10:48-1.1 General provisions

10:48-1.2 Definitions

10:48-1.3 Contested cases

10:48-1.4 Office of Administrative Law

10:48-1.5 Non-contested cases

10:48-1.6 Emergency relief

10:48-2.1 Purpose

10:48-2.2 Scope

10:48-2.3 Definitions

10:48-2.4 Exclusion from programs

10:48-2.5 Immunization expenses

10:48-2.6 Requirements for program participation or placement of persons with hepatitis B

10:48-2.7 Staff training

10:48-2.8 Responsibility for testing and monitoring

10:48-2.9 Testing and monitoring process

10:48-2.10 Admission of an individual receiving services

10:48-2.11 Transfer of an individual receiving services

10:48-2.12 Immunization of susceptible individuals at risk

10:48-2.13 Informed consent

10:48-2.14 Immunization of individuals scheduled to be admitted to developmental centers

10:48-2.15 Treatment for those who have been exposed to hepatitis and have not been immunized or who have no
natural immunity

10:48-2.16 Registry of carriers of hepatitis B

10:48-2.17 Limitations to program participation

10:48-2.18 Appeal of exclusion of individual from program

  (a) The purpose of this procedural rule is to delineate the steps to be taken when disagreements arise between citizens and the Division of Developmental Disabilities (DDD).  Its aim is to encourage and permit the early resolution of disputes and, where that is not possible, to identify the steps to be taken for review by the appropriate authority. 

  (b) This subchapter pertains to all disputes and disagreements with service components of the Division of Developmental Disabilities involving a competent adult receiving services from or applying for services of the Division, the guardian of a minor or incompetent adult, the proposed guardian, a licensee of the Division or an authorized representative of a competent adult, guardian of a minor or incompetent adult.  In the instance of an attorney, written verification of a client/attorney relationship shall be required. 

  (c) It is expected that, in most disputes between appellants and service components, the appellant will know the identity of the service component with whom there is disagreement.  Where the precise service component is not known, such information may be obtained by calling the Administrative Practice Office of DDD (609) 633-2209.

   (d) For persons of legal school age, when disputes arise relating to educational program issues, mediation pursuant to N.J.A.C. 6:28-2.6 shall be available through the Office of Education, Department of Human Services.  If either party is unwilling to participate in mediation, a written request for a due process hearing under N.J.A.C. 6:28-2.7 may be made directly to the Department of Education.  A request for mediation is not prerequisite to a hearing. 

  (e) Division staff are responsible for informing persons served and their families/guardians about appeals and to supply them with copies of the appeal procedure. 

  (f) An appeal may be settled at any time by a written agreement of both parties.  The settlement agreement shall be considered the final decision.  The terms of the settlement agreement shall be binding upon the appellant and the Division.  The terms of the settlement agreement shall be applicable only to the specific matter under appeal and shall not be released to anyone who is not a party to the settlement. 

 (g) A settlement may be accepted by the chairperson of an informal conference or the review officer in an administrative review in the same manner as an Administrative Law Judge, in the definition of settlement at N.J.A.C. 10:48-1.2. 

  (h) Contested matters shall be referred to the Office of Administrative Law (OAL) in accordance with N.J.A.C. 1:1.  Non-contested matter shall be referred to administrative review. 

  (i) Appeals of eligibility, licensure action or specific offers of placement shall be initiated within 30 calendar days from the date on the written notification of ineligibility or licensure action. 

  (j) Appeals of services shall be limited to those services indicated in the Individual Habilitation Plan as defined at N.J.S.A. 30:6D-10. 

  (k)  Except in emergencies, an appellant may request that the Division Director defer the placement of an individual pending resolution of an administrative appeal when the following circumstances apply: 

  1. The appeal is received verbally or in writing 10 calendar days before the proposed placement, and: 

   i. The appellant can demonstrate that the placement may place the individual at risk of abuse or neglect; or 

   ii. The appellant has new information that was not known or available at the time the placement offer was made; or 

The following words and terms, when used in this chapter, shall have the meanings as defined in N.J.A.C. 1:1-2 or this section unless the context clearly indicates otherwise: 

  "Administrative hearing" means a proceeding which is conducted by the Office of Administrative Law. 

