  Drugs or treatment administered to patients shall be
recorded daily on the proper record.

(2)  Observations made concerning the condition of critically or
acutely ill patients shall be recorded daily on the proper record
on each tour of duty.

(3)  Observations made concerning the condition of patients who
are not critically or acutely ill shall be recorded in summary at
least once each month for each tour of duty.

(4)  Nurses' notes shall be written in chronological order and
shall be signed and dated by the person making the entry. Nurses'
notes include, but are not limited to, observations made
concerning the general condition of the patient, change in the
physical or mental condition, an incident or accident and
significant items of care.