Virginia Law

A. Each child shall have a medical examination conducted by or under the direction of a licensed physician no earlier than 90 days prior to placement, except in the following situations:

1. An emergency-placed child shall have up to 60 days following placement to receive a medical examination if a written medical examination report providing evidence that he received a medical examination no earlier than 90 days prior to placement is not available;

2. The child is a newborn then the hospital discharge summary shall serve as the medical examination; or

3. The child has been in continuous placement of a public or private child-placing agency and the licensee has obtained copies of (i) a medical examination report that is no more than 13 months old and (ii) a report of all medical treatment provided to the child from the date of the medical examination to the date of admission of the child to the licensee's program.

B. The licensee shall follow the examining physician's recommendations regarding the frequency and type of medical examinations or treatment; however, there shall be no more than 13 months between medical examinations received by the child.

C. The medical examination report on each child shall include the following:

1. Date of examination;

2. Signature and title of examiner;

3. Current physical condition;

4. Growth and development;

5. Visual acuity;

6. Auditory acuity;

7. Nutritional status;

8. Evidence of freedom from communicable disease, including tuberculosis;

9. Allergies, including food and medication allergies;

10. Chronic conditions;

11. Disabilities; and

12. A copy of the record of immunizations the child has received since his last examination.

D. The licensee shall file a copy of the medical examination report in the child's file.

E. Each child over three years of age shall have a dental examination.

1. The dental examination shall have been completed within 13 months prior to the time of placement or if no previous dental examination has been conducted, the child shall have an exam within 60 days following the date of placement.

2. The written report of examination shall contain the signature of a licensed dentist or his designee.

3. The licensee shall file a copy of the dental examination report in the child's file.

F. The licensee shall arrange for the child to receive any routine and recommended medical, dental, mental health, psychological, and psychiatric follow-up care and treatment. Documentation regarding the arrangements for and child's receipt of care shall be maintained in the child's file.

G. The licensee shall arrange for the child to receive necessary medical, dental, mental health, psychological, and psychiatric care and treatment resulting from injuries, illness, emergencies, or other conditions that occur in between examinations or appointments. Documentation regarding the arrangements for and child's receipt of care shall be maintained in the child's file.

H. If the licensee serves as legal custodian for the child and in that capacity decides not to follow the physician's recommendation for medical, dental, or psychiatric care or treatment, the licensee shall document in the child's file the rationale upon which the decision was made, including a detailed description of how the licensee considered the best interests of the child in making the decision.

I. The licensee shall document in the file of each child a listing of all medication prescribed for the child.

J. The licensee shall document in the file of each child the medication intended effects and adverse reactions the child or youth has experienced. The licensee shall ensure that the intended effects and adverse reactions experienced by the child or youth are reported to the prescribing physician.

K. The provider applicant and all other household members who come into contact with children shall submit to tuberculosis screening or tests and provide documentation on the appropriate report of tuberculosis form published by the Virginia Department of Health (Report of Tuberculosis Screening Clearance Letter for Negative Screen (Form 1), Report of Tuberculosis Screening Report of TST/X-ray Results (Form 2), or TB Risk Assessment (TB 512)) or a form consistent with it.

1. The screening or test results shall include a statement that the individual is free from communicable tuberculosis and including the type of screening administered, date of screening, and results of the screening. If any screening or test shows positive results for communicable tuberculosis or if no screening or test has been completed on the individual, a written explanation shall be obtained from the physician, his designee, or representative of the local health department.

2. The screening or test results shall contain the screening or test date and the results shall be no older than 13 months at the time of home approval by the licensee.

3. If an individual comes in contact with a known case of tuberculosis or develops chronic respiratory symptoms of three weeks or more duration, he shall obtain tuberculosis screening and follow the recommendations of the physician, his designee, or representative of the local health department. The licensee shall require the individual to submit documentation regarding communicable status.

L. The provider applicant and each resident of the household who will be in a caretaking role for children placed in the home shall submit the results of a medical examination administered and signed by a licensed physician, his designee, or an official of a local health department.

1. The examination results shall include written examiner comments that address the applicant's or caretaker's mental and physical condition in relation to his ability to take care of a child. If concerns are noted, additional reports from specialists shall be obtained.

2. The examination results shall contain a date of examination and be no older than 13 months at the time of home approval by the licensee.

M. The medical examination shall be updated if the licensee or department has concerns about the physical or mental health of any member of the placement family. If the examination reveals that the child's safety or health is in jeopardy, the licensee shall plan for the immediate removal of any children or youth placed in the home.