  "Administrative review" means a proceeding which is conducted by a review officer appointed by the Division Director or a paper review as decided by the Division Director following an informal conference concerning a non-contested matter. 

  "Appeal" means a request made by an authorized person within the established time frames for a review of a disputed decision of the Division which involves eligibility, placement, provision of service or licensure.  The decision shall be a specific action or proposed action which is identifiable in terms of date, "and person(s) making the decision".  General complaints or employee grievances shall not be considered appeals.

   "Appellant" means the authorized person who may file an appeal with a service component.  The authorized person is one of the following: 

  1. A competent adult receiving services from or applying for services of the Division; 

  2. The guardian of a minor or incompetent adult who is receiving services from or applying for services of the Division; 

  3. The proposed guardian of an individual receiving services where the Division has assessed that the individual is in need of a guardian but a guardian has not yet been appointed; 

  4. A licensee of the Division in response to a licensure action;  or 

  5. An authorized representative of a competent adult receiving services, a guardian of a minor, a guardian for an incompetent adult receiving services or a licensee.  Written verification from the competent adult or guardian of a minor or incompetent adult authorizing representation shall be required. 

  "Chairperson" means the individual appointed by the administrative head of the component to hold an informal conference. 

  "Contested matter" means an adversarial proceeding, including any licensing proceeding, in which the legal rights, duties, obligations, privileges, benefits or other legal relations of specific parties are required by constitutional right or by statute to be determined by an agency by decisions, determinations or orders, addressed to them or disposing of their interests, after opportunity for an agency hearing.  (N.J.S.A. 52:14B-2(b), N.J.A.C. 1:1.) 

  "Evidence" is the means from which inferences may be drawn as a basis of proof in the conduct of contested cases, and includes testimony in the form of opinion and hearsay. (N.J.A.C. 1:1-2.1) 

  "Final decision" means a decision by an agency head that adopts, rejects or modifies an initial decision by an administrative law judge, an initial decision by an administrative law judge that becomes a final decision by operation of N.J.S.A. 52:14B-10 or a decision by an agency head after a hearing conducted in accordance with these rules. (N.J.A.C. 1:1-2.1) 

  "Informal conference" means a meeting prior to an administrative review in which the respective parties may informally attempt to resolve the issue which is the subject to appeal. 

  "Involved parties" means the representative of the appellant, and the service component. 

  "Non-contested case" means any hearing offered by an agency for reasons not requiring a contested case proceeding under the statutory definition of contested case.  The Director, Division of Developmental Disabilities, may, at his or her discretion with

the agreement of the Director of the OAL, transmit a non-contested matter to the OAL. (N.J.S.A. 52:14F-5(a);  N.J.A.C. 1:1-2.1) 

  "Office of Administrative Law" (OAL) means an independent unit assigned to the Department of State which has the authority to hear contested matters. 

  "Placement" means the out of home living arrangement, other than for respite, provided by the Division or the day program exclusive of independent employment arranged by the Division. 

  "Recommended Decision" means the initial determination made by a Division review officer.  That decision is subject to comments or exceptions by the parties and may be accepted, modified or rejected by the Division Director. 

  "Service component" means the operational unit of the Division of Developmental Disabilities (for example, Developmental Center, region, bureau, etc.) which has responsibility for the disputed matter.

   "Settlement" means an agreement between parties which resolves disputed matters and may end all or part of the case.  Various methods may be utilized to help parties reach agreement, including (1) pre-transmission settlement efforts by an agency;  (2) pre-transmission settlement efforts by an administrative law judge at the request of an agency;  (3) mediation by an administrative law judge;  and (4) post-transmission settlement conferences by an administrative law judge. (N.J.A.C. 1:1-2.1)

  "Settlement conference" means an initial step toward resolving a contested matter prior to transmitting the appeal to the OAL as a contested case.

