CHAPTER 46 ‑ LOCAL STANDARDS

SECTION .0100 ‑ GENERAL

10A NCAC 46 .0101 GENERAL AID‑TO‑COUNTY FUND

10A NCAC 46 .0102 SPECIAL NEEDS FUNDS

History Note: Authority G.S. 130A‑5(3);

Eff. April 1, 1985;

Amended Eff. October 1, 1985;

Transferred and Recodified from 10 NCAC 12 .0108 Eff. April 4, 1990; (.0101);

Transferred and Recodified 10 NCAC 12 .0109 Eff. April 4, 1990 (.0102);

Amended Eff. September 1, 1990;

Expired Eff. February 1, 2016 pursuant to G.S. 150B-21.3A.

SECTION .0200 – STANDARDS FOR LOCAL HEALTH DEPARTMENTS

10A NCAC 46 .0201 MANDATED SERVICES

The following is a list of mandated services required to be provided in every county of this state. The local health department shall provide or ensure the provision of these services in accordance with the rules in this Section:

(1) Adult Health;

(2) Home Health;

(3) Dental Public Health;

(4) Food, Lodging and Institutional Sanitation;

(5) Individual On‑Site Water Supply;

(6) Sanitary Sewage Collection, Treatment and Disposal;

(7) Communicable Disease Control;

(8) Vital Records Registration;

(9) Maternal Health;

(10) Child Health;

(11) Family Planning;

(12) Public Health Laboratory Support.

History Note: Authority G.S. 130A‑9;

Eff. July 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0227 Eff. April 4, 1990;

Amended Eff. July 1, 2015;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0202 GENERAL

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0228 Eff. April 4, 1990;

Amended Eff. September 1, 1990;

Expired Eff. February 1, 2016 pursuant to G.S. 150B-21.3A.

10A NCAC 46 .0203 QUALITY ASSURANCE

A local health department shall establish, implement, and maintain written policies to assure quality in all administrative, environmental, clinical, and educational services and activities mandated by the Commission which are contracted for or provided by the local health department. Policies shall include:

(1) Provisions for a periodic program assessment to be conducted at least once per year which shall include:

(a) A review of appropriate clinical and non‑clinical records.

(b) Development of a corrective action time‑table for making necessary improvements.

(d) A review of appropriate state or local reports and statistics.

(e) Documentation of review findings.

(f) Documentation of corrective action.

(2) Provisions for staff development and training opportunities.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0229 Eff. April 4, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0204 CHILD HEALTH

(a) A local health department shall provide, contract for the provision of, or certify the availability of child health services for all individuals within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) A description of the procedures for child health services provided by the local health department, a copy of the contract for the provision of child health services, or a certification of availability of child health services. These child health services shall include:

(A) Child health information, referral, immunizations, and hemoglobinopathy screening upon request.

(B) Identification and follow‑up of high priority infants.

(D) Follow‑up of chronically ill and handicapped infants and children upon request.

(E) Routine periodic well‑child supervision to children less than five years of age, not served by another health care resource, through one or more of the following mechanisms:

(i) referral to other health care providers;

(ii) contracts with other health care providers; or

(iii) provision of the following health assessment services in a local health department child health clinic:

(I) initial and interim health history;

(II) physical assessment and laboratory services;

(III) developmental evaluation;

(IV) nutrition assessment;

(V) counseling, including anticipatory guidance; and

(VI) referral for further diagnosis and treatment.

(2) A description of the target population for child health services provided by the local health department, including eligibility criteria. The local health department shall emphasize provision of child health services to individuals who would not otherwise have access to these services.

(3) A description of fees, if any, for child health services provided by the local health department.

(b) A local health department shall establish, implement, and maintain written policies for the provision of community and patient child health education services within the jurisdiction of the local health department. The policies shall include a description of the procedures for provision of services for identification of, recruitment of, and outreach to the target population.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Amended Eff. July 1, 1985;

Transferred and Recodified from 10 NCAC 12 .0230 Eff. April 4, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0205 MATERNAL HEALTH

(a) A local health department shall provide, contract for the provision of, or certify the availability of maternal health services for all individuals within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) A description of the procedures for maternal health services provided by the local health department, a copy of the contract for the provision of maternal health services, or a certification of availability of maternal health services. These maternal health services shall include:

(A) Pregnancy testing, information, and referral as appropriate;

(B) Ongoing prenatal care to all pregnant women, not served by another health care resource, through one or more of the following mechanisms:

(i) Referral to other health care providers;

(ii) contracts with other health care providers; or

(iii) provision of the following prenatal services in a local health department maternity clinic:

(I) Initial history, and physical and laboratory examinations;

(II) assessment of medical, nutritional, and social problems;

(III) weekly assessments by a physician or a registered nurse, as medically indicated;

(IV) laboratory, nutrition, and patient education follow‑up services;

(V) high‑risk identification and referral; and

(VI) scheduling of postpartum visits.

