(a) Timing of Health Screening. A health screening shall be conducted on each resident within two hours after admission.     
      (b) Persons Qualified to Conduct Health Screening. The health screening shall be conducted by:      
        (1) an appropriately supervised licensed vocational nurse (LVN), a registered nurse (RN), a nurse practitioner, a physician assistant, or a physician;       
        (2) a qualified and properly trained person who is operating under delegation from a physician in accordance with Texas Occupations Code §157.001, including, but not limited to, a medical assistant, emergency medical technician, or paramedic; or       
        (3) an individual who has been trained on administering the facility's health screening by a person listed in paragraph (1) or (2) of this subsection.       
      (c) Training Requirements for Health Screening. The training must include, at a minimum, instruction on:      
        (1) how to take medical history;       
        (2) how to make the required observations;       
        (3) how to determine the appropriate disposition of a resident based on observations and responses to questions; and       
        (4) how to document the findings on the screening instrument.       
      (d) Health Screening Instrument. The health screening instrument shall be approved by an RN, nurse practitioner, physician assistant, or physician and shall include, at a minimum:      
        (1) mental health conditions and treatment, including any hospitalizations;       
        (2) suicide risk assessment in accordance with the facility's suicide prevention plan;       
        (3) observation of the following, at a minimum:                  (A) general appearance, such as sweating, tremors, anxious, disheveled, or appropriate;                   (B) behavior, such as disorderly, erratic, or appropriate;                   (C) state of consciousness, such as alert, responsive, or lethargic;                   (D) ease of movement, such as ability to walk and move limbs, gait, and bodily deformities;                   (E) breathing, such as persistent cough, hyperventilation, or normal; and                   (F) skin condition, such as lesions, swelling, yellowing, rashes, scars, tattoos, bruises, and/or needle marks;         
        (4) history of or current serious infectious disease including, at a minimum, tuberculosis;       
        (5) recent communicable illness symptoms, such as chronic cough, coughing up blood, lethargy, weakness, weight loss, loss of appetite, fever, and/or night sweats;       
        (6) history of or current sexually transmitted infections;       
        (7) history of or current illnesses or chronic health conditions including, at a minimum:                  (A) allergies;                   (B) asthma or other respiratory problems;                   (C) dermatological conditions;                   (D) seizure disorder;                   (E) eye conditions; and                   (F) other acute or chronic conditions as determined by the health service authority;         
        (8) history of or current gynecological problems;       
        (9) current or recent pregnancy;       
        (10) current use of medication(s) including, at a minimum, name, dosage, frequency, time of last dose taken, and name of prescribing physician;       
        (11) dental problems;       
        (12) use of alcohol or illegal drugs, including, at a minimum, type, amount, time of last use, and past treatment;       
        (13) drug withdrawal symptoms;       
        (14) special health requirements, such as dietary needs, physical disabilities, or prosthetics;       
        (15) evidence of physical trauma;       
        (16) recent injuries;       
        (17) weight and height; and       
        (18) any other health concerns reported by the resident.       
      (e) Screening Methodology. The health screening shall be administered through directly questioning the resident, observing the resident's behavior and physical condition, and review of any available records. If any of the information is unknown at the time of the health screening, the screener shall indicate this by entering "unknown," "not applicable," or a line in the space or electronic field provided for this information on the health screening form.     
      (f) Disposition and Medical Referral.      
        (1) The individual who completes the screening shall:                  (A) document the disposition of the youth, such as referral to emergency services or placement in the general population with later referral for medical follow up; and                   (B) sign the screening instrument and document his/her title and the date and time of the screening.         
        (2) For residents who are identified by the screening instrument as requiring follow-up consultation with a health care professional, facility staff shall:                  (A) contact the health care professional designated by the screening instrument as soon as possible but no later than 24 hours after completion of the screening, unless the screening instrument provides otherwise; and                   (B) ensure the resident receives follow-up medical care as directed by the health care professional.         
        (3) The facility shall maintain and implement written policies and procedures to ensure that residents identified with potential medical problems (e.g., asthma, diabetes) are appropriately supervised until medical follow-up is received.       
        (4) For residents who report taking prescription medication, facility staff shall document whether the resident's parent, guardian, or custodian has provided the facility with the medication and a written request to administer the medication. If the medication or written request has not been provided, facility staff shall contact a health care professional within 24 hours after completion of the screening to receive instruction.       
      (g) Mandatory Health Assessment. Each resident shall receive a health assessment within 30 days after admission into the facility. The health assessment shall be conducted by:      
        (1) an appropriately supervised licensed vocational nurse, a registered nurse, a nurse practitioner, a physician assistant, or a physician; or       
        (2) a qualified and properly trained person who is operating under delegation from a physician in accordance with Texas Occupations Code §157.001, including, but not limited to, a medical assistant, emergency medical technician, or paramedic.       
      (h) Results of Screening and Assessment. The results of the health screening and health assessment shall be communicated to appropriate staff.     
      (i) Contagious or Infectious Disease. Any finding of the health screening that indicates a significant potential health risk to the staff or residents from a contagious or infectious disease shall be immediately reported to the facility administrator, and the affected resident shall be placed in medical separation until proper medical clearance is obtained.     
      (j) Intra-Jurisdictional Custodial Transfer. A health screening is not required for intra-jurisdictional custodial transfer of residents if the non-secure facility receiving the resident is located within the same premises as the sending facility. If the two facilities are not located within the same premises, the only items required for the health screening are items enumerated in subsection (d)(2) and (15) of this section.     
     Source Note:        The provisions of this §355.504 adopted to be effective November 15, 2013, 38 TexReg 7973