The following words and terms when used in this regulation shall have the following meanings unless the context clearly indicates otherwise:

"Administrator" means the person appointed by the governing body as having responsibility for the overall management of a hospital or pediatric health care facility. Job titles may include chief executive officer, director, executive director, office manager, or business manager.

"Anonymous physical evidence recovery kit" or "anonymous PERK" has the same meaning as in § 19.2-11.5 of the Code of Virginia.

"Applicant" means a hospital or pediatric health care facility that does not have an approved plan.

"Approved pediatric transfer facility" means a pediatric health care facility for which a PSAS transfer plan has been approved pursuant to this chapter

"Approved pediatric treatment facility" means a pediatric health care facility for which a PSAS treatment plan has been approved pursuant to this chapter.

"Approved plan" means a SAS treatment plan, PSAS treatment plan, SAS transfer plan, or PSAS transfer plan that has been approved pursuant to this chapter.

"Assent" means the expressed willingness of an individual to participate in an activity.

"Board" means the State Board of Health.

"Clinic" means an outpatient establishment, facility, or department of a hospital where patients are given medical diagnosis, treatment, or advice, including of a specialist nature. This includes a clinic operated by a local health department, but does not include a clinic directly maintained or operated by the federal government.

"Commissioner" means the State Health Commissioner.

"DCLS" means the Division of Consolidated Laboratory Services of the Virginia Department of General Services.

"Department" means the Department of Health.

"Directed plan of correction" means a plan prescribed by the department that details specific corrective actions for cited violations in inspection findings that shall be taken by the regulant to achieve specific outcomes within specific timeframes.

"Emergency contraception" means medication approved by the U.S. Food and Drug Administration that can significantly reduce the risk of pregnancy if taken within 72 hours after sexual assault.

"EMTALA" means the Emergency Medical Treatment and Labor Act (42 USC § 1395dd et seq.)

"Follow-up health care" means any physical examination, laboratory tests to determine the presence of STIs, or appropriate medications, including HIV prophylaxis, provided to a SAS or PSAS by a health care professional within 90 days after the date on which treatment or transfer services pursuant to this chapter are first provided.

"Forensic medical examination" means health care services provided to a SAS or PSAS that include medical history, physical examination, laboratory testing, assessment for drug-facilitated or alcohol-facilitated sexual assault, collection of evidence in accordance with the requirements of Chapter 1.2 (§ 19.2-11.5 et seq.) of Title 19.2 of the Code of Virginia, discharge and follow-up health care planning necessary to ensure the health, safety, and welfare of the SAS or PSAS, and the collection and preservation of evidence that may be used in a criminal proceeding.

"Health care professional" means any person (i) licensed, certified, or registered by a health regulatory board of the Department of Health Professions or (ii) holding a multistate licensure privilege to practice nursing or an applicant for licensure, certification or registration.

"Hospital" means any hospital licensed by the department pursuant to Article 1 (§ 32.1-123 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia.

"Inspector" means an individual employed by the department and designated by the commissioner to conduct inspections, investigations, or evaluations.

"Legal representative" means a PSAS’s parent, guardian, or any person who by order of a court of component jurisdiction has legal custody of the PSAS.

"OLC" means the Office of Licensure and Certification of the department.

"Pediatric health care facility" means a hospital, clinic, or physician's office that provides health care services to pediatric patients.

"Physician’s office" means the office of one or more physicians, surgeons, or nurse practitioners with autonomous practice privileges. A physician’s office does not mean a hospital as defined in § 32.1-123 of the Code of Virginia or a facility directly maintained or operated by the federal government.

"Physical evidence recovery kit" or "PERK" has the same meaning as in § 19.2-11.5 of the Code of Virginia.

"Plan of correction" means a plan developed by a regulant and approved by the department that is the regulant’s written response to inspection findings and details corrective actions to cited violations, who is responsible for implementing corrective actions, how the regulant will prevent reoccurrence, and specifies the date by which the regulant will correct those deficiencies.

"Proposed plan" means a SAS treatment plan, PSAS treatment plan, SAS transfer plan, or PSAS transfer plan that has been submitted pursuant to this chapter to the Department.

"PSAS" means a pediatric survivor of sexual assault who is less than 18 years of age.

"PSAS transfer plan" means a plan for the transfer of a PSAS to an approved pediatric treatment facility that includes PSAS transfer services and the written agreement of an approved pediatric treatment facility to accept transfer.

"PSAS transfer services" means an appropriate medical examination and such stabilizing treatment as may be necessary prior to the transfer of a PSAS from an approved pediatric transfer facility to an approved pediatric treatment facility in accordance with the provisions of a PSAS transfer plan approved by the department.

"PSAS treatment plan" means a plan for the treatment of a PSAS at an approved pediatric treatment facility that includes PSAS treatment services and the storage, retention, and dissemination of photographic evidence.

"PSAS treatment services" means a forensic medical examination and other health care services provided to a PSAS by an approved pediatric treatment facility in accordance with this chapter.

"Rape crisis center" has the same meaning as ascribed in 34 USC § 12291(a)(25).

"Regulant" means a treatment hospital, transfer hospital, approved pediatric treatment facility, or approved pediatric transfer facility that has a PSAS treatment plan, PSAS transfer plan, SAS treatment plan, or SAS transfer plan approved by the department.

"SAS" means a survivor of sexual assault who is 18 years of age or older.

"Sexual assault forensic examiner" or "SAFE" means a sexual assault nurse examiner, physician, physician assistant, nurse practitioner, or registered nurse who has completed training that meets or is substantially similar to the Sexual Assault Nurse Examiner Education Guidelines established by the International Association of Forensic Nurses or its successor.

