(a) Risk assessment system. A center shall adopt, implement, and enforce a written risk assessment system that complies with this section, conforms to accepted standards of practice, and has been approved by the center's clinical director. The center shall apply the risk assessment system to clients prior to acceptance as a center client and throughout the pregnancy for continuation of services and during the postpartum period.     
      (b) Admission. A birth attendant shall perform the risk assessment of a potential client prior to accepting the client for admission and shall only admit a client that has been assessed to have a low-risk pregnancy.     
      (c) Change in risk status, transfer, and referral. Criteria for the assessment of a client who develops complications during pregnancy that would require the transfer or referral of the client or newborn from the center shall be reviewed and updated annually by the clinical director.      
        (1) The center shall recognize and document in the client's clinical record when the client's condition deviates from a low-risk pregnancy at any time during the antepartum, intrapartum, or postpartum period. The center shall refer or transfer the client to a hospital or physician consultant in accordance with the written policies described in paragraph (2) of this subsection.       
        (2) The center shall enforce policies for the transfer or referral of a client or newborn to a physician consultant or a referral hospital. The written policies shall include provisions:                  (A) for transfer to a hospital if emergency care is required;                   (B) for notifying the receiving physician prior to the transfer;                   (C) for notifying the receiving hospital prior to the transfer;                   (D) for sending a copy of the clinical record to the hospital or physician consultant at the time of transfer; and                   (E) describing the duties and responsibilities of staff during the transfer procedure.         
        (3) The center shall document the transfer or referral in the client's clinical record in accordance with §137.53(9)(R) of this title (relating to Clinical Records).       
     Source Note:        The provisions of this §137.40 adopted to be effective December 2, 2007, 32 TexReg 8507