10:48-1.3 Contested cases

(a) Appeals of licensure actions, determination of ineligibility for services and appeals of specific offers of placement shall be considered to be contested. 

  1. The request shall be in writing and shall contain the information required below.  This information shall be the basis of an initial pleading should the matter be transmitted to the Office of Administrative Law.  An appeal shall be denied if the required information is not provided.  The request shall include: 

   i. Name and address of appellant; 

   ii. Name and address of person with developmental disabilities, if the appeal is made by the person's legal guardian; 

   iii. A brief statement of the matter under appeal; 

   iv. A list of potential witnesses;  and 

   v. Reference to the law, rule, regulation or policy alleged to be violated. 

  (b) Appeals of licensure actions shall be forwarded to the Division Director for actions in accordance with N.J.A.C. 10:48-1.4. 

  (c) If the matter does not meet the conditions of (a) above, and the appellant believes that the matter is contested as defined herein, the appellant shall set forth his or her reasons supporting that the matter should be considered contested in writing. 

  (d) The appeal shall be made to the administrative head of the component, who shall review the appeal and decide if it is a contested or non-contested matter. 

  1. If the matter is determined to be contested, prior to transmittal to the OAL, a settlement conference shall be scheduled by the administrative head of the component. 

  2. If the matter is determined to be non-contested, the requirements of N.J.A.C. 10:48-1.5 shall apply. 

   i. The appellant shall be notified in writing that the matter is non-contested. 

   ii. If the appellant disagrees, he or she may request a review of that decision by the Division Director. 

  (e) The appellant shall be notified in writing of a time and date of a settlement conference. 

  (f) The settlement conference shall require a meeting of the parties, unless both parties agree to a conference by telephone. 

  1. The settlement conference shall be chaired by a designee of the administrative head of the component. 

  2. The purpose of the conference is to negotiate a settlement and all matters discussed shall remain confidential and inadmissible as evidence. 

  3. Evidence or testimony shall not be presented. 

  4. No tape recording of the matter shall be made. 

10:48-1.4 Office of Administrative Law

(a) Those matters determined to be contested shall be referred to the Office of Administrative Law (OAL) for a hearing, in accordance with the Administrative Procedure Act at N.J.S.A. 52:14B-2(b) and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1. 

  (b) If the contested matter is not settled or involves a licensure action, the Division Director shall transmit the matter to the Office of Administrative Law. 

  1. In the instance of licensure appeals, the matter shall be transmitted within 10 working days of the receipt of the appeal. 

  2. In the instance of all other contested matters, the matter shall be transmitted within 10 working days of the notice of the administrative head of the component that the settlement conference did not resolve the matter.

   3. While contested cases are being prepared for transmittal to OAL, further efforts may be made to resolve the issue informally. 

  4. The Director, Division of Developmental Disabilities may, at his or her discretion with the agreement of the Director of the OAL, transmit a non-contested matter to the OAL (N.J.S.A. 52:14F-5(o)). 

  (c) A decision rendered by the OAL shall be adopted, rejected or modified by the Director, Division of Developmental Disabilities within 45 days of its receipt (N.J.S.A. 52:4B-10(c)).  This shall be construed as constituting the final administrative decision of the matter under appeal. 

  (d) Upon issuance, the final administrative decision shall be sent to the involved parties with notice that any further appeal must be to the Appellate Division of the Superior Court of New Jersey. 

  (e) The Director shall notify the appellant that a matter has been transmitted to OAL.

 10:48-1.5 Non-contested cases

(a) Informal conference requirements are as follows: 

  1. An informal conference shall be scheduled by the administrative head of the component in response to a non-contested matter.  The informal conference shall be scheduled no more than 20 working days from the date that a matter is determined to be non-contested.  Extension of the conference date beyond 20 working days may only occur upon mutual agreement of both parties. 

  2. The administrative head of the component shall appoint a chairperson to convene the Informal Conference. 

  3. The chairperson shall prepare a report specifically identifying the issue(s) under appeal, a summary of the position of both parties and a decision with respect to each issue.  The reasons for the decision shall be provided.  The summary shall be provided to the appellant within 20 working days of the conference.  A copy of this summary shall be retained in the individual's file. 

