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340:75-14-3. Medical services for the child in Oklahoma Department of Human Services (DHS) custody

• 4 through 7 & 15

Revised 9-15-20

(a) Definitions.The following words and terms, when used in this Subchapter, shall have the following meaning, unless the context clearly indicates otherwise:

(1) "Consent" means obtaining approval from a person for the procedure after providing an explanation of the necessity for the procedure involved, any known risks involved and, when appropriate, any alternative course of care.

(A) "Informed consent"means voluntary written consent from a person who received full, accurate, and sufficient information and explanation about a child's medical condition, medication, and treatment to enable the person to make a knowledgeable decision without being subjected to any deceit or coercion.

(B) "Separate and specific consent" means a licensed physician, psychiatrist, or other medical professional recommended a treatment or medication and requires an additional consent form provided by the professional be signed to authorize the treatment to occur or medication to be administered.

(C) "Sufficient explanation" means information provided and explained in plain language by the prescribing physician or physician's representative to the consent-giver including, but not limited to, the:

(i) medical care and treatment or the medication;

(ii) reason for prescribing the treatment or medication and the medication's purpose or intended results;

(iii) side effects, risks, and contraindications including the effects of stopping the medication;

(iv) method for administering the treatment or medication and dosage range, when applicable;

(v) potential drug interactions;

(vi) alternative treatments;

(vii) behavioral health or other services used to complement the use of the psychotropic medication, when applicable; and

(viii) other treatment interventions considered by the physician that may include, but are not limited to, medical, mental health, behavioral, counseling, or other services.

(2) "DHS custody" means a child is in the voluntary, emergency, temporary, or permanent custody of DHS.

(3) "Medical" care or "treatment" means, per Section 1-3-102 of Title 10A of the Oklahoma Statutes (10A O.S. § 1-3-102) medical care or treatment that is either extraordinary or routine and ordinary.

(A) Extraordinary medical care and treatment includes, but is not limited to:

(i) surgery;

(ii) general anesthesia;

(iii) blood transfusions; or

(iv) invasive or experimental procedures.

(B) Routine and ordinary medical care and treatment does not include any type of extraordinary care or treatment and includes, but is not limited to:

(i) any necessary medical and dental examinations and treatments;

(ii) medical screenings;

(iii) clinical laboratory tests;

(iv) blood testing;

(v) preventative care;

(vi) health assessments;

(vii) physical examinations;

(viii) immunizations;

(ix) contagious or infectious disease screenings;

(x) tests and care required for treatment of illness and injury including x-rays, stitches, and casts; or

(xi) the provision of psychotropic medication.

(4) "Placement provider" means the person, foster parent, or administrator of a facility providing out-of-home care for a child in DHS custody.

(5) "Psychotropic medications" means medications with well-demonstrated efficacy in the treatment of mental disorders through the modification of behavior, mood, and emotions.

(b) Medical services for the child in DHS custody in out-of-home care.  • 1  through 11  DHS is required to provide medical care necessary to preserve the child's health, per Oklahoma Children's Code provisions, 10A O.S. § 1-7-103.The child in DHS custody receives:

(1) Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) screening according to the schedule of frequency or at a minimum, an annual physical exam.In addition, DHS provides, within 21-calendar days of entering custody, a standardized assessment for each child placed in DHS emergency custody, to evaluate the physical, developmental, medical, mental health, and educational needs, including health problems requiring immediate treatment, diagnosis of infections and communicable diseases, and an evaluation of injuries or other signs of abuse or neglect. • 1 3

(2) a yearly behavioral health or developmental screening, and when recommended a behavioral health or developmental assessment, within 60-calendar days of the screening;  • 2 & 3

(3) a yearly dental exam when the child is over 3 years of age.A child under 3 years of age receives dental services as needed;

(4) an initiation of immunizations that are kept current;

(5) a visual and hearing evaluation exam and corrective lenses or hearing aids, when indicated;

(6) outpatient or inpatient behavioral mental health treatment, when appropriate;

(7) physician's services when the child is sick.This service is not considered a physical exam;

(8) contagious or infectious disease screenings, including Human Immunodeficiency Virus (HIV) exams or testing, are provided as needed or upon request by a placement provider in a manner consistent with the Centers for Disease Control guidelines for time and testing frequency, per Oklahoma Administrative Code 340:75-1-113; and

(9) follow-up and referral services as recommended by a qualified professional.

