Ga. Comp. R. & Regs. 82-5-1

82-5-1 PATIENT'S RIGHT

This regulation establishes patient rights for individuals served in Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) state-owned and state-operated hospitals and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). It covers rights related to treatment appropriateness, individualized service plans, restraint and seclusion, consent to treatment, personal effects, communications, visitation, personal affairs, and clinical records. Facility operators must notify individuals and their guardians or parents of these rights at admission, train all staff on the regulations, and maintain policies ensuring compliance with these standards.

Subject 82-5-1 PATIENT'S RIGHT

Rule 82-5-1-.01 Legal Authority

These rules are adopted and published pursuant to the
 Official Code of Georgia Annotated (O.C.G.A.) Title 37, Chapters 3, 4, and
 7.

Rule 82-5-1-.02 Purpose, Implementation, and Definitions

(1)

 Purpose.
 The Purpose of
 these regulations is to safeguard the rights of persons treated pursuant to the
 Official Code of Georgia Annotated (O.C.G.A.) Chapters 37-3, 37-4 and
 37-7.

(2)

 Applicability.
 These regulations set forth rights of individuals served
 in hospitals and intermediate care facilities for individuals with intellectual
 disabilities that are owned and operated by the Department. 

(a)

 When the individual is a minor or an
 adult with a legally appointed guardian, the regulations are applicable to that
 person with certain exceptions as specifically stated in various parts of the
 regulations. These variations are noted in the text of the
 regulations.

(b)

 For persons being
 served by virtue of a court order related to a criminal matter, the regulations
 are applicable to the extent that they do not violate or conflict with the
 provisions of the order or the need to provide for the safety of the individual
 or of others.

(3)

 Implementation.
 Each facility shall instruct each staff member in the
 contents of these regulations. Each facility also, at the beginning of each
 individual's treatment, shall notify the individual or the individual's parent
 or guardian, if applicable, of the rights and remedies contained in these
 regulations and of their applicability to the individual. Notifications shall
 be done in a manner commensurate with the individual's abilities and
 capabilities of comprehension and understanding.

(4)

 Definitions.
 Unless a
 different meaning is required by the context, the following terms used in these
 regulations shall have the meanings hereinafter set forth: 

(a)

 "Chief Medical Officer" means the
 physician designated by the chief administrative officer of the facility with
 overall responsibility for individual treatment at any facility receiving
 individuals pursuant to O.C.G.A. Chapters 37-3 or 37-7, or their designee.
 Where individuals are receiving treatment under the provisions of O.C.G.A.
 Chapter 37-4, this term shall include the term "Regional Hospital
 Administrator" when applicable.

(b)

 "Court," with the exception of references in these regulations to courts
 presiding over criminal cases in which an individual has been found incompetent
 to stand trial or not guilty by reason of insanity, means, in the case of an
 individual who is 17 years of age or older, the probate court for the county of
 residence of the individual or the county in which such individual is found. In
 the case of an individual who is under the age 17 years, it means the juvenile
 court for the county of residence of the individual or the county in which such
 individual is found.

(c)

 "Department" means the Georgia Department of Behavioral Health and
 Developmental Disabilities and includes its duly authorized agents and
 designees.

(d)

 "Facility" means any
 State-owned or State-operated Hospital and any State-owned or State-operated
 Intermediate Care Facility for Individuals with Intellectual Disabilities
 (ICF/IID).

(e)

 "Guardian" means a
 person appointed by a Court under O.C.G.A. Title 29 to act on behalf of an
 individual who has been judicially determined to lack sufficient capacity to
 make or communicate significant responsible decisions concerning his or her
 health or safety.

(f)

 "Individual"
 means any person with mental illness who receives treatment in a facility
 pursuant to O.C.G.A. Chapter 37-3 and any person with a substance use disorder
 who receives treatment in a facility pursuant to O.C.G.A. Chapter 37-7. It also
 includes any person with an intellectual or developmental disability who
 receives habilitation in a facility pursuant to O.C.G.A. Chapter 37-4.
 "Individual" also includes a person for whom treatment or habilitation is
 sought. "Individual" also includes those who receive such services pursuant to
 a Court Order in a criminal case, including persons who are committed to a
 facility after having been found incompetent to stand trial or not guilty by
 reason of insanity.

(g)

 "Individualized service plan" (ISP; also referred to as "Individual Recovery
 Plan" or IRP) means a plan that is developed during an individual's stay in a
 facility, and that includes specific elements based on the reason for the
 individual's stay, as follows:

1.