  4. The appellant may be represented by legal counsel at the informal conference. 

  5. No transcript shall be made of the informal conference. 

  6. The Rules of Evidence shall not be strictly enforced. 

  (b) Should resolution not be possible at the informal conference level, the appellant may submit a written request to the Director, Division of Developmental Disabilities, for an administrative appeal. 

  1. Written request for an administrative appeal shall be made within 15 working days from the date on the written summary. 

  2. The Director shall offer an Administrative Review Conference with the parties present or a paper review without the parties appearing.  The Division Director shall appoint an Administrative Review Officer. 

  (c) Administrative paper review requirements are as follows: 

  1. Each party shall submit written arguments supporting their position to the review officer within 20 calendar days of the written notification of the paper review.  Evidence may also be provided. 

  2. The Rules of Evidence shall be relaxed to include hearsay.  It is also permissible to accept a written statement of an individual into evidence instead of an affidavit. 

  3. Discovery shall be provided in accordance with the requirements of N.J.A.C. 10:41-2. 

  4. A written decision shall be forwarded to the involved parties within 20 working days of the receipt of both arguments.  The written decision shall set forth the reasons for conducting a paper review.  This shall be considered the Recommended Decision. 

  5. Written comments, objections or exceptions to the Recommended Decision may be made by either party and be sent to the Division Director within 10 working days from the date of the Recommended Decision. 

  6. After review of the Recommended Decision and any comments, objections or exceptions, the Division Director shall issue a Final Decision in writing, within 20 working days of the close of the comment period. 

  7. Upon issuance, the Final Decision shall be sent to the parties with notice that any further appeal must be made to the Appellate Division of the Superior Court of New Jersey. 

  (d) Administrative review conference requirements are as follows: 

  1. An administrative review conference shall be scheduled within 20 working days of receipt of the appeal.  Adjournments may be granted by the Division Director for good and valid reason.

   2. The appellant may be represented by attorney or spokesperson and may present documentation and such witnesses as have knowledge of the issues involved. 

  3. The service component shall be represented by a person designated by the administrative head of the component and may produce documentation and such witnesses as have direct knowledge of the issues involved.  The person representing the component may not be the same person who chaired the informal conference. 

  4. A verbatim tape recording of the proceeding shall be made.  The party requesting a written transcript shall bear the costs of transcription and shall provide copies to the other party and review officer at no cost.

   5. The Rules of Evidence shall be relaxed to include hearsay.  It is also permissible to accept a written statement by an individual if the individual is not present at the administrative review.

   6. Discovery shall be provided in accordance with the requirements of N.J.A.C. 10:41-2.

  7. The appellant may request that an employee of the Division testify at the conference.  The appellant shall make such a request in writing to the Review Officer at least five working days prior to the conference.  The request shall include the name, work location, title (if known) and a summary of the information to be provided by the employee. 

  8. The administrative review conference shall adhere to the following format: 

   i. An opening statement by each party; 

   ii. The presentation of testimony and evidence.  There shall be the opportunity for cross examination; 

   iii. Rebuttal of testimony and evidence.  There shall be the opportunity for cross examination;  and 

   iv. A summary. 

  9. The review officer shall render a written decision within 20 working days of the review conference.  This shall be considered the Recommended Decision. 

  10. Written comments, objections or exceptions to the Recommended Decision may be made by either party and be sent to the Division Director within 10 working days from the date of the Recommended Decision.

   11. After review of the Recommended Decision and any comments, objections or exceptions, the Division Director shall issue a Final Decision in writing, within 20 working days of the close of the comment period. 

  12. Upon issuance, the Final Decision shall be sent to the parties with notice that any further appeal must be made to the Appellate Division of the Superior Court of New Jersey.

 Emergency relief shall be available - as provided in N.J.A.C. 1:1-2.6.

