HEALTH. An agency must have and implement policies and procedures that maintain
and protect the health of individuals.
INDIVIDUAL AND FAMILY INVOLVEMENT. An
agency must have and implement a written policy that addresses opportunities
for all of the following:
of individuals in decisions regarding the agency's operations.
(b) Interaction of families, guardians, legal
and designated representatives, and significant others.
For individuals, families, guardians,
legal and designated representatives, and significant others:
(A) Participation on the Board of Directors
or on committees; or
(B) Review of
the agency's policies directly affecting the individuals receiving services
from the agency.
CONFIDENTIALITY OF RECORDS. An agency
must have and implement written policies and procedures that ensure all records
for individuals are kept confidential except as otherwise provided by
applicable state and federal rule or laws.
(a) For the purpose of disclosure from
individual medical records under this rule, an agency is considered a "public
provider" as defined in ORS
(b) Access to records by the Department does
not require authorization by an individual or their legal or designated
representative or family.
the purpose of disclosure of non-medical individual records, all or portions of
the information contained in the non-medical individual records may be exempt
from public inspection under the personal privacy information exemption to the
public records law set forth in ORS
(a) PROFESSIONAL BEHAVIOR SERVICES. An agency
must have and implement written policies and procedures to assure professional
behavior services are delivered by a qualified behavior professional in
accordance with OAR chapter 411, division 304.
BEHAVIOR SUPPORTS. An agency must have
and implement written policies and procedures for the delivery of behavior
supports that prohibits abusive practices and assures behavior supports are
included in a Positive Behavior Support Plan.
(A) The agency must inform each individual,
and as applicable their legal or designated representative, of the behavior
support policies and procedures at the time of entry and as changes
(B) A decision to alter an
individual's behavior must be made by the individual or their legal or
(5) EMERGENCY PHYSICAL RESTRAINT. An agency
must have and implement written policies and procedures to assure that the use
of any emergency physical restraint is reviewed by an agency's Executive
Director, or as applicable their designee, within two hours of the emergency
NURSING SERVICES. An agency must have and implement written policies and
procedures to assure direct nursing services are delivered by a qualified
registered or licensed professional nurse in accordance with OAR chapter 411,
MANAGING INDIVIDUALS' MONEY. An agency must have and implement written policies
and procedures for the handling and management of money for the individuals.
Such policies and procedures must provide for all of the following:
(a) Financial planning and management of the
funds for an individual.
Safeguarding the funds for an individual.
(c) Individuals receiving and spending their
(d) Taking into account
the interests and preferences of the individual.
COMPLAINTS. An agency must have and
implement written policies and procedures for individual complaints in
accordance with OAR 411-318-0015
Complaints by or on behalf of individuals must be addressed in accordance with
(b) Upon an
individual's entry and request and annually thereafter, the policy and
procedures for complaints must be explained and provided to an individual and
their legal or designated representative (as applicable).
AGENCY DOCUMENTATION REQUIREMENTS. An
agency must have and implement policies and procedures that address agency
documentation requirements. Documentation must be:
(a) Prepared at the time or immediately
following the event being recorded.
(b) Accurate and contain no willful
(c) Legible, dated,
and signed by the person making the entry.
(d) Maintained for no less than five
Or. Admin. R.
SPD 12-2011, f. & cert.
ef. 7-1-11; SPD 19-2011(Temp), f. & cert. ef. 7-1-11 thru 12-28-11; SPD
1-2012, f. & cert. ef. 1-6-12;
42-2014, f. 12-26-14, cert. ef.
25-2016, f. & cert. ef.
29-2017, amend filed 11/30/2017, effective
21-2019, amend filed 06/28/2019, effective
44-2019, amend filed 10/29/2019, effective
Statutory/Other Authority: ORS
Statutes/Other Implemented: ORS