(2) A description of the target population for maternal health services provided by the local health department, including eligibility criteria. The local health department shall emphasize provision of maternal health services to individuals who would not otherwise have access to these services.

(3) A description of fees, if any, for maternal health services provided by the local health department.

(b) A local health department shall establish, implement, and maintain written policies for the provision of community and patient maternal health education services within the jurisdiction of the local health department. Education services shall promote healthy lifestyles for good pregnancy outcome.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0231 Eff. April 4, 1990;

Amended Eff. September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0206 FAMILY PLANNING

(a) A local health department shall provide, contract for the provision of, or certify the availability of family planning services for all individuals within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) A description of the procedures for family planning services provided by the local health department, a copy of the contract for the provision of family planning services, or a certification of availability of family planning services. These family planning services shall include:

(A) Patient history assessments;

(B) Physical examinations and laboratory services;

(D) Provision of contraceptive information and the use of informed consent procedures when prescribing a method of contraception;

(E) Treatment, referral, and follow‑up.

(2) A description of the target population for family planning services provided by the local health department, including eligibility criteria. The local health department shall emphasize provision of family planning services to individuals who would not otherwise have access to contraceptive services in the community.

(3) A description of fees, if any, for family planning services provided by the local health department.

(b) A local health department shall establish, implement, and maintain written policies for the provision of community and client family planning education services within the jurisdiction of the local health department. The policies shall include a description of the procedures for provision of services for identification of, recruitment of, and outreach to the target population.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0232 Eff. April 4, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0207 DENTAL PUBLIC HEALTH

(a) A local health department shall provide, contract for the provision of, or certify the availability of dental public health services for all individuals within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) A description of the procedures for dental public health services provided by the local health department, a copy of a contract for the provision of dental public health services, or a certification of availability of dental public health services. These dental public health services shall include:

(A) Approved preventive dental health services for targeted children and adults.

(B) Dental screening and referral services for targeted children and adults.

(C) Cooperation with the Division in promoting and obtaining fluoridation of community and school water systems, including keeping records of all water systems within the jurisdiction of the local health department which are fluoridated.

(2) A description of the target population for dental public health services, provided by the local health department, including eligibility criteria.

(3) A description of fees, if any, for dental public health clinical treatment services provided by the local health department.

(b) A local health department shall establish, implement, and maintain written policies for the provision of community and client dental public health education services within the jurisdiction of the local health department. The policies shall include a description of the scope of dental health educational services, to include nutrition and dietary information, to be provided to the target population.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Amended Eff. January 1, 1986;

Transferred and Recodified from 10 NCAC 12 .0233 Eff. April 4, 1990;

Amended Eff. September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0208 HOME HEALTH

(a) A local health department shall provide, contract for the provision of, or certify the availability of home health services for all individuals within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) A description of the home health services provided by the local health department, a copy of the contract for the provision of home health services, or a certification of availability of home health services.

(2) A description of fees for home health services provided by the local health department.

(b) A local health department which provides home health services shall meet the standards for licensure of home health agencies found in 10 NCAC 3L.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0234 Eff. April 4, 1990;

Amended Eff. September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0209 ADULT HEALTH

(a) A local health department shall provide, contract for the provision of, or certify the availability of adult health services for all individuals within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) A description of the procedures for adult health services provided by the local health department, a copy of the contract for the provision of adult health services, or a certification of availability of adult health services. These shall include the following prevention and detection services for cancer, diabetes, and hypertension.

(A) Identification, recruitment, screening, including laboratory services, referral, and follow‑up;

(B) Nutrition services to patients and persons at risk.

(2) A description of the target population for adult health services provided by the local health department, including eligibility criteria.

(3) A description of fees, if any, for adult health services provided by the local health department.

(b) A local health department shall establish, implement, and maintain written policies for the provision of cancer, diabetes, and hypertension health education services to the community, persons at risk, and patients.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0235 Eff. April 4, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0210 INDIVIDUAL (ON‑SITE) WATER SUPPLY

(a) A local health department shall provide individual (on‑site) water supply sanitation services within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) Provisions for inspecting individual water supplies upon request and identifying needed improvements. When indicated, water samples are collected for bacteriological or chemical analysis in an approved manner, and the samples are submitted to a certified lab for analysis.