"SAS transfer plan" means a plan for the transfer of a SAS to a treatment hospital that includes SAS transfer services and the written agreement of a treatment hospital to accept transfer.

"SAS transfer services" means an appropriate medical examination and such stabilizing treatment as may be necessary prior to the transfer of a SAS from a transfer hospital to a treatment hospital in accordance with the provisions of a SAS transfer plan approved by the department.

"SAS treatment plan" means a plan for the treatment of a SAS at a treatment hospital that includes SAS treatment services and the storage, retention, and dissemination of photographic evidence.

"SAS treatment services" means a forensic medical examination and other health care services provided to a SAS by a treatment hospital in accordance with this chapter.

"STI" means sexually transmitted infection.

"Transfer hospital" means a hospital with a SAS transfer plan approved by the department.

"Transportation service" means transportation provided to a SAS or PSAS who is transferred from a transfer hospital, treatment hospital, approved pediatric treatment facility, or approved pediatric transfer facility to a treatment hospital or approved pediatric treatment facility pursuant to a SAS transfer plan or PSAS transfer plan approved in accordance with this chapter.

"Treatment hospital" means a hospital with a SAS treatment plan approved by the department to provide SAS treatment services to a SAS who presents with a complaint of sexual assault within the previous seven days or who have disclosed past sexual assault by a specific individual and were in the care of that individual within the previous seven days.

A. A hospital shall:

1. Develop either a:

a. SAS treatment plan that meets the requirements of Part II (12VAC5-416-110 et seq.) of this chapter; or

b. SAS transfer plan that meets the requirements of Part IV (12VAC5-416-350 et seq.) of this chapter; and

2. Submit any such plan to the department as specified by 12VAC5-416-30.

B. A hospital may not provide SAS treatment services or SAS transfer services unless the department has granted approval of the proposed plan, except that a hospital may provide SAS treatment services or SAS transfer services prior to approval of its initial proposed plan if the hospital was providing one or more of these services on or before July 1, 2023.

C. A pediatric health care facility shall:

1. Develop either a:

a. PSAS treatment plan that meets the requirements of Part III (12VAC5-416-230 et seq.) of this chapter; or

b. PSAS transfer plan that meets the requirements of Part V (12VAC5-416-390 et seq.) of this chapter; and

2. Submit any such plan to the department as specified by 12VAC5-416-30.

D. A pediatric health care facility may not provide PSAS treatment services or PSAS transfer services unless the department has granted approval of the proposed plan, except that a pediatric health care facility may provide PSAS treatment services or PSAS transfer services prior to approval of its initial proposed plan if the pediatric health care facility was providing one or more of these services on or before July 1, 2023.

A. An applicant shall transmit to the OLC its proposed plan by electronic mail or postal mail no sooner than 60 calendar days before the applicant’s desired effective date for the proposed plan.

B. The OLC shall consider a proposed plan submission to be complete when all components of the proposed plan are included in the submission. The OLC may deny approval to an applicant whose proposed plan has been incomplete for more than 180 calendar days.

C. An applicant may withdraw a proposed plan at any time prior to the OLC’s determination of whether to approve the proposed plan by notifying the OLC in writing of its intent to withdraw.

D. The OLC shall notify the applicant of the outcome of its review in writing no more than 30 calendar days after receipt of the proposed plan. If the OLC denies approval of the proposed plan, the OLC shall provide a written statement setting forth the reasons for denial.

E. The OLC shall grant the administrator or his designee the opportunity to revise and resubmit a proposed plan that the OLC initially determines to be unacceptable. The administrator or his designee shall resubmit the proposed plan to the OLC no more than 15 calendar days after the OLC has notified the administrator or his designee pursuant to subsection D.

A. A regulant shall:

1. Review its approved plan or plans at least triennially with the administrator or his designee and appropriate clinical staff; and

2. Document in writing the triennial review process and any recommendations for updates.

B. If a regulant determines that pursuant to subsection A that an update is needed to an approved plan, it shall submit the proposed plan to the OLC in writing no less than 60 days in advance of the proposed plan’s implementation date.

C. The OLC shall notify the regulant of the outcome of its review in writing no more than 30 calendar days after receipt of the proposed plan. If the OLC denies approval of the proposed plan, the OLC shall provide a written statement setting forth the reasons for denial.

D. The OLC shall grant the administrator or his designee the opportunity to revise and resubmit a proposed plan that the OLC initially determines to be unacceptable. The administrator or his designee shall resubmit the proposed plan to the OLC no more than 15 calendar days after the OLC has notified the administrator or his designee pursuant to subsection C of this section.

A. A treatment hospital proposing to transition to a transfer hospital shall:

1. Notify the OLC in writing no less than 60 calendar days in advance of transitioning to a transfer hospital; and

2. Submit a SAS transfer plan with its notification.

B. A transfer hospital proposing to transition to a treatment hospital shall:

1. Notify the OLC in writing no less than 60 calendar days in advance of transitioning to a treatment hospital; and

2. Submit a SAS treatment plan with its notification.

C. An approved pediatric treatment facility proposing to transition to an approved pediatric transfer facility shall:

1. Notify the OLC in writing no less than 60 calendar days in advance of transitioning to an approved pediatric transfer facility; and

2. Submit a PSAS transfer plan with its notification.

D. An approved pediatric transfer facility proposing to transition to an approved pediatric treatment facility shall:

1. Notify the OLC in writing no less than 60 calendar days in advance of transitioning to an approved pediatric treatment facility; and

2. Submit a PSAS treatment plan with its notification.

A. The OLC shall investigate complaints regarding alleged violations of this chapter or Article 8 (§ 32.1-162.15:2 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia. The OLC shall determine if an investigation requires an on-site inspection. In making this determination, the OLC shall consider several factors, to include:

1. If the complainant has first-hand knowledge of the alleged incident;

2. The regulatory history of the regulant or applicant, including the number of substantiated prior complaints;

3. If the OLC has recently inspected the regulant or applicant, and if the incident would have been observed during the prior inspection; and

4. The nature of the complaint, including degree of potential serious harm to SASs, PSASs, or other patients.

B. The OLC may request records from a regulant or applicant to assist in making a determination pursuant to subsection A. The regulant or applicant shall provide the requested records no more than 5 business days after the OLC makes the request.