(c) Consent for medical services.  • 8  through 13

(1) DHS authority to consent to routine and ordinary medical care and treatment.   • 9

(A) DHS may consent to routine and ordinary medical care and treatment when the child is in DHS custody.  DHS makes reasonable attempts, per 10A O.S. § 1-3-102, when the child is in voluntary, emergency, or temporary custody to:

(i) notify the child's parent or legal guardian of the provision of routine and ordinary medical care and treatment; and

(ii) keep the parent or legal guardian involved in the care.

(B) DHS may authorize the placement provider, in writing, through the placement provider agreement, to consent to routine and ordinary medical care and treatment needed for the child upon the advice of a licensed physician, including psychotropic medication.  • 14

(2) Consent for extraordinary medical care.  13

(A) DHS employees are not authorized to consent to extraordinary medical care and treatment for any child in DHS voluntary, emergency, temporary, or permanent custody.

(B) When the child is in DHS voluntary, emergency, or temporary custody, consent for the child's extraordinary medical care and treatment is obtained from the parent or legal guardian, unless the:

(i) parent is unavailable to provide consent;

(ii) parent refuses to consent; or

(iii) care and treatment is related to the suspected abuse or neglect.

(C) Court authority is required for extraordinary medical care and treatment when the:

(i) child is in DHS permanent custody;

(ii) parent is unavailable to provide consent;

(iii) parent refuses to provide consent; or

(iv) care and treatment is related to the suspected abuse or neglect.

(D) When the recommended extraordinary medical care and treatment is not the result of a life-threatening emergency requiring immediate medical intervention, the court, per 10A O.S. § 1-3-102:

(i) holds a hearing, upon the application of the district attorney and notice to all parties; and

(ii) may authorize the recommended extraordinary care and treatment.

(E) DHS does not, in any circumstance, consent to a child's abortion, sterilization, termination of life support, or to a Do Not Resuscitate order.The court may authorize the withdrawal of life-sustaining medical treatment or the denial of the administration of cardiopulmonary resuscitation on behalf of the child in DHS custody, upon the written recommendation of a licensed physician, after notice to the parties, and a hearing.  • 12

(3) Medical consent for child in protective custody.

(A) Per 10A O.S. § 1-3-102, when the child taken into protective custody without a court order, requires emergency medical care prior to the emergency custody hearing, a peace officer, court employee, or the court may authorize treatment as necessary to safeguard the health and life of the child when the:

(i) treatment is related to the suspected abuse and neglect;

(ii) parent or guardian is unavailable to consent to the treatment recommended by a physician; or

(iii) parent or guardian refuses to consent to the treatment recommended by a physician.

(B) Before a peace officer, court employee, or the court authorizes treatment based on the unavailability of the parent or legal guardian, law enforcement exercises diligence in locating the parent or guardian, when known.

(4) Consent for medical care for the child in his or her own home.The parent of the child in DHS custody placed in his or her own home consents to routine and ordinary medical care and treatment and extraordinary medical care and treatment needed by the child. In the event of parental refusal, DHS may consent to routine and ordinary medical care and treatment needed by a child in DHS custody, per OAC 340:75-14-3(c)(1).In the event of parental refusal to consent to extraordinary medical care and treatment needed by a child in DHS custody, DHS complies with procedures, per OAC 340:75-14-3(c)(2).

(5) Consent for extraordinary medical care for the child who traveled out-of-state.When the child is out-of-state and requires extraordinary medical care and treatment, the judge may authorize the physician or medical facility to provide the extraordinary medical care via a verbal or written order.

(6) Experimental medical procedures.Medical procedures that are experimental may not be compensable through SoonerCare (Medicaid) and are considered to be extraordinary medical care and treatment that must be authorized by the parent or court order.

INSTRUCTIONS TO STAFF 340:75-14-3

Revised 6-13-22

1.  Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) schedule.  EPSDT purpose is to prevent and identify conditions that may interfere with the child or young adult's natural growth and development.

(1) The schedule of frequency for EPSDT provides:

(A) six-health screenings during the child's first year of life;

(B) two screenings in the child's second year of life;

(C) one screening yearly for the child 2 through 5 years of age; and

(D) one screening every other year for the child 6 through 20 years of age.

(2) The eligible child may receive dental screening services once every 12 months.

(3) More frequent screening services are allowed when a medical condition is suspected.

2Documentation of medical services.  The child welfare (CW) specialist and placement provider ensure the continuity of medical services and records while the child is in out-of-home care.

