19 CSR 40-6.010
Perinatal Substance Abuse Forms for Health Care Providers
PURPOSE: This rule establishes the forms
and protocol to be used by health care
providers to implement the perinatal substance abuse legislation in sections 191.725,
191.741 and 191.743, RSMo.
(1) All licensed health care providers who
provide obstetrical and gynecological care to
pregnant women shall use the Department of
Health form MCFH-4, the protocol required
by section 191.741, RSMo, in Appendix A of
this rule or any other assessment form which
documents the substance abuse risk status of
each patient. The medical record shall show
documentation of this assessment.
(2) The health care providers designated in
section (1) of this rule shall have all patients
sign the Department of Health form MCFH3 in Appendix B of this rule, or any form
which is signed and dated by the patient and
which states the substances discussed.
(3) To document the offer of service coordination for each pregnant woman at high risk
for substance abuse, the health care providers
designated in section (1) of this rule shall use
the Department of Health form MCFH-2 in
Appendix C of this rule and retain it in the
medical record, or have documentation of the
offer for service coordination and the
woman’s response in the medical record. The
health care provider shall make the referral
for service coordination to the Department of
Health by telephone or in writing.
AUTHORITY: sections 191.725, 191.741 and
191.743, RSMo Supp. 1991.* Original rule
filed Feb. 2, 1994, effective July 30, 1994.
*Original authority: 191.725, RSMo 1991; 191.741, RSMo
1991 and 191.743, RSMo 1991.