(2) Provisions for investigating complaints and suspected outbreaks of illness associated with water supplies. Corrective actions shall be taken in cases of valid complaints and confirmed outbreaks of illness.

(3) Provisions for keeping records of activities described in Paragraphs (a)(1) and (2) of this Rule.

(b) A local health department shall establish, implement, and maintain written policies for the provision of orientation and in‑service training for sanitarians. The policies shall include the following minimum requirements for sanitarians providing individual on‑site water supply services:

(1) Initial field training for newly employed sanitarians;

(2) CDC Homestudy Course 3010‑G or its equivalent as approved by the Division of Public Health; and

(3) Registration by the Board of Sanitarian Examiners.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Amended Eff. October 1, 1986;

Transferred and Recodified from 10 NCAC 12 .0236 Eff. April 4, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0211 SANITARY SEWAGE COLLECTION, TREATMENT AND DISPOSAL

(a) A local health department shall regulate sewage collection, treatment, and disposal within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) Provisions for the enforcement of permit requirements specified in the sewage law and rules.

(2) Provisions for investigating complaints and suspected outbreaks of illness associated with sewage collection, treatment, and disposal. Corrective actions shall be taken in cases of valid complaints and confirmed outbreaks of illness.

(3) Provisions for keeping records of activities described in Paragraphs (a)(1) and (2) of this Rule.

(1) Initial field training for newly employed sanitarians;

(2) CDC Homestudy Course 3010‑G or its equivalent as approved by the Division of Public Health;

(3) On‑site Sewage Branch Soils Workshop; and

(4) Registration by the Board of Sanitarian Examiners.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0237 Eff. April 4, 1990;

Amended Eff. September 1, 1991;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0212 GRADE A MILK SANITATION

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Amended Eff. October 1, 1985;

Transferred and Recodified from 10 NCAC 12 .0238 Eff. April 4, 1990;

Repealed Eff. July 1, 2015;

Expired Eff. February 1, 2016 pursuant to G.S. 150B-21.3A.

10A NCAC 46 .0213 FOOD, LODGING/INST SANITATION/PUBLIC SWIMMING POOLS/SPAS

(a) A local health department shall provide food, lodging, and institutional sanitation and public swimming pools and spas services within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) The frequency of inspections of food, lodging, and institutional facilities and public swimming pools and spas with the following being the minimum:

Type of Establishment Frequency Per Fiscal Year (July 1 – June 30)

Adult Day Service Facilities 1/year

Bed and breakfast homes 1/year

Bed and breakfast inns 1/6 months

Child day‑care facilities 1/6 months

Food Service Establishments

Risk Category I 1/year

Risk Category II 1/6 months

Risk Category III 1/4 months

Risk Category IV 1/3 months

Institutions 1/6 months

Local confinement facilities 1/year

Lodging 1/year

Migrant housing water and sewage evaluation 1/year

Primitive Experience Camps

Operating 6 months or less per year 1/year

Operating more than 6 months per year 1/6 months

Private boarding schools and colleges 1/year

Public swimming pools and spas which operate only between 1/operational

April 1 and October 31 each year season

Public swimming pools and spas which operate at times other 2/year

than between April 1 and October 31 each year

Residential care facilities 1/year

Schools 1/year

Summer camps 1/year

Tattoo Artists 1/year

Risk Category I applies to food service establishments that prepare only non-potentially hazardous foods.

Risk Category II applies to food service establishments that cook and cool no more than two potentially hazardous foods. Potentially hazardous raw ingredients shall be received in a ready-to-cook form.

Risk Category III applies to food service establishments that cook and cool no more than three potentially hazardous foods.

Risk Category IV applies to food service establishments that cook and cool an unlimited number of potentially hazardous foods. This category also includes those facilities using specialized processes or serving a highly susceptible population.

(2) Provisions for investigating complaints and suspected outbreaks of illness associated with food, lodging, and institutional facilities, and public swimming pools. Corrective actions shall be taken in cases of valid complaints and confirmed outbreaks of illness.

(3) Provisions for keeping records of activities described in Subparagraphs (1) and (2) of this Paragraph.

(b) A local health department shall establish, implement, and maintain written policies for the provision of sanitation education for food service personnel and orientation and in-service training for Environmental Health Specialists. The policies shall include the following requirements for Environmental Health Specialists providing food, lodging, and institutional sanitation services:

(1) Completion of the centralized training course provided by the Division for newly employed Environmental Health Specialists;

(2) Compliance with Delegation of Authority as stated in 15A NCAC 01O .0100; and

(3) Compliance with the Board of Sanitarian Examiners' requirements.