C. When the investigation is complete, the OLC shall notify the complainant, if known, and the regulant or applicant in writing of the findings of the investigation.

D. For any violation cited during a complaint investigation, the administrator or his designee shall submit a plan of correction in accordance with 12VAC5-416-80.

A. The OLC may combine an inspection of a treatment hospital or transfer hospital with an inspection conducted pursuant to § 32.1-126 of the Code of Virginia.

B. A regulant or applicant shall make available to the inspector any requested records and shall allow access to interview the agents, employees, contractors, and any person under the regulant's or applicant’s control, direction, or supervision.

1. Upon request of the inspector after the inspector's arrival:

a. The treatment hospital or transfer hospital shall provide to the inspector a list of all SASs it treated or transferred in the previous 12 months; and

b. The approved pediatric treatment facility or approved pediatric transfer facility shall provide to the inspector a list of all PSASs it treated or transferred in the previous 12 months.

2. If copies of records are removed from the premises, the regulant or applicant may redact names and addresses of patients contained in such records prior to removal.

3. The inspector shall inform the regulant or applicant that it may redact names and addresses of patients prior to the inspector removing copies of records from the premises.

C. The OLC shall provide a written inspection report to the administrator. If the OLC cites one or more violations in the written inspection report, the administrator or his designee shall submit a plan of correction in accordance with 12VAC5-416-80.

A. Upon receipt of a written inspection report, the administrator or his designee shall prepare a written plan of correction addressing each violation cited at the time of inspection.

B. The administrator shall submit to the OLC a written plan of correction no more than 15 working days after receipt of the inspection report. The plan of correction shall contain for each violation cited:

1. A description of the corrective action or actions to be taken and the position title of the employees to implement the corrective action;

2. The expected correction date, not to exceed 45 working days from the exit date of the inspection; and

3. A description of the measures implemented to prevent a recurrence of the violation.

C. A regulant or applicant shall ensure that the person responsible for the validity of the plan of correction signs, dates, and indicates their title on the plan of correction.

D. The OLC shall:

1. Notify the administrator or his designee if the OLC determines any item in the plan of correction is unacceptable; and

2. Grant the administrator or his designee an opportunity to revise and resubmit a plan of correction that the OLC initially determines to be unacceptable. If the administrator or his designee revises and resubmits the plan of correction, the revision is due to the OLC no more than 15 working days after the OLC has notified the administrator or his designee pursuant to subdivision 1 of this subsection.

E. The department may impose a directed plan of correction when a regulant or applicant:

1. Has one or more violations that warrant directing the regulant or applicant to take specific actions; or

2. Has been cited for the same violation in the most recent prior inspection.

F. Upon request of the OLC, a regulant or applicant shall produce evidence that all or part of a plan of correction or directed plan of correction has been implemented. The OLC may conduct an inspection to verify any portion of a plan of correction or directed plan of correction.

G. The administrator or his designee shall ensure the plan of correction or directed plan of correction is implemented and monitored so that compliance is maintained.

A. The commissioner may authorize a variance only to a specific standard or requirement of this chapter, not to regulations of another agency or to any standards or requirements in federal, state, or local laws. A variance shall:

1. Require advance written approval from the commissioner;

2. Not be extended to general applicability; and

3. Not endanger the health, safety, or well-being of SASs, PSASs, other patients, or the public.

B. A regulant may request a variance at any time. The request for a variance shall describe in writing:

1. How compliance with the current standard or requirement is economically burdensome and constitutes impractical hardship unique to the regulant; and

2. Proposed alternatives to meet the purpose of the standard or requirement that will ensure the health, safety, and well-being of SASs, PSASs, other patients, and the public.

C. The regulant may withdraw a request for a variance at any time by notifying the OLC in writing.

D. The commissioner shall notify the regulant in writing of the commissioner's decision on the variance request. If granted, the commissioner may attach conditions to a variance that, in the sole judgment of the commissioner, protects the health, safety, and well-being of SASs, PSASs, other patients, and the public.

E. The commissioner may rescind or modify a variance if:

1. The impractical hardship unique to the regulant changes or no longer exists;

2. Additional information becomes known that alters the basis for the original decision, including if the regulant failed to comply with the standard or requirement prior to receiving a variance;

3. The regulant fails to meet any conditions attached to the variance; or

4. Results of the variance jeopardize the health, safety, or well-being of SASs, PSASs, other patients, and the public.

F. If a variance is denied, expires, or is rescinded, the commissioner or his designee shall enforce the standard or requirement to which the variance was granted.

G. The administrator shall develop and document procedures for monitoring the implementation of any variance.

A. A hospital or pediatric health care facility may not violate the provisions of this chapter or Article 8 (§ 32.1-162.15:2 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia.

