(a) A center must review a written agreement and disclosure form with a minor's parent or with the adult minor before services are provided at the center.
(b) The agreement and disclosure form must include evidence or attestation that the parent has the legal authority to consent to a minor's medical care.
(c) The agreement and disclosure form must document that a center obtained a minor's parent's or an adult minor's written informed consent specifying the services that may be provided on behalf of a center to a minor.
(d) The agreement and disclosure form must document that the center provided the following information orally and in writing to the minor's parent or the minor, in a language or format he or she understands:
  (1) the notice of rights and responsibilities described in §15.901 of this subchapter (relating to Rights and Responsibilities);
  (2) information on the Advance Directives Act, THSC, Chapter 166;
  (3) the extent to which payment for services provided on behalf of the center may be expected from any third-party payment source known to a center, the charges for services not covered by a third-party payment source and charges that a minor's parent or adult minor may have to pay;
  (4) a list of the staff who will provide services on behalf of the center;
  (5) a list of expected outcomes and any specific limitations or barriers to reaching the outcomes;
  (6) the method of supervision and oversight by a center of the services to be provided at the center;
  (7) DADS toll-free telephone number and its purpose;
  (8) the process for directing a grievance to the administrator about services provided at the center and the time frame in which the center must review and resolve a grievance;
  (9) an adult minor's and a parent's responsibilities;
  (10) an emergency plan for a minor; and
  (11) notice of the center's policies regarding:
    (A) attendance requirements;
    (B) implementing an advance directive in accordance with §15.902 of this subchapter (relating to Advance Directives);
    (C) disclosure of the minor's medical record;
    (D) person-centered direction and guidance;
    (E) restraints;
    (F) reporting abuse, neglect, or exploitation of a minor by an employee, volunteer, or contractor;
    (G) drug testing of employees in direct contact with a minor in accordance with §15.419 of this subchapter (relating to Drug Testing Policy); and
    (H) management and disposal of medications in the center.
(e) The agreement and disclosure form must be signed by a minor's parent or an adult minor.
(f) A center must provide a signed copy of the agreement and disclosure form to the minor's parent or the adult minor.
(g) The center must keep the signed written agreement and disclosure form in the minor's medical record.
(h) The center must update the agreement and disclosure form if information in the form changes.
(i) The center must comply with the terms of the agreement.

Source Note: The provisions of this §550.603 adopted to be effective September 1, 2014, 39 TexReg 6569; transferred effective May 1, 2019, as published in the Texas Register April 12, 2019, 44 TexReg 1875