History Note: Authority G.S. 130A-4(b); 130A‑9;

Eff. October 1, 1984;

Amended Eff. March 1, 1988; December 1, 1987; October 1, 1986;

Transferred and Recodified from 10 NCAC 12 .0239 Eff. April 4, 1990;

Amended Eff. August 1, 2007; May 1, 1996; July 1, 1993; October 1, 1992; December 1, 1991;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0214 COMMUNICABLE DISEASE CONTROL

(a) A local health department shall provide services and perform activities for the control of communicable disease within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include a description of the procedures for communicable disease control services and activities provided by the local health department which shall include:

(1) General Communicable Disease Control:

(A) Reporting communicable diseases as required by law. Additionally, cases of vaccine‑preventable diseases shall be reported to the designated division program representative within 24 hours of receipt of the report.

(B) Investigating any outbreaks of a reportable communicable disease within the jurisdiction of the local health department to determine the cause of the outbreak and to ensure that appropriate steps are taken to arrest the outbreak and prevent its recurrence.

(C) Investigating each case of a communicable disease for which there is a surveillance form supplied by the Department. Forms shall be completed and submitted to the Department.

(D) Distributing communicable disease report cards with instructions for submission to all pediatricians, internists, and family or general practitioners practicing within the jurisdiction of the local health department.

(2) Tuberculosis Control:

(A) Tuberculosis diagnostic and follow‑up services for cases, contacts, and suspects which include:

(i) Medical and epidemiological history;

(ii) Assessment of blood pressure, weight, urinalysis, if indicated, and visual acuity and color discrimination, if indicated;

(iii) Special investigations, such as Mantoux skin test, chest x‑ray, mycobacteriology, and other investigations as indicated.

(B) Tuberculosis treatment services which include:

(i) Provision of anti‑tuberculosis drugs as medically prescribed;

(ii) Monthly monitoring of intake and for adverse side effects of anti‑tuberculosis drugs by office visit, home visit, or telephone;

(iii) Coordination and communication with private medical providers.

(3) Immunization:

(A) Providing resources to ensure that all children within the jurisdiction of the local health department receive all vaccines required by law within the time frames established by law.

(B) Providing vaccines in clinics, with at least one each month accessible to working parents.

(C) Enforcing the immunization law pertaining to day‑care facilities, including submitting the immunization records audit form.

(D) Assisting local school officials in enforcing the immunization law pertaining to public and private schools (k‑12).

(E) Ensuring accountability for all doses of vaccine provided by the Division.

(4) Venereal Disease Control:

(A) Diagnostic testing and examination services for syphilis and gonorrhea shall be available each weekday;

(B) Treatment services, both therapeutic and preventive, for reportable venereal disease shall be available each weekday;

(C) Counseling and education designed to influence disease intervention and prevention behaviors, particularly that designed to enlist patient cooperation in referring sex partners for examination and treatment, shall be available each weekday;

(D) Follow‑up and referral of persons with positive venereal disease laboratory tests shall be available each weekday.

(b) A local health department shall establish, implement, and maintain written policies for the provision of communicable disease control education services to the community, health care personnel, and patients. The services shall include provision of clinic schedules, information on communicable disease reporting, and other communicable disease control information to local medical organizations, veterinarians, animal control officers, health care providers, and the media, as appropriate.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0240 Eff. April 4, 1990;

Amended Eff. September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0215 VITAL RECORDS

(a) A local health department shall provide vital records services within the jurisdiction of the local health department. The local health director shall serve as the local registrar and shall perform the duties of that office as prescribed by law. A local health department shall establish, implement, and maintain written policies which shall include:

(1) Procedures for reporting flagrant, willful violations of the vital records law and reporting known vital events for which a certificate has not been obtained.

(2) A file of all vital records laws, rules, and instructions issued by the state registrar.

(3) Procedures for the examination of birth, death, and fetal death certificates for accuracy and completeness.

(4) Procedures for returning incomplete or inaccurate certificates to or querying the persons responsible for filing them for completion and correction.

(b) A local health department shall establish, implement, and maintain written policies for obtaining vital records education services from the State Registrar's Office for local registration personnel, hospital administrators, and their medical records personnel, funeral directors, medical examiners, and others involved in the registration system. The policies shall include provisions for orientation of new deputy registrars, subregistrars, and back‑up health department personnel.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0241 Eff. April 4, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0216 LABORATORY

A local health department shall provide, contract for the provision of, or certify the availability of public health laboratory services appropriate to the activities of the Department for all individuals within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written policies which shall include:

(1) A description of the public health laboratory services provided by the local health department, a copy of a contract for the provision of public health laboratory services, or a certification of availability of public health laboratory services. These public health laboratory services shall include:

(a) Clinical tests to aid in the diagnosis and treatment of diseases and conditions.