B. The commissioner may:

1. For each violation of subsection A of this section by a hospital:

a. Deny, revoke, or suspend the license to operate the hospital in accordance with the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia);

b. Refer the hospital for criminal prosecution pursuant to subsection A of § 32.1-27 of the Code of Virginia; or

c. Petition an appropriate court for an injunction, mandamus, or other appropriate remedy or imposition of a civil penalty against the hospital pursuant to subsection B or C of § 32.1-27 of the Code of Virginia; and

2. For each violation of subsection A of this section by a pediatric health care facility:

a. Report the health care professionals involved in the violation to the appropriate health regulatory board in the Department of Health Professions;

b. Refer the pediatric health care facility for criminal prosecution pursuant to subsection A of § 32.1-27 of the Code of Virginia; or

c. Petition an appropriate court for an injunction, mandamus, or other appropriate remedy or imposition of a civil penalty against the pediatric health care facility pursuant to subsection B or C of § 32.1-27 of the Code of Virginia.

C. If the commissioner determines that a violation of subsection A of this section by a hospital jeopardizes the health or safety of patients, the commissioner may immediately revoke, suspend, or deny a license. Suspension of a license shall in all cases be for an indefinite time.

D. Upon receipt of a completed application and a nonrefundable service charge prescribed by § 32.1-130, the commissioner may issue a new license to the hospital that has had its license revoked if the commissioner determines that:

1. The conditions upon which revocation was based have been corrected; and

2. The hospital is in compliance with this chapter, Article 8 (§ 32.1-162.15:2 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia, and all other applicable state and federal law and regulations.

E. Upon receipt of a completed application, the commissioner may partially or completely restore a suspended license to the hospital if the commissioner determines that:

1. The conditions upon which suspension was based have been completely or partially corrected; and

2. The interests of the public will not be jeopardized by resumption of operation.

F. The hospital shall submit evidence relevant to subdivisions D 1, D 2, E 1, and E 2 of this section that is satisfactory to the commissioner or his designee. The commissioner or his designee may conduct an inspection prior to making a determination.

G. The commissioner may not require an additional fee for restoring a license pursuant to subsection E of this section.

A treatment hospital shall ensure that its SAS treatment plan meets the minimum standards established in Part II (12VAC5-416-110 et seq.) of this chapter and includes the provision of a forensic medical examination to a SAS when ordered by a health care professional and with the consent of the SAS.

A. A treatment hospital shall ensure that at least one SAFE is available during all hours of operation in person.

B. A treatment hospital shall ensure that health care professionals providing services in its emergency department annually complete training developed and made available by the department on the topics of:

1. Sexual assault;

2. Detection of sexual assault;

3. Provision of services for SASs and PSASs; and

4. Collection of evidence in cases involving alleged sexual assault.

C. If the training specified in subsection B is not available, a treatment hospital shall substitute the training for continuing education provided by the treatment hospital or by third parties on the same topics identified in this subsection.

A. Except as provided in § 54.1-2970.1 of the Code of Virginia, a treatment hospital shall obtain informed consent from the SAS for:

1. Medical evaluation and treatment, including the administration of prophylaxis and emergency contraception, the need for follow-up care, and medical advocacy services and counseling;

2. Reporting the alleged crime;

3. Performing a forensic medical examination;

4. Photodocumentation;

5. Evidence collection; and

6. Transferral of evidence to law enforcement.

B. In obtaining informed consent for evidence collection, a treatment hospital shall inform the SAS that the ability to collect viable evidence declines as time elapses.

C. Except as provided in § 54.1-2970.1 of the Code of Virginia, a treatment hospital shall obtain informed consent in writing from the SAS to the maximum extent practicable, provided that if it cannot obtain informed consent in writing, it shall:

1. Obtain oral informed consent from the SAS; and

2. Document in the SAS's medical records why informed written consent was not obtained.

D. A treatment hospital shall maintain documentation of compliance with this section in the SAS’s medical records.

A treatment hospital shall ensure that all findings of the forensic medical examination are comprehensively and objectively documented.

A. A treatment hospital shall document specific information related to the alleged sexual assault, including:

1. Time, date, and place of the alleged sexual assault;

2. The SAS’s ability to give consent to the reported sexual activity;

3. Alleged use of force, threats of force, weapons, coercion, drugs, or alcohol to facilitate the sexual assault;

4. Types or means of the alleged sexual assault;

5. Number of alleged assailants;

6. The occurrence of penetration of any body part with a penis, finger, or other object;

7. Whether the SAS voided, removed or inserted a tampon, douched, wiped or cleaned the genital area, bathed, showered, gargled, brushed teeth, smoked, ate, drank, chewed gum, changed clothes, or took medications after the alleged sexual assault;

8. Whether the SAS bit an alleged assailant or was bitten by the alleged assailant; and

9. Any other relevant information as determined by the health care professional who is providing care.

B. To the maximum extent practicable, a treatment hospital shall ensure that:

1. Information documented pursuant to subsection A includes direct quotations from the SAS describing the alleged sexual assault; and

2. Information solicited pursuant to subsection A is through the use of open-ended, non-leading questions that encourage free narrative from the SAS.

C. A treatment hospital shall document the SAS’s medical history, including:

1. Use of contraceptives and which type the SAS uses;

2. Last menstrual period, if applicable;

3. Last consensual intercourse;

4. Pregnancy status, if applicable;

5. History of anogenital surgery; and

6. Any other relevant information as determined by the health care professional who is providing care.

A. A treatment hospital shall ensure that health care professionals conducting the forensic medical examination or collecting the PERK:

1. Are specially educated and clinically trained to perform these tasks;

2. Clearly document all findings; and

3. Prevent cross contamination of evidence by changing gloves whenever cross contamination could occur.

B. A treatment hospital shall ensure that in conducting a forensic medical examination:

1. A clean sheet is placed on the floor to be a barrier for the collection paper before the SAS undresses;

2. A SAS is permitted to remove and place each piece of clothing being collected in a separate paper bag; and

3. A health care professional:

a. Conducts an appropriate evaluation to determine the SAS’s risk of infection or STIs, including HIV, resulting from the alleged sexual assault;

b. Documents the presence of any physical injury, biological evidence, or foreign debris;

c. Photographs and recovers any trace evidence, including sand, soil, leaves, grass, and biological secretions;

d. Documents the location on the body from which trace evidence is collected;

e. Performs appropriate photodocumentation of collection sites and injuries before evidence collection;

f. Recovers debris, moist secretions, and dry secretions in accordance with best practices; and

g. Documents the location, size, and complete description of any trauma, including bite marks, strangulation injuries, or areas of point tenderness, including those occurring around the mouth, breasts, thighs, wrists, upper arms, legs, back, and anogenital region.