(1) The records the CW specialist or placement provider obtain are made:

(A) a part of the child's paper case record and Life Book;

(B) a part of the electronic case by scanning into the KIDS document management system (DMS); and

(C) available to the parent, any subsequent placement provider, and those leaving care for successful adulthood.

(2) The CW specialist updates the:

(A) appropriate KIDS screens no later than 30-calendar days after the child's appointment for medical, dental, or behavioral health services;

(B) child's immunization and prescription records and KIDS Service Log; and

(C) KIDS Adoption and Foster Care Analysis and Reporting System (AFCARS) screens when the child receives a specific diagnosis by the physician or therapist.

3.  Initial health and developmental screening.  The CW specialist ensures, in coordination with the placement provider and parent, when applicable, the child in out-of-home care receives needed routine and specialized medical care, including medical, dental, visual, and behavioral health services timely.  The CW specialist schedules and ensures the initial health and developmental screening for the child is completed no more than 21-calendar days after the removal.

4.  SoonerStart.  When the child is younger than 3 years of age, the CW specialist:

(1) refers the child to SoonerStart via Form 04MP053E, Child Welfare Services (CWS) SoonerStart Referral for Child in Oklahoma Human Services (OKDHS) Custody, no later than 15-business days, excluding shelter days, after the child's removal;

(2) notifies the parent and placement provider of the SoonerStart referral;

(3) informs the placement provider  cooperation is required with SoonerStart in the provision of any service recommended for the child;

(4) updates the KIDS Contacts screen with purpose type – SoonerStart Referral;

(5) notifies SoonerStart of any change in the child's placement by providing a copy of Form 04KI025E, Change in Placement Notification, within two-business days when the screening, evaluation, or both, were not completed by SoonerStart;

(6) discusses the information provided by SoonerStart with the parent, within 15-business days of receipt;

(7) documents SoonerStart information in KIDS Medical screen;

(8) includes SoonerStart information in KIDS Family and Child Strengths and Needs Assessment screens;

(9) files SoonerStart information in the child's paper case record; and

(10) completes Form 04AF022E, Report of Violation of Rules in an OKDHS Resource Home, when notified by SoonerStart of the placement provider's lack of cooperation or follow through with recommendations, and forwards to the resource specialist.

5.  Human Immunodeficiency Virus (HIV)-related and communicable disease services.  Per Oklahoma Administrative Code (OAC) 340:75-1-113, when requested by a placement provider, Oklahoma Human Services (OKDHS) provides examinations or HIV tests on the child based on the Centers for Disease Control and Prevention (CDC) guidelines for time and testing frequency.

(1) When a child in OKDHS custody receives a positive test for HIV, OKDHS:

(A) makes appropriate notifications and follows confidentiality, per OAC 340:75-1-113;

(B) schedules an appointment with the child's primary care physician (PCP); and

(C) attends the appointment with the PCP to ensure a referral is made to an infectious disease (ID) specialist.

(2) During the course of the case, the permanency planning specialist ensures:

(A) the child attends the ID appointments as recommended;

(B) the child receives the medication the ID specialist prescribed to him or her;

(C) the child has regular lab work the ID specialist ordered; and

(D) specialized HIV and AIDS counseling and education is provided, per OAC 340:75-1-113.

(3) For other communicable diseases, OKDHS ensures:

(A) notification is provided based on confidentiality guidelines, per policy OAC 340:75-1-113;

(B) medication to treat the infection is provided to the child;

(C) the child receives follow-up medical care as needed to treat the infection; and

(D) education on prevention is provided when the communicable disease is a sexually-transmitted disease.

(4) In the event of a pandemic, OKDHS provides:

(A) education from the CDC to employees, foster parents, and children in care;

(B) CDC-recommended personal protective equipment (PPE) to the staff; and

(C) CDC guidelines to follow unless they conflict with state law.

6 Healthcare for child placed in the parent's home.  The child in OKDHS custody living in the parent's home may continue to be eligible to receive financial assistance from the Oklahoma Health Care Authority for necessary medical services.  The parent has the primary responsibility to provide and arrange for the child's medical care when the child is in OKDHS emergency or temporary custody but is living with the parent.  Refer to OAC 340:75-13-62 for medical coverage when the child resides with the parent.