 If the
 individual's stay in the facility is pursuant to O.C.G.A. Chapter 37-3 (i.e.
 related to mental illness as contemplated by that Chapter) or Chapter 37-7
 (i.e. related to substance use as contemplated by that Chapter), the ISP must
 be specifically tailored to the individual's treatment needs, and shall clearly
 include the following: 

(i)

 A statement of
 treatment goals or objectives, based upon and related to a proper evaluation,
 which can be reasonably achieved within a designated time interval;

(ii)

 Treatment methods and procedures to be
 used to obtain these goals, which methods and procedures are related to these
 goals and which include a specific prognosis for achieving these
 goals;

(iii)

 Identification of the
 types of professional personnel who will carry out the treatment and
 procedures, including appropriate medical or other professional involvement by
 a physician or other health professional properly qualified to fulfill legal
 requirements mandated under State and Federal law;

(iv)

 Documentation of the individual's
 involvement and, if applicable, the individual's acceptance of and/or adherence
 to the service plan; and

(v)

 A
 statement attesting that the chief medical officer or Regional Hospital
 Administrator, or that person's designee if such designee is a physician
 appointed in writing, has made a reasonable effort to meet the plan's
 individualized treatment goals in the least restrictive available environment
 possible, closest to the individual's home community.

2.

 The ISP also includes the corresponding
 individualized program plan for an individual's stay in a facility pursuant to
 O.C.G.A. Chapter 37-4 (i.e. related to habilitation for
 intellectual/developmental disabilities as contemplated by that Chapter). Such
 an ISP shall be updated on a continuing basis, and shall include, at a minimum,
 the following elements:

(i)

 A statement of the
 nature of the specific problems and the specific needs of the
 individual;

(ii)

 A statement of the
 least restrictive setting available and conditions necessary to achieve the
 purposes of habilitation based upon the needs of the individual;

(iii)

 A description of intermediate and
 long-range goals with the projected timetable for their attainment;

(iv)

 A description of the proposed program,
 facility, or department(s) responsible for involvement with the individual to
 attain these goals;

(v)

 An
 explanation of criteria for acceptance or rejection of other alternative
 settings for habilitation; and

(vi)

 Proposed criteria for release to less restrictive settings for
 habilitation.

(h)

 "Intermediate Care Facility for
 Individuals with Intellectual Disabilities" means a facility in which only
 individuals served pursuant to O.C.G.A. Chapter 37-4 are served.

(i)

 "Physician" means any person duly
 authorized to practice medicine in this State pursuant to O.C.G.A. Chapter
 43-34 and, unless otherwise noted in these regulations, an Advanced Practice
 Registered Nurse or Physician Assistant practicing under the direction or
 supervision of a practicing Physician.

(j)

 "Regional Hospital Administrator" means
 the chief administrative officer who has overall management responsibility at
 any facility receiving individuals pursuant to O.C.G.A. Chapters 37-3, 37-4,
 and 37-7, or an individual appointed as the designee of such Regional Hospital
 Administrator.

(k)

 "Representative"
 means the person appointed pursuant to O.C.G.A. Title 37, Chapters 37-3, 37-4,
 or 37-7 to receive notices and perform other actions authorized by O.C.G.A.
 Title 37, Chapters 3, 4, and 7.

(l)

 "Staff member" or "staff" means any person who is an employee, independent
 contractor, or other agent of the Department or of a facility. The use of
 "staff member" in these regulations for such persons shall in no way alter the
 legal relationship between such persons and the Department or subject the
 Department to any liability to which it is not otherwise subject.

(m)

 "Treatment" means care; diagnostic
 services; therapeutic services, including the administration of medications;
 and any other service for the treatment or habilitation of an individual. It
 includes such services, as well as social service care, vocational
 rehabilitation, and career counseling. It also includes habilitation of an
 individual pursuant to O.C.G.A. Chapter 37-4.

Rule 82-5-1-.03 Treatment

(1)

 Appropriateness.

(a)

 General. Each individual shall receive
 care and treatment that is suited to the individual's needs in the least
 restrictive environment available offering appropriate care and
 treatment.

(b)

 Individual Service
 Plans. 

1.

 The examination of individuals
 shall be governed as follows:

(i)

 For
 individuals being treated pursuant to O.C.G.A. Chapters 37-7 and 37-3, each
 individual shall be assessed by the staff as soon as possible after admission,
 but within the time limits contained within O.C.G.A. Chapters 37-7 and 37-3, or
 48 hours, whichever comes first;

(ii)

 Admissions to facilities may no longer
 take place under O.C.G.A. Chapter 37-4.

2.

 The development of an individualized
 service plan shall be governed as follows:

(i)

 For persons being treated in a hospital pursuant to O.C.G.A. Chapters 37-7 and
 37-3, staff shall develop an individualized service plan for each individual as
 soon after the initial assessment as practicable, but within the time limits
 contained within O.C.G.A. Chapters 37-7 and 37-3 or 10 days, whichever comes
 first;

(ii)

 Admissions to
 facilities may no longer take place under O.C.G.A. Chapter 37-4.