 SUBCHAPTER 2. VIRAL HEPATITIS

 The purpose of this subchapter is to delineate Division of Developmental Disabilities policies and procedures regarding the screening, treatment and control of viral hepatitis B in the service components of the Division.

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

  "Acute viral hepatitis B" means the recent onset of viral hepatitis B which is identified by positive blood tests for HBsAg, and elevated liver function tests with other clinical symptoms compatible with hepatitis B. 

  "Anti-HBs" means the presence in the blood of the antibody to hepatitis B surface antigen which indicates that the person has had a hepatitis B infection and is immune or has received a hepatitis B immune globulin. Provided that the person has not recently received immune globulin anti-HBs means, for the purposes of this subchapter, that the person is not susceptible. 

  "At risk" means a person who is neither a carrier of hepatitis B virus, nor has an antibody to hepatitis B, and who is, or may be expected to be, exposed to the blood or body fluids of an individual who is hepatitis B surface antigen positive, through either the person's own designated duties or through the behavior of the individual, which may include, but is not limited to, biting, scratching or self-mutilation. 

  "Department" means the Department of Human Services. 

  "Developmental Center" means those State-operated facilities providing residential services to specific individuals. 

  "Division" means the Division of Developmental Disabilities within the Department of Human Services. 

  "Exposure to hepatitis B" means a specific eye, mouth, mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious material. 

  "HBsAg" means Hepatitis B surface antigen. Its presence in the blood indicates the person is a carrier. 

  "Hepatitis B carrier" means a person in whom the surface antigen for hepatitis is found in the blood when that person is tested twice six months apart.

  "Hepatitis B immune globulin" means a prophylaxis, which contains a higher level of antibody to hepatitis B surface antigen than immune globulin. It is usually recommended for those exposed to HBsAg positive blood and who do not have protective antibodies. 

   "Hepatitis B Vaccine" means a vaccine recommended for those at risk of contracting hepatitis B. This vaccine is

preventative in nature; its use is not contingent on exposure to the virus. Vaccination for hepatitis B is recommended for all infants, children, adolescents and young adults and other persons of all ages in areas of high prevalence or those who may be at increased risk of infection due to exposure to blood, blood product or bodily fluids. 

  "Individual habilitation plan" ("IHP") means a written plan of intervention and action that is developed by the interdisciplinary team.  It specifies both the goals and objectives being pursued on behalf of the individual and the steps being taken to achieve them by each agency.  It identifies a continuum of skill development that outlines progressive steps and the anticipated outcomes of services.  The individual habilitation plan is a single, consistent and comprehensive plan that encompasses all relevant components, such as an education plan, a program plan, a rehabilitation plan, a service plan, a treatment plan, and a health care plan.  Various aspects of the plan, such as education, rehabilitation, health care, and others, are assigned to those persons or agencies who can provide, or are legally required to provide, the training or services. 

  "Infectious person" means a person who is hepatitis B surface antigen positive. 

  "Immune person" means a person who is hepatitis B surface antibody positive. 

  "Institution" means developmental centers operated by the Division or private mental retardation facilities. 

  "Interdisciplinary team" ("IDT") means an individually constituted group of relevant individuals responsible to develop a single integrated IHP. The team shall consist of the individual served, the individual's parent (if the client is a minor or an adult who deserves that the parent be included), guardian or advocate, those persons who work most directly with the individual and professionals and representatives of service areas who are relevant to the identification of the individual's needs and the design and evaluation of program to meet them.

  "Private mental retardation facility" means an institution for the mentally retarded, whether operated for profit or not, which is not maintained, supervised or controlled by any agency of the government, or the state, or any county or municipality and which maintains and operates facilities and collects fees for the residential care and habilitation training of 16 or more, non-related developmentally disabled individuals for periods exceeding 24 hours. 

  "Susceptible person" means a person who has no serologic marker for hepatitis B virus. 

  "Transfer" means the removal of an individual from one service unit and placement into another service unit, as follows:

 From                                          To

Developmental Center                 Developmental Center
Community Services                    Community Service

Developmental Center

  "Viral hepatitis B" means a type of inflammation of the liver.  Hepatitis B virus is found in the blood, blood products, and to a lesser degree, in other body secretions.  The major mode of transmission is blood to blood contact.