7.  Unavailable local medical care.  When the child in out-of-home placement needs medical care outside of the district of the child's residence, the attending physician makes the recommendation and referral.  When the attending physician recommends treatment the physician cannot provide, but does not make the referral, the CW specialist makes the appointment.

8.  Notification of injury or medical treatment.

(1) When the CW specialist is notified or aware of a child's injury other than minor, normal, childhood scrapes, bumps, and bruises, the CW specialist:

(A) completes the KIDS Injury screen in the child's KK case within two- business days of the injury or injury notification; and

(B) documents the details of the injury in the KIDS Contacts screen of the child's case.

(2) The CW specialist prints Form 04KI081E, Notice of Injury from the KIDS Report screen when the child in OKDHS custody requires medical treatment as a result of an accidental or non-accidental injury to advise the parties of the:

(A) nature of the injury;

(B) occurrence's date; and

(C) medical care provided or planned to meet the child's needs.

(3) A medical examination or consultation with a medical professional is required, when:

(A) a child 5 years of age and younger, or a child with a perceived or diagnosed physical or developmental disability, has any unexplained injury  not consistent with normal childhood play or development;

(B) a child 5 years of age and younger, or a child with a perceived or diagnosed physical or developmental disability, has a broken bone or fracture;

(C) there is an implausibly explained or unexplained bruise or injury to the head, face, ears, neck, stomach, or genitals; or

(D) a non-ambulatory child  has a bruise, burn, or fracture.

(4) When medical attention for accidental or non-accidental injury is sought or required for the child in OKDHS custody, as described above, OKDHS sends Form 04KI081E to notify the:

(A) court of jurisdiction;

(B) child's parents;

(C) each parent's attorney;

(D) child's attorney;

(E) district attorney;

(F) court-appointed special advocate, when applicable; and

(G) tribe, when applicable.

(5) The placement provider reports all injuries, other than normal minor childhood scrapes, bumps, and bruises, to CW staff.

(6) When the injury appears to be the result of abuse or neglect, a referral is made to the OKDHS Abuse and Neglect Hotline (Hotline).

(7) An observed injury to the head, face, ears, neck, stomach, or genitals or a burn or fracture to a child 5 years of age and younger or to a child with a perceived or diagnosed developmental disability, is reported to the Hotline unless the CW specialist and CW supervisor consult with the assigned district director or field manager.  The district director or field manager documents a contact explaining why a report to the Hotline was unnecessary.

(8) The district director or field manager is required to review all information to make an informed safety decision and determine if a referral to the Hotline is necessary.

(9) Refer to OAC 340:75-3-410 Instructions to Staff for guidance regarding joint review of resource home referrals.

9.  Consent for routine and ordinary medical care and treatment when child is in out-of-home care.

(1) Consent.

(A) OKDHS provides written authorization to the placement provider of a child in OKDHS custody to consent to routine and ordinary medical care and treatment, including psychotropic medication upon the advice of a licensed physician through Form 04FC011E, Placement Agreement for Out-of-Home Care.

(B) When the treating professional requires his or her form be signed as a separate and specific consent to authorize recommended treatment or medication, such consent form may only be signed by the child's:

(i) parent whose parental rights are intact;

(ii) legal guardian; or

(iii) a district director after:

(I) a reasonable attempt to locate the parent or legal guardian failed; and

(II) consideration of a sufficient explanation by a physician regarding the risks involved in the proposed treatment or medication.

(2) OKDHS makes reasonable attempts, when the child is in voluntary, emergency, or temporary custody to:

(A) notify the child's parent or legal guardian of the provision of routine and ordinary medical care and treatment; and

(B) keep the parent or legal guardian involved in the care.

(3) The placement provider notifies the CW specialist immediately when the child receives any routine and ordinary care and the CW specialist documents the treatment in KIDS and notifies the parent or legal guardian.

10.  (a) Transporting the child's medication.  The CW specialist ensures the child's medication is transported with the child when the child is moved from one placement to another.

(1) When transporting a child with prescription medication from one placement to another, the CW specialist takes two copies of Form 04MP012E, Receipt and Release of Prescription and Over-the-Counter Medication(s) (OTC).

(2) The CW specialist completes two copies of Form 04MP012E Section I, Receipt of Prescription and Over-the-Counter Medication(s) (OTC), with the parent or placement provider prior to the child's removal from his or her own home or out-of-home placement.