C. If drug-facilitated or alcohol-facilitated sexual assault is suspected, a treatment hospital shall ensure that blood or urine or both are collected with the consent of the SAS.

D. A treatment hospital shall ensure that health care professionals performing a forensic medical examination conduct all necessary laboratory testing.

A. A treatment hospital shall ensure that the chain of custody is maintained for all samples collected during the forensic medical examination.

B. A treatment hospital shall ensure that all specimens are properly sealed, initialed, and labeled with:

1. The name of the treatment hospital;

2. The SAS’s name and patient identification number;

3. Date and time of specimen collection;

4. Description and location of the body part of the origin of the specimen;

5. The name and signature of the person collecting the specimen; and

6. Any other information that may be required by law.

C. A treatment hospital shall ensure that all transfer in the custody of evidence are documented in a written record of:

1. The name, title, and signature of the person receiving the evidence; and

2. Date and time of transfer.

D. A treatment hospital may designate a secured location to store evidence and maintain chain of custody, provided the treatment hospital has consulted with local law enforcement on the location, security, and policies and procedures for storage.

A. A treatment hospital shall provide appropriate oral and written information regarding:

1. The possibility of infection or STIs, including HIV resulting from the alleged sexual assault;

2. Accepted medical procedures and medications for the prevention or treatment of infection or STIs;

3. The indications, contraindications, and potential risks of medical procedures or medications for the prevention or treatment of infection or STIs;

4. The possibility of pregnancy resulting from the alleged sexual assault;

5. Medically and factually accurate oral and written information about emergency contraception;

6. The indications, contraindications, and potential risks associated with the use of emergency contraception; and

7. The availability of emergency contraception for SASs.

B. Unless the prophylaxis is medically contraindicated or the SAS refuses to consent to the administration of prophylaxis, the treatment hospital shall provide, or arrange for, the administration to a SAS of prophylaxis for STIs in accordance with the:

1. Sexually Transmitted Infections Treatment Guidelines, July 2021 (U.S. Centers for Disease Control and Prevention); and

2. Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, January 2020 (U.S. Centers for Disease Control and Prevention).

C. Unless emergency contraceptive is medically contraindicated or the SAS refuses to consent to the administration of emergency contraceptive, the treatment hospital shall provide, or arrange for, the administration to a SAS of emergency contraceptive.

D. The provisions of subsection C of this section may not apply to a treatment hospital operated under the auspices of a religious institution objecting to the administration or arrangement of administration for emergency contraceptive on religious grounds.

A. If a SAS who undergoes a forensic medical examination elects not to report the offense to law enforcement, the treatment hospital shall ensure that the health care professional informs the SAS:

1. The PERK will be forwarded to DCLS for storage as an anonymous PERK;

2. The anonymous PERK will be stored by DCLS;

3. The SAS has the right to object to the destruction of the anonymous PERK;

4. How the SAS can have the anonymous PERK released to a law enforcement agency at a later date; and

5. The rights of the SAS pursuant to § 19.2-11.11 of the Code of Virginia.

B. The treatment hospital shall ensure that the health care professional forwards the anonymous PERK to DCLS in accordance with the policies and procedures established by DCLS.

A. A treatment hospital shall:

1. Enter into a memorandum of understanding with at least one rape crisis center; and

2. Adopt procedures to ensure compliance with mandatory reporting requirements pursuant to §§ 63.2-1509 and 63.2-1606 of the Code of Virginia.

B. A treatment hospital shall review its memorandums of understanding with rape crisis centers at least triennially and shall document the outcome of this review in writing.

C. A treatment hospital shall provide written and oral information about medical advocacy services provided by a rape crisis center with which the hospital has entered into a memorandum of understanding pursuant to this section.

A. A treatment hospital shall ensure that a SAS is provided with oral and written medical discharge instructions that include:

1. A summary of the examination, which includes:

a. Evidence collected;

b. Tests conducts;

c. Medication prescribed or provided;

d. Information provided during the examination; and

e. Treatment received;

2. Medication doses to be taken, if any;

3. Recommended examinations and laboratory tests to determine the presence or absence of STIs;

4. Follow-up care related to HIV prophylaxis;

5. Any other follow-up health care appointments needed or scheduled; and

6. Referrals.

B. A treatment hospital shall provide to a SAS contact information and the hours of operation for local advocacy programs.

C. A treatment hospital shall inform a SAS in writing that the SAS is not required to disclose the alleged sexual assault to other health care professionals to receive follow-up health care.

D. The follow-up health care appointments that a treatment hospital may schedule or recommend to a SAS include:

1. For patients with evidence of acute trauma, a short-term follow-up appointment to reexamine and document the development of visible findings and photograph areas of injury, and an exam two to four weeks later to document resolution of findings or healing of injuries; and

2. For all patients, a repeat examination for STIs in accordance with the policies and procedures of the treatment hospital and with best practices.