(b) Clinical tests to monitor the response to treatment.

(d) Analyses required for environmental activities of the local health department.

(2) An identification of one person to manage the laboratory services program.

(3) A description of fees, if any, for public health laboratory services provided by the local health department.

(4) A standard operating procedures manual which contains standardized protocols and describes quality control requirements for all procedures performed by the local health department.

(5) An assurance that persons performing tests and analyses have demonstrable skill and competence in achieving accuracy and precision of tests and analyses.

(6) Provisions for adequate space and facilities.

(7) A description of the laboratory records system. The system shall include documentation of quality control.

(8) Provisions for the protection of the safety of staff, patients, clients, and the general public regarding specimen collection, laboratory operations, and disposal of wastes.

(9) A description of eligibility criteria, if any, for public health laboratory services provided by the local health department.

History Note: Authority G.S. 130A‑9;

Eff. October 1, 1984;

Transferred and Recodified from 10 NCAC 12 .0242 Eff. April 4, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

SECTION .0300 ‑ LOCAL HEALTH DEPARTMENT STAFF

10A NCAC 46 .0301 MINIMUM STANDARD HEALTH DEPARTMENT: STAFFING

In addition to meeting the requirements in 10A NCAC 48B .0103, to be accredited pursuant to G.S. 130A-34.1, a local health department shall meet the following requirements:

(1) The local health department shall employ a full-time health director, a full-time public health nurse, a full-time registered sanitarian, and a full-time secretary. For this Rule, full-time means the employee is employed to work a standard work week of the local health department. However, the local health department may share a local health director with one or more other local health departments.

(2) All local health department nurses shall either:

(a) Have a nursing degree from a baccalaureate school accredited by the National League for Nursing or the Commission on Collegiate Nursing Education; or

(b) Complete within one year of employment with the health department an introductory course in principles and practices of public health and public health nursing sponsored by the Department. The curriculum for the course shall be developed by the Department with input from local health departments and schools of nursing.

History Note: Authority G.S. 130A-5(3); 130A-9; 130A-34.1;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. July 1, 1985;

Transferred and Recodified from 10 NCAC 12 .0101 Eff. April 4, 1990;

Amended Eff. October 1, 2008; September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

10A NCAC 46 .0302 MEDICAL CONSULTANTS

(a) The local health department shall ensure adequate medical consultation in accordance with this Rule.

(b) When the health director of a local health department is not a physician licensed to practice medicine in North Carolina, medical consultation shall be considered adequate when one or more physicians licensed to practice medicine in North Carolina serve on a regular basis as medical consultants.

(c) The medical consultants of a local health department shall have the following responsibilities not otherwise assured by a licensed physician associated with the health department:

(1) Approving, by signature, all medical procedures adopted by the local health department;

(2) Consulting with local health department staff in the resolution of unanticipated medical problems as they arise;

(3) Ensuring, through consultation and review, that the quality of medical services provided by a local health department meets current medical standards of care;

(4) Providing all other medical supervision required by the Public Health Laws and local health department programs.

(d) The provisions of this Rule shall in no way limit the use of medical consultants in health departments where the health director is a physician.

History Note: Authority G.S. 130A‑9;

Eff. April 1, 1982;

Transferred and Recodified from 10 NCAC 12 .0302 Eff. April 4, 1990;

Amended Eff. September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 5, 2016.

SECTION .0400 ‑ SANITATION INSPECTIONS

10A NCAC 46 .0401 definitions

10A NCAC 46 .0402 approval of construction: renovation plans

10A NCAC 46 .0403 inspections and reports

10A NCAC 46 .0404 scoring: approval/disapproval

History Note: Authority G.S .110-91(1); 110-92; 130A-145; 143B-168.3;

Eff. January 1, 1986;

Repealed Eff. November 1, 2005.

SECTION .0500 ‑ SANITATION STANDARDS FOR CENTERS

10A NCAC 46 .0501 sanitation requirements

10A NCAC 46 .0502 procedure when infection suspected

10A NCAC 46 .0503 severability

History Note: Authority G.S. 110.91-(1); 110-92; 130A-145; 143B-168.3;

Eff. January 1, 1986;

Amended Eff. January 1, 1987;

Repealed Eff. November 1, 2005.