10:48-2.4 Exclusion from programs

 (a) Individuals identified by a physician as hepatitis B carriers, or individuals who have acute hepatitis B, shall not be excluded from regular participation in services solely on the basis of being diagnosed as hepatitis B infected or carriers. 

  (b) The placement in programs of individuals who have acute hepatitis B or who are carriers of hepatitis B shall be determined on a case by case basis.  Any exclusion of an individual from a program or from program activities shall be based upon objective criteria as determined by the individual's interdisciplinary team and shall be related to a direct danger of infection to others.  Reasonable and appropriate alternate activities, as determined by the interdisciplinary team, shall be provided to individuals who are excluded because of a diagnosis of active hepatitis B or carrier.

  (c) If an individual is excluded from programming because of a diagnosis of hepatitis B or carrier of hepatitis B, the individual, guardian or family shall be advised of the reason for exclusion. 

  (d) The IDT shall evaluate the exclusion of individuals from programming every 90 days as long as the exclusion is in effect. The evaluation shall be noted in the individual's client record.

(a) When individuals receiving services who are considered to be at risk are offered the opportunity to be immunized for hepatitis B, health care benefits and entitlements, medical insurance, or other means of medical coverage shall be utilized first as a means of payment. To the extent that the immunization costs are not covered by these sources, the Division shall incur the expense either partially or totally. 

  (b)  When staff who are considered to be at risk are offered the opportunity to be immunized for hepatitis B, the Division shall incur the expense. The Division shall incur no liability if the individual chooses to be immunized. 

  (c) As a prerequisite for admission to a developmental center, appropriate immunization of the individual receiving services shall be required.

(a) Decision concerning placement or program participation within community programs shall be made jointly by the Division and the service provider, in consultation with the individual's physician. 

 (b) Medical questions may be referred to a mutually agreed-upon expert for consultation. 

 (c) Individuals shall be immunized for hepatitis B before placement in a developmental center.

 10:48-2.7 Staff training

 (a) Before the admission to service of an individual who has acute hepatitis B or who is a hepatitis B carrier, all staff shall receive instruction in the methods by which hepatitis B is transmitted and how personal hygiene can prevent the transmission of hepatitis. 

  (b) Staff shall be informed of the various types of hepatitis vaccine and the protection provided by each type and shall be given the opportunity to receive immunization. 

  (c) The service provider shall provide, or cause to be provided, the required training. 

  (d) Training shall be repeated as circumstances require.

 10:48-2.8 Responsibility for testing and monitoring

 (a) The provisions of this subchapter shall be followed in developmental centers and in private mental retardation facilities in New Jersey. 

 (a) Except in emergency situations, each individual shall have a blood test to determine the presence of hepatitis B, using currently accepted techniques, within 60 days before the admission of the individual to developmental centers or private mental retardation facilities. 

  (b) In emergency situations which require that the individual be admitted before testing has been completed or before the test results are obtained, the testing and monitoring process shall be completed within five working days after the individual is admitted.

   (c) If the individual is HBsAg positive, the individual shall be tested once more six months later, unless he or she is a known carrier.  Testing thereafter shall be at the discretion of the attending physician. 

  (d) No further testing is required if the anti-HBs is positive and the patient is certified by a physician as having a natural immunity.

10:48-2.10 Admission of an individual receiving services

 (a) An individual may be admitted to a developmental center if he or she has been tested and found to have acute hepatitis B or be a carrier of hepatitis B, if the developmental center can provide adequate medical care and precautions, as determined by the Medical Director of the center. 

  (b) An individual may be admitted to a community program if he or she has been tested and found to have acute hepatitis B or be a carrier of hepatitis B, upon evaluation on a case-by-case basis, by the Division and the program, in consultation with the individual's physician.