A treatment hospital shall report to the department by December 1 of each year:

1. The total number of SASs to whom a forensic medical examination was provided; and

2. The total number of PERKs offered and completed.

An approved pediatric treatment facility shall ensure that its PSAS treatment plan meets the minimum standards established in Part III (12VAC5-416-230 et seq.) of this chapter and includes the provision of a forensic medical examination to a PSAS when ordered by a health care professional and with the assent of the PSAS and consent of the PSAS’s legal representative.

An approved pediatric treatment facility shall ensure that at least one SAFE is available during all hours of operation in person.

A. An approved pediatric treatment facility:

1. Shall ensure that all necessary and reasonable efforts are made to obtain informed assent of PSASs who are six years of age or older prior to and during treatment, unless the attending health care professional reasonably believes that the PSAS lacks the developmental and linguistic capacity to give informed assent;

2. May obtain informed assent of PSASs who are less than six years of age prior to and during treatment, if the attending health care professional reasonably believes that the PSAS has the developmental and linguistic capacity to give informed assent; and

3. Shall ensure that the attending health care professional documents in the PSAS’s medical record the informed assent or the attending health care professional’s judgment that the PSAS lacks the developmental and linguistic capacity to give informed assent.

B. Except as provided in § 54.1-2970.1 of the Code of Virginia, an approved pediatric health care facility shall obtain informed consent from the PSAS’s legal representative for:

1. Medical evaluation and treatment, including the administration of prophylaxis and emergency contraception, the need for follow-up care, and medical advocacy services and counseling;

2. Reporting the alleged crime;

3. Performing a forensic medical examination;

4. Photodocumentation;

5. Evidence collection; and

6. Transferral of evidence to law enforcement.

C. In obtaining informed consent for evidence collection, an approved pediatric treatment facility shall inform the PSAS and the PSAS’s legal representative that the ability to collect viable evidence declines as time elapses.

D. Except as provided in § 54.1-2970.1 of the Code of Virginia, an approved pediatric treatment facility shall obtain informed consent in writing from the PSAS's legal representative to the maximum extent practicable, provided that if it cannot obtain informed consent in writing, it shall:

1. Obtain oral informed consent from the PSAS's legal representative; and

2. Document in the PSAS's medical records why informed written consent was not obtained.

E. An approved pediatric treatment facility shall maintain documentation of compliance with this section in the PSAS’s medical records.

F. If a PSAS refuses to grant informed assent and the PSAS’s legal representative gives informed consent, an approved pediatric treatment facility that is a hospital:

1. May not proceed with PSAS treatment services and shall only screen, treat, and stabilize the PSAS in accordance with EMTALA; and

2. May attempt to obtain a PSAS’s informed assent at a later time.

G. If a PSAS refuses to grant informed assent and the PSAS’s legal representative gives informed consent, an approved pediatric treatment facility that is not a hospital:

1. May not proceed with PSAS treatment services and shall only screen or treat serious medical injury, pain, or trauma to stabilize the PSAS; and

2. May attempt to obtain a PSAS’s informed assent at a later time.

An approved pediatric treatment facility shall ensure that all findings of the forensic medical examination are comprehensively and objectively documented.

A. An approved pediatric treatment facility shall document specific information related to the alleged sexual assault, including:

1. Time, date, and place of the alleged sexual assault;

2. The PSAS’s ability to give consent to the reported sexual activity;

3. Alleged use of force, threats of force, weapons, coercion, drugs, or alcohol to facilitate the sexual assault;

4. Types or means of the alleged sexual assault;

5. Number of alleged assailants;

6. The occurrence of penetration of any body part with a penis, finger, or other object;

7. Whether the PSAS voided, removed or inserted a tampon, douched, wiped or cleaned the genital area, bathed, showered, gargled, brushed teeth, smoked, ate, drank, chewed gum, changed clothes, or took medications after the alleged sexual assault;

8. Whether the PSAS bit an alleged assailant or was bitten by the alleged assailant; and

9. Any other relevant information as determined by the health care professional who is providing care.

B. To the maximum extent practicable, an approved pediatric treatment facility shall ensure that:

1. Information documented pursuant to subsection A includes direct quotations from the PSAS describing the alleged sexual assault; and

2. Information solicited pursuant to subsection A is through the use of open-ended, non-leading questions that encourage free narrative from the PSAS.

C. An approved pediatric treatment facility shall document the PSAS’s medical history, including:

1. Use of contraceptives and which type the PSAS uses;

2. Last menstrual period, if applicable;

3. Last consensual intercourse;

4. Pregnancy status, if applicable;

5. History of anogenital surgery; and

6. Any other relevant information as determined by the health care professional who is providing care.

A. An approved pediatric treatment facility shall ensure that health care professionals conducting the forensic medical examination or collecting the PERK:

1. Are specially educated and clinically trained to perform these tasks;

2. Clearly document all findings; and

3. Prevent cross contamination of evidence by changing gloves whenever cross contamination could occur.

B. An approved pediatric treatment facility shall ensure that in conducting a forensic medical examination:

1. A clean sheet is placed on the floor to be a barrier for the collection paper before the PSAS undresses;

2. A PSAS is permitted to remove and place each piece of clothing being collected in a separate paper bag; and

3. A health care professional:

a. Conducts an appropriate evaluation to determine the PSAS’s risk of infection or STIs, including HIV, resulting from the alleged sexual assault;

b. Documents the presence of any physical injury, biological evidence, or foreign debris;

c. Photographs and recovers any trace evidence, including sand, soil, leaves, grass, and biological secretions;

d. Documents the location on the body from which trace evidence is collected;

e. Performs appropriate photodocumentation of collection sites and injuries before evidence collection;

f. Recovers debris, moist secretions, and dry secretions in accordance with best practices; and

g. Documents the location, size, and complete description of any trauma, including bite marks, strangulation injuries, or areas of point tenderness, including those occurring around the mouth, breasts, thighs, wrists, upper arms, legs, back, and anogenital region.

