Chapter 10. DEPARTMENT OF HEALTH SERVICES - HEALTH CARE INSTITUTIONS: LICENSING

An administrator of a hospital that provides respiratory care services shall ensure that: 1. Respiratory care services are provided under the direction of a medical staff member; 2. Respiratory care services are provided according to an order that includes: a. The patient's name;…

If respiratory care services are authorized to be provided on a nursing-supported group home's premises, an administrator shall ensure that: 1. Respiratory care services are provided under the direction of a resident's designated medical practitioner; 2. Respiratory care services…

A. An administrator shall ensure that policies and procedures for medication services: 1. Include: a. A process for providing information to a resident or the resident's representative about medication prescribed for the resident including:i. The prescribed medication's anticipat…

An administrator shall ensure that: 1. An infection control program is established, under the direction of an individual qualified according to policies and procedures, to prevent the development and transmission of infections and communicable diseases including: a. A method to i…

A. An administrator shall ensure that a registered nurse who is part of the interdisciplinary team for a resident requiring a modified or special diet: 1. Consults with a registered dietitian or the resident's designated medical practitioner, as needed, about the resident's modif…

A. An administrator shall ensure that:1. A disaster plan is developed, documented, maintained in a location accessible to personnel members and other employees, and, if necessary, implemented that includes: a. A floor plan of the facility showing emergency protection equipment, e…

A. An administrator shall ensure that:1. The premises and equipment are free from a condition or situation that may cause a resident or other individual to suffer physical injury; 2. The premises are free of accumulations of garbage or refuse; 3. Garbage and refuse in the facilit…

A. An administrator shall ensure that:1. A nursing-supported group home is in compliance with applicable federal and state disability laws; 2. If a nursing-supported group home has a resident with a mobility, sensory, or other physical impairment, documentation is available for r…

A. An administrator of a hospital that provides perinatal organized services shall ensure that: 1. Perinatal services are provided in a designated area under the direction of a medical staff member; 2. Only medical and surgical procedures approved by the medical staff are perform…

A. An administrator of a hospital that provides pediatric services or pediatric organized services according to the requirements in this Section shall ensure that: 1. Consistent with the health and safety of a pediatric patient, arrangements are made for a parent or a guardian of…

A. An administrator of a hospital that contains an organized psychiatric services unit or a special hospital licensed to provide psychiatric services shall ensure that in the organized psychiatric unit or special hospital: 1. Psychiatric services are provided under the direction …

An administrator of a hospital that is authorized to provide behavioral health observation/stabilization services shall ensure that: 1. Behavioral health observation/stabilization services are provided according to the requirements in R9-10-1012, and 2. Restraint and seclusion ar…

An administrator shall ensure that: 1. If rehabilitation services are provided as an organized service, the rehabilitation services are provided under the direction of an individual qualified according to policies and procedures; 2. Rehabilitation services are provided according …

A. A governing authority may designate the following as a multi-organized service unit: 1. An adult unit that provides both intensive care services and medical and nursing services other than intensive care services, 2. A pediatric unit that provides both intensive care services …

An administrator of a hospital that provides social services shall ensure that: 1. A registered nurse or another personnel member designated according to policies and procedures coordinates social services; 2. If a personnel member provides social services that require a license …

An administrator shall ensure that: 1. An infection control program that meets the requirements of this Section is established under the direction of an individual qualified according to policies and procedures; 2. An infection control program has a procedure for documenting:a. T…

An administrator shall ensure that: 1. Dietary services are provided according to 9 A.A.C. 8, Article 1; 2. A copy of the hospital's food establishment license or permit under 9 A.A.C. 8, Article 1, is maintained; 3. For a hospital that contracts with a food establishment, as est…

An administrator shall ensure that: 1. A disaster plan is developed and documented that includes: a. Procedures for protecting the health and safety of patients and other individuals; b. Assigned personnel responsibilities; and c. Instructions for the evacuation, transport, or tr…

An administrator shall ensure that: 1. An individual providing environmental services who has the potential to transmit infectious tuberculosis to patients, as determined by the infection control risk assessment criteria in R9-10-230(4)(c), provides evidence of freedom from infec…

A. An administrator shall ensure that: 1. A hospital complies with the applicable physical plant health and safety codes and standards incorporated by reference in R9-10-104.01 in effect on the date the hospital submitted, according to R9-10-104, an application for an approval of…

In addition to the definitions in A.R.S. § 36-401, R9-10-101, and R9-10-201, the following definition applies in this Section: "Administrative separation" means the temporary isolation of a patient for the purpose of preserving the integrity of evidence during the course of a cri…

In addition to the definitions in A.R.S. § 36-401 and R9-10-101, the following applies in this Article unless otherwise specified: "Child and adolescent residential treatment services" means behavioral health services and physical health services provided in or by a behavioral he…

In addition to the license application requirements in A.R.S. § 36-422 and R9-10-105, an applicant for a license as a behavioral health inpatient facility shall include in a Department-provided format whether the applicant is requesting authorization to provide: 1. Inpatient serv…

A. A governing authority shall: 1. Consist of one or more individuals responsible for the organization, operation, and administration of a behavioral health inpatient facility; 2. Establish, in writing: a. A behavioral health inpatient facility's scope of services, and b. Qualifi…

