481—67.4 (231B,231C,231D) Program notification to the department.  The director or the director’s designee shall be notified within 24 hours, or the next business day, by the most expeditious means available:
	 67.4(1) Of any accident causing major injury. For the purposes of this rule, “major injury” shall also mean a substantial injury.
	  a.   	 “Major injury” shall be defined as any injury which:
	 (1) 	 Results in death; or
	 (2) 	 Requires admission to a higher level of care for treatment, other than for observation; or
	 (3) 	 Requires consultation with the attending physician, designee of the physician, or physician extender who determines, in writing on a form designated by the department, that an injury is a “major injury” based upon the circumstances of the accident, the previous functional ability of the tenant, and the tenant’s prognosis.
	  b.   	 The following are not reportable accidents:
	 (1) 	 An ambulatory tenant who falls when neither the program nor its employees have culpability related to the fall, even if the tenant sustains a major injury; or
	 (2) 	 Spontaneous fractures; or
	 (3) 	 Hairline fractures.
	 67.4(2) When damage to the program is caused by a natural or other disaster.
	 67.4(3) When there is an act that causes major injury to a tenant or when a program has knowledge of a pattern of acts committed by the same tenant on another tenant that results in any physical injury. For the purposes of this subrule, “pattern” means two or more times within a 30-day period.
	 67.4(4) When a tenant elopes from a program.
	 67.4(5) When a tenant attempts suicide, regardless of injury.
	 67.4(6) When a fire occurs in a program and the fire requires the notification of emergency services, requires full or partial evacuation of the program, or causes physical injury to a tenant.
	 67.4(7) When a defect or failure occurs in the fire sprinkler or fire alarm system for more than 4 hours in a 24-hour period. (This reporting requirement is in addition to the requirement to notify the state fire marshal.)
Note: Additional reporting requirements are created by other rules and statutes, including but not limited to Iowa Code chapters 235B and 235E, which require reporting of dependent adult abuse.
[ARC 8174B, IAB 9/23/09, effective 1/1/10]