C. If drug-facilitated or alcohol-facilitated sexual assault is suspected, an approved pediatric treatment facility shall ensure that blood or urine or both are collected with the assent of the PSAS.

D. An approved pediatric treatment facility shall ensure that health care professionals performing a forensic medical examination conduct all necessary laboratory testing.

A. An approved pediatric treatment facility shall ensure that the chain of custody is maintained for all samples collected during the forensic medical examination.

B. An approved pediatric treatment facility shall ensure that all specimens are properly sealed, initialed, and labeled with:

1. The name of the approved pediatric treatment facility;

2. The PSAS’s name and patient identification number;

3. Date and time of specimen collection;

4. Description and location of the body part of the origin of the specimen;

5. The name and signature of the person collecting the specimen; and

6. Any other information that may be required by law.

C. An approved pediatric treatment facility shall ensure that all transfers in the custody of evidence are documented in a written record of:

1. The name, title, and signature of the person receiving the evidence; and

2. Date and time of transfer.

D. An approved pediatric treatment facility may designate a secured location to store evidence and maintain chain of custody, provided the approved pediatric treatment facility has consulted with local law enforcement on the location, security, and policies and procedures for storage.

A. An approved pediatric treatment facility shall provide appropriate oral and written information regarding:

1. The possibility of infection or STIs, including HIV resulting from the alleged sexual assault;

2. Accepted medical procedures and medications for the prevention or treatment of infection or STIs;

3. The indications, contraindications, and potential risks of medical procedures or medications for the prevention or treatment of infection or STIs;

4. The possibility of pregnancy resulting from the alleged sexual assault;

5. Medically and factually accurate oral and written information about emergency contraception;

6. The indications, contraindications, and potential risks associated with the use of emergency contraception; and

7. The availability of emergency contraception for PSASs.

B. Unless the prophylaxis is medically contraindicated, the PSAS refuses to assent to the administration of prophylaxis, or the PSAS’s legal representative refuses to consent to the administration of prophylaxis, the approved pediatric treatment facility shall provide, or arrange for, the administration to a PSAS of prophylaxis for STIs in accordance with the:

1. Sexually Transmitted Infections Treatment Guidelines, July 2021 (U.S. Centers for Disease Control and Prevention); and

2. Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, January 2020 (U.S. Centers for Disease Control and Prevention).

C. Unless emergency contraceptive is medically contraindicated, the PSAS refuses to assent to the administration of emergency contraceptive, or the PSAS’s legal representative refuses to consent to the administration of emergency contraceptive, the approved pediatric treatment facility shall provide, or arrange for, the administration to a PSAS of emergency contraceptive.

D. The provisions of subsection C of this section may not apply to an approved pediatric treatment facility operated under the auspices of a religious institution objecting to the administration or arrangement of administration for emergency contraceptive on religious grounds.

A. If a PSAS who undergoes a forensic medical examination elects not to report the offense to law enforcement, the approved pediatric treatment facility shall ensure the health care professional informs the PSAS or the PSAS’s legal representative:

1. The PERK will be forwarded to DCLS for storage as an anonymous PERK;

2. The anonymous PERK will be stored by DCLS;

3. The PSAS has the right to object to the destruction of the anonymous PERK;

4. How the PSAS can have the anonymous PERK released to a law enforcement agency at a later date; and

5. The rights of the PSAS and PSAS’s parent or guardian under § 19.2-11.11 of the Code of Virginia.

B. The approved pediatric treatment facility shall ensure the health care professional forwards the anonymous PERK to DCLS in accordance with the policies and procedures established by DCLS.

A. An approved pediatric treatment facility shall:

1. Enter into a memorandum of understanding with at least one rape crisis center; and

2. Adopt procedures to ensure compliance with mandatory reporting requirements pursuant to § 63.2-1509 of the Code of Virginia.

B. An approved pediatric treatment facility shall review its memorandums of understanding with rape crisis centers at least triennially and shall document the outcome of this review in writing.

C. An approved pediatric treatment facility shall provide written and oral information about medical advocacy services provided by a rape crisis center with which the approved pediatric treatment facility has entered into a memorandum of understanding pursuant to this section.

A. An approved pediatric treatment facility shall ensure that a PSAS and the PSAS’s legal representative is provided with oral and written medical discharge instructions that include:

1. A summary of the examination, which includes:

a. Evidence collected;

b. Tests conducts;

c. Medication prescribed or provided;

d. Information provided during the examination; and

e. Treatment received;

2. Medication doses to be taken, if any;

3. Recommended examinations and laboratory tests to determine the presence or absence of STIs;

4. Follow-up care related to HIV prophylaxis;

5. Any other follow-up health care appointments needed or scheduled; and

6. Referrals.

B. An approved pediatric treatment facility shall provide to a PSAS and the PSAS’s legal representative contact information and the hours of operation for local advocacy programs.

C. An approved pediatric treatment facility shall inform a PSAS and the PSAS’s legal representative in writing that the PSAS is not required to disclose the alleged sexual assault to other health care professionals to receive follow-up health care.

D. The follow-up health care appointments that an approved pediatric treatment facility may schedule or recommend to a PSAS and the PSAS’s legal representative include:

1. For patients with evidence of acute trauma, a short-term follow-up appointment to reexamine and document the development of visible findings and photograph areas of injury, and an exam two to four weeks later to document resolution of findings or healing of injuries; and

2. For all patients, a repeat examination for STIs in accordance with the policies and procedures of the approved pediatric treatment facility and with best practices.