(3) The CW specialist provides a copy of completed Form 04MP012E to the parent or placement provider, scans a copy into the KIDS DMS, and the copy is filed in the paper case record.  Form 04MP012E is not required when the child is discharged from a hospital setting.

(4) When the child is discharged from a hospital setting, the CW specialist obtains the appropriate medication or prescriptions to be filled and provides a copy of the discharge summary to the parent or placement provider.  The hospital discharge summary is scanned into the KIDS DMS and the original is filed in the paper case record.

(b) Medication not transported.  When the CW specialist is provided medication in any of the ways described in (1)(A) through (E) of this subsection or when a child in OKDHS custody is prescribed medical marijuana, the CW specialist leaves the medication with the parent or placement provider and documents the action on Form 04MP012E in Section II, Medication(s) Not Transported.  The CW specialist:

(1) does not transport medication when the medication is supplied to the CW specialist:

(A) in plastic sacks or any other container that is not the original prescription bottle or packaging;

(B) with multiple types or dosage strengths of medication in a single prescription bottle;

(C) with an expired date;

(D) with more medication than the amount indicated on the prescription label or OTC package information, such as combining two containers of medication; or

(E) with the altered prescription labels or OTC packaging;

(2) does not transport medical marijuana when it is prescribed to a child in OKDHS custody;

(3) provides a copy of completed Form 04MP012E to the parent or placement provider;

(4) contacts the prescribing physician immediately when the prescribed medication is not transported, and requests the physician call in a new prescription to a local pharmacy; and

(5) picks up the new medication prior to placing the child in the new location.

(c) Releasing medications.  Form 04MP012E, Section III, Release of Prescription and Over-the-Counter Medication(s), is completed with the parent or new placement provider when releasing medication.

(d) Psychotropic medications.  When the CW specialist transports the child, who was prescribed psychotropic medication, from acute or residential inpatient treatment, the CW specialist:

(1) inquires if the discharging physician monitors the medication; and

(2) when the discharging physician does not monitor the medication, he or she arranges for another physician to assess the child as soon as possible so the child's continued need for medication may be determined or monitored.

(e) Medication disposal.

(1) Each district director designates a person responsible for medication disposal and the designee signs Section III of Form 04MP012E, when medication prescribed to the child in OKDHS custody requires disposal.  Prior to requesting disposal of the medication, the CW specialist verifies the medication:

(A) is no longer prescribed for the child;

(B) cannot be properly administered;

(C) has expired; or

(D) is not accepted by the child's placement.

(2) Expired or discontinued medication is safely disposed of in compliance with Environmental Protection Agency recommendations and applicable federal, state, and local requirements, per http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm.

(3) Scheduled medication is disposed of in compliance with Oklahoma Bureau of Narcotics and Dangerous Drugs and Oklahoma State Bureau of Investigation requirements at http://www.ok.gov/obndd/Prescription_Monitoring_Program/index.html.

(f) Medication Storage.  Medication is stored to ensure safety for all children.  All medications, prescribed, OTC, and medical marijuana are stored in a secure location that is locked or has limited access to maximize safety.  The storage of medication in each home environment is assessed for safety according to the physical and mental development of the children in the home.  Guidelines for medication storage are found at https://www.cdc.gov/medicationsafety/ and may include a medication lock box to keep medications out of reach and sight of children.

11.  Reasonable attempts to secure the parent or legal guardian's consent for medical care for the child in OKDHS custody placed in his or her own home.  When a parent or legal guardian refuses to consent to routine and ordinary medical care and treatment and extraordinary medical care and treatment, the CW specialist meets with the parent or legal guardian and discusses the concerns about the prescribed treatment and the reason for refusal.  To address expressed concerns about the treatment, the CW specialist facilitates communication between the parent or legal guardian and the prescribing physician.  When the parent or legal guardian continues to refuse consent, the CW specialist, following consultation with the CW supervisor, notifies the court.

12Extraordinary medical care.

(1) When a CW specialist is responsible for a child in OKDHS custody and extraordinary medical care is recommended that includes abortion, medical marijuana, sterilization, termination of life support, or a Do Not Resuscitate order, Permanency Planning Programs staff and OKDHS Legal Services (LS) must be consulted.

(2) OKDHS keeps the court and OKDHS LS informed when a child that comes into OKDHS custody has a medical marijuana license.

13. Reasonable attempts to secure the parent or legal guardian's consent for extraordinary medical care.

(1) The CW specialist makes reasonable attempts to secure parental consent for extraordinary medical services provided to the child in OKDHS voluntary, emergency, or temporary custody.  A reasonable attempt includes attempts to contact the parent or legal guardian by phone to advise of necessary medical services for the child.