 10:48-2.11 Transfer of an individual receiving services

  (a) If an individual is to be transferred, testing shall be performed unless the individual has been identified as having a natural immunity, is a known carrier or has had testing within 30 days prior to the proposed transfer date, or has a positive anti-HBs within five years of vaccination. Monitoring and retesting shall be conducted as indicated in N.J.A.C. 10:48-2.8 and 2.9. 

  (b) If testing has occurred within 30 days prior to the proposed transfer date, the monitoring and retesting shall be conducted as deemed appropriate by the attending physician. 

  (c) Any delays in transferring an individual who has acute hepatitis B who is a hepatitis B carrier shall be reviewed on a case-by-case basis by the sending and receiving programs.  A decision to delay the transfer of an individual shall be reviewed no less than every 90 days.

All individuals receiving services or staff in day or residential programs in New Jersey who are not carriers and who do not have natural immunity and are at risk of contracting hepatitis B shall be provided with the opportunity to receive hepatitis B vaccine, under the terms indicated in N.J.A.C. 10:48-2.4(a) and (b).

10:48-2.13 Informed consent

(a) Staff responsible for testing or vaccination shall obtain the individual's or individual's guardian's, or staff person's, informed consent before testing or vaccination.  The informed consent shall be placed in the client record or staff person's file, as appropriate. 

  (b) Individuals who are not mentally deficient or incompetent and staff who are at risk shall be informed of the risk of contracting hepatitis B and the availability of vaccines, the benefits of the vaccines and possible adverse side effects of the vaccines.  Written documentation of the information given to the individual or staff person shall be placed in the client record or staff person's file, as appropriate. 

  (c) In the cases of minors or mentally deficient or incompetent adults who are at risk, the guardian of the person shall be informed of the availability of the vaccine, the benefits of the vaccine, and the possible adverse side effects.  Written documentation of the information given to the guardian of the person shall be placed in the client record. 

  (d) The person being informed shall be advised to consult his or her personal physician, or the personal physician of a minor or the mentally deficient or incompetent individual, as appropriate, to determine if the vaccine is contraindicated in the particular situation.

   (e) A staff member, an individual who is competent, a guardian of a minor or a guardian of a deficient or incompetent individual may elect to decline the offer of vaccination, after receiving information of the vaccine from the staff person designated to obtain consent. 

  (f) A staff member, an individual who is competent, or a guardian of a minor or a guardian of a mentally deficient or incompetent individual shall sign a statement that he or she understands the benefits and the possible side effects of the vaccine and that he or she either agrees to or refuses the testing and/or the vaccine.  The signed statement shall be kept in the employee's file or client record. 

  (g) The requirements of (a) through (f) above shall be documented and kept in the client record or employee's file.  Documentation shall be kept on file of all informed consent forms distributed and whether or not they were returned.

 (a) Prior to the admission of individuals to a developmental center, at least one dose of hepatitis B vaccine shall be administered to any individual who has been tested pursuant to the recommendations of the Center for Disease Control Report Number 50, published March 1986 and who has no antibody or antigen to hepatitis B. 

  (b) For emergency admissions, if admission occurs before testing and immunization can be initiated, then full hepatitis B testing and immunization shall take place as part of the initial admission medical evaluation.

10:48-2.15 Treatment for those who have been exposed to hepatitis and have not been immunized or who have no natural immunity

 (a) Division staff shall be responsible to advise individuals receiving services about the recommended treatment for those who have been exposed to hepatitis and have not been immunized or who have no natural immunity: 

  1. Appropriate Division or agency staff shall inform the individual or guardian and staff that immunization is recommended in some cases, including, but not limited to, the following: 

   i. When the individual or staff person has been bitten by an individual who tests positive for HBsAg, if the bite breaks the  skin; 

   ii. When the susceptible individual or staff person has been exposed to the blood or other body fluids of an individual who tests positive for HBsAg. 

  2. Appropriate Division or agency staff shall inform the individual or guardian or staff person that the appropriate post-exposure treatment, as determined by a physician, should be started within 24 hours.

10:48-2.16 through 10:48-2.17 (Reserved)

10:48-2.18 Appeal of exclusion of individual from program