3.

 Each individualized service
 plan shall be reviewed at regular intervals to determine the individual's
 progress toward the stated goals and objectives of the plan and to determine
 whether the plan should be modified because of the individual's present
 condition. These reviews should be based upon relevant progress notes in the
 individual's clinical record and upon other related information. Information
 from the individual and other sources, including family members, should be
 obtained and utilized where feasible. Reviews should be conducted as required
 by applicable standards such as those required by Medicare, Medicaid, and the
 Joint Commission.

(c)

 Physical Restraints, and Seclusion. 

1.

 Seclusion may not be used with individuals who are served by a DBHDD ICF/IID
 facility. Use of physical restraints in a DBHDD ICF/IID must comply with the
 requirements of the State Operations Manual of the Centers for Medicare and
 Medicaid Services, Appendix J; relevant federal regulations; and O.C.G.A.
 § 
37-4-124
.

2.

 Other use of seclusion or restraint under
 these regulations shall only be accomplished in a manner that complies with the
 requirements of the State Operations Manual of the Centers for Medicare and
 Medicaid Services, Appendix A; relevant federal regulations; O.C.G.A. § 
37-3-165
; and O.C.G.A. § 
37-7-165
.

3.

 "Time-out" means a situation in which an
 individual is placed in a room from which egress is prevented. This definition
 applies only for an individual admitted pursuant to Chapter 37-4. A time-out is
 permitted only if all of the following conditions are met: 

(i)

 the placement is a part of an approved
 systematic time-out (emergency placement of an individual into a time-out room
 is not allowed under these regulations); and

(ii)

 the individual is under the direct,
 constant visual supervision of designated staff; and

(iii)

 the door to the room is held shut by
 staff, or by a mechanism requiring constant physical pressure from a staff
 member to keep the mechanism engaged.

4.

 The Department shall establish and
 maintain policies that set forth the manner in which Department staff will
 comply with these requirements.

(2)

 Participation of Individual. 

(a)

 Access to information. Each individual
 and the individual's guardian (if applicable and not prohibited by law), or in
 the case of a minor individual the individual and the individual's parent(s)
 (unless prohibited by law), shall:

1.

 have the
 right to review the individual's own medical records subject to conditions in
 § of
 these regulations, the right to be told their diagnosis, and the right to be
 consulted and informed about the treatment recommendation and any risk
 involved;

2.

 have the right to be
 fully informed about the individual's medication, including its side effects
 and available treatment alternatives; such disclosures shall be made unless the
 disclosure to the individual is determined by the chief medical officer, the
 Regional Hospital Administrator, or the individual's treating physician to be
 detrimental to the individual's physical or mental health and unless a notation
 to that effect is made part of the individual's record; and

3.

 have the right to be so informed about
 matters related to the individual's treatment or habilitation, as required or
 allowed under these regulations, to the fullest extent possible in a manner
 that is commensurate with the individual's, guardian's, and/or parent's
 abilities of comprehension and understanding; such information shall not be
 withheld from a guardian or parent of a minor child in cases in which
 disclosure is to be made to that person.

(b)

 Consent to Medical Treatment and
 Involuntary Administration of Psychotropic Medication. The Department shall
 recognize the personal physical integrity of all individuals and their rights
 to consent to or refuse medical treatment.

1.

 No treatment of any kind shall be administered by the Department to an
 individual if that individual refuses the treatment prior to the treatment,
 except that: 

(i)

 Psychotropic medication may
 be administered without the consent of the individual or other person where a
 physician determines that refusal would be unsafe to the individual or others.
 If the individual continues to refuse medication after such initial emergency
 treatment, a concurring opinion from a second physician must be obtained before
 medication can be continued without the individual's consent. Additionally: 

(I)

 All psychotropic medications shall be
 used solely for the purposes of providing effective treatment and protecting
 the safety of the individual and other persons and shall not be used as
 punishment or for the convenience of staff; and

(II)

 The Department shall establish and
 maintain policies that set forth the manner in which Department staff may
 administer psychotropic medication in compliance with state and federal law in
 cases where and individual does not consent to administration of such
 medication.

(ii)

 For an
 adult individual who has been judicially determined to be incompetent to give
 consent or make decisions of a similar nature, consent for treatment shall be
 obtained from the individual's guardian with capacity to make such decisions,
 provided the individual does not refuse to consent to medical treatment;
 however, nothing in this subsection should be construed as to abridge any
 rights of an individual 18 years of age or over to refuse to consent to medical
 treatment as to his own person. If the individual is a minor, consent shall be
 obtained from the minor's parent or guardian.