(A) When the parent or legal guardian cannot be reached by phone, the CW specialist attempts personal contact at any known address for the parent or legal guardian.  Attempts to locate the parent or legal guardian include contacts with relatives or other persons knowledgeable about the family and documenting the attempts in a KIDS Contacts.

(B) When services are provided at a medical facility or by a medical practitioner, the parent is required to contact the facility or practitioner directly.  The CW specialist facilitates contact, when needed.

(2) A child in OKDHS voluntary, emergency, or temporary custody in need of extraordinary medical care and treatment requires court authorization when the:

(A) parent is unavailable to provide consent;

(B) parent refuses to provide consent; or

(C) needed care and treatment is related to the suspected abuse or neglect of the child.

(3) A child in OKDHS permanent custody always requires court authorization when in need of extraordinary medical care and treatment.

14(a) Administration of psychotropic medication.  Each child in care receives individualized, medical and behavioral health care planning, including the administration of psychotropic medication, when necessary.

(1) Psychotropic medication decisions are based upon adequate information that includes:

(A) a psychiatric history and assessment;

(B) a medication history;

(C) a medical history, including known drug allergies; and

(D) consideration of the individual's complete current medication regimen, including non-psychoactive medications, such as antibiotics.

(2) Psychotropic medication is integrated as part of a comprehensive treatment plan including:

(A) appropriate behavior planning;

(B) symptom and behavior monitoring; and

(C) communication between the prescribing clinician, the child, parents, legal guardians, or placement providers, CW specialists, therapists, pediatricians, and other relevant members of the child's treatment team.

(b) Consent for psychotropic medication for children in OKDHS custody.  Psychotropic medication is recognized as routine and ordinary medical care and may be authorized by the CW specialist or placement provider, when authorized through Form 04FC011E.

(1) When a child in OKDHS custody is prescribed a psychotropic medication, the CW specialist ensures the medication is documented in KIDS.

(2) When the child is in OKDHS voluntary, emergency, or temporary custody, the parent or legal guardian is notified.

(3) When a child is prescribed a psychotropic medication, the CW specialist ensures it is properly monitored.

(c) Emergency medical care and treatment or administration of psychotropic medication.  Emergency medical care and treatment or psychotropic medications may be provided or administered in advance of parental or OKDHS authorization when the child's attending physician determines an emergency exists.  The CW specialist notifies the parent or legal guardian as soon as possible after receiving notification of the emergency and documents details in KIDS Contacts.

(d) Use of psychotropic medication for chemical restraint.  The use of psychotropic medication as a means of control, punishment, or discipline of the child in OKDHS custody for staff convenience or for chemical restraint is strictly prohibited.

(e) Monitoring the child prescribed psychotropic medication.

(1) The child taking psychotropic medication is seen by the prescribing physician as directed by the child's primary physician.

(2) The child in an acute setting displaying unsafe behavior, experiencing significant medication side-effects, not responding to a medication trial, or in an active phase of medication trial is seen as directed by the prescribing physician.

(3) Monitoring the use of psychotropic medication provided to the child in OKDHS custody is a joint responsibility among the prescribing physician, caregiver, CW specialist, and CW supervisor.  The CW specialist and the placement provider have joint responsibility to:

(A) ensure the prescribing physician's directions and intent for the medication are implemented;

(B) contact the prescribing physician immediately when the child's condition becomes unstable; and

(C) arrange for medical evaluations and required laboratory tests to monitor the medication's therapeutic levels or potential organ system damage.  Laboratory tests are performed according to the prescribing physician's directions.

15Medical and behavioral health professional consultation with CWS nurses and behavioral health consultants.

(1) CWS nurses are available for consultation and to assist CWS staff with:

(A) understanding medical concerns;

(B) medication reviews;

(C) medical chart reviews;

(D) parent and resource parent education on medical issues;

(E) home visits; and

(F) hospital visits.

(2) CWS behavioral health consultants are available for consultation and to assist CWS staff with:

(A) understanding behavioral health concerns, including factors that contribute to a child's or family's difficulties in functioning;

(B) referrals and linkage to behavioral health services and resources;

(C) education on behavioral health, substance use or abuse, and evidence-based practices;

(D) family meetings; and

(E) placement stabilization.

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