A. In cases in which an approved pediatric treatment facility is not able to provide the full range of treatment services required by Part III (12VAC5-416-230 et seq.) of this chapter, the PSAS treatment plan shall include:

1. The specific PSAS treatment services that the approved pediatric treatment facility will provide for a PSAS;

2. Provisions for PSAS transfer services for a PSAS; and

3. The written agreement of an approved pediatric treatment facility to accept transfer of a PSAS who cannot be treated by the originating approved pediatric treatment facility.

B. If the approved pediatric treatment facility does not provide services 24 hours per day, seven days per week, it shall:

1. Inform the public regarding the need to seek an alternative source of treatment, including emergency medical services; and

2. Post conspicuous signage on its premises, including in an area readily visible and accessible to the public from the exterior of the approved pediatric treatment facility.

C. An approved pediatric treatment facility’s provision of PSAS transfer services pursuant to subdivision A 2 of this section shall comply with Part V (12VAC5-416-390 et seq.) of this chapter.

A transfer hospital shall ensure that its SAS transfer plan meets the minimum standards established in Part IV (12VAC5-416-350 et seq.) of this chapter.

A. A transfer hospital shall screen patients for sexual assault, as deemed appropriate by a qualified health care professional in accordance with EMTALA.

B. A transfer hospital shall adopt procedures to ensure compliance with mandatory reporting requirements pursuant to §§ 63.2-1509 and 63.2-1606 of the Code of Virginia.

A transfer hospital shall ensure that a SAS is screened, treated, and stabilized in accordance with EMTALA prior to initiating any transfer.

A. A transfer hospital shall comply with EMTALA in coordinating transfer with a receiving treatment hospital.

B. A transfer hospital shall communicate with the receiving treatment hospital to confirm the availability of a SAFE to provide SAS treatment services to ensure minimal or no delay in the provision of a forensic medical examination.

C. A transfer hospital shall provide a SAS with:

1. Written and oral information about:

a. Emergency contraception;

b. The indications, contraindications, and potential risks associated with the use of emergency contraception; and

c. The availability of emergency contraception; and

2. A copy of the SAS's medical record from the encounter, as appropriate.

An approved pediatric transfer facility shall ensure that its PSAS transfer plan meets the minimum standards established in Part V (12VAC5-416-390 et seq.) of this chapter.

A. An approved pediatric transfer facility that is a hospital shall screen pediatric patients for sexual assault, as determined to be appropriate by a qualified health care professional in accordance with EMTALA.

B. An approved pediatric transfer facility that is not a hospital shall:

1. Screen pediatric patients for sexual, as determined to be appropriate by a qualified health care professional; and

2. Have a written policy and procedure specifying the qualifications of the health care professionals at the approved pediatric transfer facility who may make the determination specified in subdivision B 1 of this section.

C. An approved pediatric transfer facility shall adopt procedures to ensure compliance with mandatory reporting requirements pursuant to § 63.2-1509 of the Code of Virginia.

D. If an approved pediatric treatment facility does not provide services 24 hours per day, seven days per week, it may not refuse to screen a PSAS solely on the basis that the PSAS arrived before the impending cessation of its daily operations. For the purposes of this subsection, "daily operations" means the publicly posted hours that the approved pediatric treatment facility provides services to patients.

A. An approved pediatric transfer facility that is a hospital shall ensure that a PSAS is screened, treated, and stabilized in accordance with EMTALA prior to initiating any transfer.

B. An approved pediatric transfer facility that is not a hospital shall ensure that a PSAS is screened, treated, and stabilized prior to initiating any transfer.

C. If an approved pediatric transfer facility reasonably believes that the PSAS’s legal representative has abused or neglected the PSAS, the approved pediatric transfer facility shall consult with child protective services or local law enforcement immediately.

D. If the PSAS’s legal representative refuses to grant consent to treatment of an acute injury, the approved pediatric transfer facility shall consult with child protective services or local law enforcement immediately.

A. An approved pediatric transfer facility that is a hospital shall comply with EMTALA in coordinating transfer with a receiving approved pediatric treatment facility.

B. An approved pediatric transfer facility shall communicate with the receiving approved pediatric treatment facility to confirm the availability of a SAFE to provide PSAS treatment services to ensure minimal or no delay in the provision of a forensic medical examination.

C. When making a transfer, the approved pediatric transfer facility shall:

1. Ensure the transfer does not unduly burden the PSAS;

2. Take precautions to minimize the loss of forensic evidence; and

3. Provide a copy of the PSAS’s records, including reports of any treatment administered or testing performed, to the approved pediatric treatment facility.

A. Prior to initiating a transfer, an approved pediatric transfer facility shall discuss with the PSAS and the PSAS’s legal representative the reasons for the transfer.

B. An approved pediatric transfer facility shall ensure that a PSAS and the PSAS’s legal representative are advised of the impact of accepting or declining a transfer to assist the PSAS in making an informed decision on transfer to include the effect on quality of care, the usefulness of evidence collection, and any criminal investigation or prosecution.

C. An approved pediatric transfer facility shall provide a PSAS and the PSAS’s legal representative with:

1. Written and oral information about:

a. Emergency contraception;

b. The indications, contraindications, and potential risks associated with the use of emergency contraception; and

c. The availability of emergency contraception; and

2. A copy of the PSAS’s medical record from the encounter, as appropriate.

Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, January 2020 (U.S. Centers for Disease Control and Prevention).

Sexually Transmitted Infections Treatment Guidelines, July 2021 (U.S. Centers for Disease Control and Prevention).