An administrator shall ensure that: 1. A plan is established, documented, and implemented for an ongoing quality management program that, at a minimum, includes: a. A method to identify, document, and evaluate incidents; b. A method to collect data to evaluate services provided t…

An administrator shall ensure that: 1. Contracted services are provided according to the requirements in this Article, and 2. Documentation of current contracted services is maintained that includes a description of the contracted services provided. Notes Ariz. Admin. Code § R9-1…

A. An administrator shall ensure that: 1. A personnel member, an employee, or a student is at least 18 years old; a. At least 18 years old and is licensed or certified under A.R.S. title 32 and providing services within the personnel member's scope of practice; b. At least 18 yea…

A. Except as provided in R9-10-315(E) or (F), an administrator shall ensure that: 1. A patient is admitted based upon the patient's presenting behavioral health issue and treatment needs and the behavioral health inpatient facility's ability and authority to provide physical heal…

A. Except for a patient admitted to receive crisis services or as provided in R9-10-315(E) or (F), an administrator shall ensure that a treatment plan is developed and implemented for a patient that: 1. Is based on the behavioral health assessment and on-going changes to the beha…

A. Except as provided in R9-10-315(E) or (F), an administrator shall ensure that a discharge plan for a patient is: 1. Developed that: a. Identifies any specific needs of the patient after discharge; b. If the discharge date has been determined, includes the discharge date; c. Is…

A. Except as provided in subsection (B), an administrator shall ensure that: 1. A personnel member coordinates the transport and the services provided to the patient; 2. According to policies and procedures: a. An evaluation of the patient is conducted before and after the transp…

A. An administrator shall ensure that: 1. The requirements in subsection (B) and the patient rights in subsection (D) are conspicuously posted on the premises; 2. At the time of admission, a patient or the patient's representative receives a written copy of the requirements in su…

A. An administrator shall ensure that: 1. A medical record is established and maintained for each patient according to A.R.S. Title 12, Chapter 13, Article 7.1; 2. An entry in a patient's medical record is: a. Recorded only by a personnel member authorized by policies and procedu…

A. An administrator of a behavioral health inpatient facility that uses a vehicle owned or leased by the behavioral health inpatient facility to provide transportation to a patient shall ensure that: 1. The vehicle: a. Is safe and in good repair, b. Contains a first aid kit, c. C…

A. An administrator shall ensure that: 1. Medical services are provided under the direction of a physician or registered nurse practitioner; 2. Nursing services are provided: a. Under the direction of a registered nurse, b. According to an acuity plan developed for the behavioral…

A. An administrator shall ensure that: 1. Behavioral health services listed in the behavioral health inpatient facility's scope of services are provided to meet the needs of a patient; 2. When behavioral health services are: a. Listed in the behavioral health inpatient facility's…

A. An administrator shall ensure that restraint is provided according to the requirements in subsection (C). B. An administrator of a behavioral health inpatient facility authorized to provide seclusion shall ensure that:1. Seclusion is provided according to the requirements in s…

A. An administrator of a behavioral health inpatient facility authorized to provide behavioral health observation/stabilization services shall comply with the requirements for behavioral health observation/stabilization services in R9-10-1012. B. If a behavioral health inpatient …

A. An administrator of a behavioral health inpatient facility authorized to provide child and adolescent residential treatment services shall:1. If abuse, neglect, or exploitation of a patient under 18 years of age is alleged or suspected to have occurred before the patient was a…

An administrator of a behavioral health inpatient facility authorized to provide detoxification services shall ensure that: 1. Detoxification services are available; 2. Policies and procedures state: a. Whether the behavioral health inpatient facility is authorized to provide inv…

A. An administrator shall ensure that policies and procedures for medication services: 1. Include: a. A process for providing information to a patient about medication prescribed for the patient including: i. The prescribed medication's anticipated results, ii. The prescribed med…

A. An administrator shall ensure that: 1. The behavioral health inpatient facility obtains a license or permit as a food establishment under 9 A.A.C. 8, Article 1; 2. A copy of the behavioral health inpatient facility's food establishment license or permit is maintained; 3. If a …

A. An administrator shall ensure that a behavioral health inpatient facility has: 1. A fire alarm system installed according to the National Fire Protection Association 72: National Fire Alarm and Signaling Code, incorporated by reference in R9-10-104.01, and a sprinkler system i…

A. An administrator shall ensure that:1. The premises and equipment are:a. Cleaned and, if applicable, disinfected according to policies and procedures designed to prevent, minimize, and control illness or infection; and b. Free from a condition or situation that may cause a pati…

A. An administrator shall ensure that the premises and equipment are sufficient to accommodate: 1. The services stated in the behavioral health inpatient facility's scope of services, and 2. An individual accepted as a patient by the behavioral health inpatient facility. B. An ad…

In addition to the definitions in A.R.S. § 36-401 and R9-10-101, the following definitions apply in this Article unless otherwise specified: 1. "Administrator" has the same meaning as in A.R.S. § 36-446. 2. "Care plan" means a documented description of physical health services an…

In addition to the license application requirements in A.R.S. § 36-422 and R9-10-105, an applicant for a license as a nursing care institution shall include: 1. In a Department-provided format whether the applicant: a. Has: i. A secured area for a resident with Alzheimer's diseas…