(iii)

 In the absence of a guardian of an
 adult, if there is a determination in the medical record by a licensed
 physician after the physician has personally examined an adult that the adult
 lacks sufficient understanding or capacity to make significant responsible
 decisions regarding his or her medical treatment or the ability to communicate
 by any means such decisions, consent shall be obtained from a surrogate who is
 authorized under Georgia law to consent to such treatment.

(iv)

 When treatment is being provided by an
 outside provider, the responsibility for determining capacity of the individual
 to consent, and subsequently obtaining consent, lies with the outside provider.

(v)

 When the treatment for which
 consent is sought is not standard psychiatric treatment, the consent obtained
 from the persons listed in this section shall not be sufficient to authorize
 the treatment unless court approval is also obtained after a hearing. Standard
 psychiatric treatment shall not include insulin coma or
 psychosurgery.

(vi)

 In cases of
 grave emergency where the medical staff of the facility determines that
 immediate surgical or other intervention is necessary to prevent serious
 physical consequences or death, and where delay in obtaining consent would
 create a grave danger to the physical health of the individual as determined by
 at least two physicians, then essential surgery or other intervention may be
 administered without the consent of the individual or other person. In such
 cases, a record of the determination of the physicians shall be entered into
 the medical records of the individual and this will be the prior consent for
 such surgery or other intervention. Such consent shall be valid notwithstanding
 the type of admission of the individual, and it shall also be valid whether the
 individual has been adjudicated incapacitated pursuant to O.C.G.A Title 29.
 Actual notice of any action taken pursuant to this section shall be given to
 the individual and the spouse, next of kin, attorney, guardian, or
 representative of the individual as soon as practicable.

(3)

 Participation of
 Representative. 

(a)

 Two representatives shall
 be appointed for each individual whose rights are the subject of these
 regulations. If two representatives cannot be located, a guardian ad litem
 shall be requested from the Court by the relevant facility. Appointments shall
 be made in accordance with Rule
 
.07
 of this Chapter.

(b)

 The Department shall establish and
 maintain policies that set forth the rights and responsibilities of
 representatives and of individuals with regard to their representatives in a
 manner that complies with O.C.G.A. Title 37, Chapters 3, 4, and 7.

(4)

 Private Physician. 

(a)

 If an individual is able to secure the
 services of a private physician who is not on the medical staff of the
 facility, the individual shall have the right to have that physician visit the
 individual at the inpatient facility. The individual or the individual's
 guardian, parent, or other surrogate, if applicable, shall sign a written form
 indicating the name, telephone, and address of the private physician and
 requesting that the physician be allowed to make such visits. Thereafter, the
 private physician shall be allowed to visit the individual at the inpatient
 facility at any reasonable time, and subject only to other reasonable
 regulations. The staff shall require the private physician to produce proper
 identification and proof of current certification as a physician upon the
 initial visit and thereafter as necessary. The private physician shall be
 provided a private area in which to examine and consult with the individual.
 Upon the individual's written authorization, the private physician shall be
 allowed to examine the individual's clinical record.

(b)

 As such an examination by a private
 clinician is required by law, a private clinician who examines an individual in
 a facility of the Department under this provision is not required to be
 credentialed by the facility where the examination takes place.

Rule 82-5-1-.04 Treatment Environment

(1)

General.

(a)

 The dignity of each individual shall be
 respected at all times and upon all occasions, including any occasion on which
 the individual is taken into custody, detained, or transported. Except where
 required under conditions of extreme urgency, those procedures, facilities,
 vehicles and restraining devices normally used for criminals or those accused
 of crime shall not be used in connection with individual, to the extent that
 this is under the Department's control.

(2)

 Abuse, Neglect, and Sexual Activity. 

(a)

 Abuse or neglect of any individual is
 prohibited. A staff member may use only such force as is necessary to restrain
 and secure an individual threatening imminent harm, or committing harm, to
 himself or others, and may use only such force as is necessary to prevent an
 involuntary individual from leaving a facility. Such necessary force shall not
 constitute abuse. For the purpose of this section, an involuntary individual is
 one who is being treated involuntarily, or who is being examined or evaluated
 to determine the need for involuntary treatment, or who is the subject of a
 petition and certificate seeking involuntary treatment.

(b)

 No staff member shall engage in any sort
 of sexual activity with any individual.

(c)

 The Department shall establish and
 maintain policies requiring incident management. All incidents are to be
 immediately reported in accordance with Department policy by staff who witness
 an incident of abuse or sexual activity. A staff member who fails to comply
 with the applicable requirements of this Section shall be subject to adverse
 action in accordance with personnel procedures of the Department or the
 governing authority.

(3)

 Personal Effects. 

(a)

 An individual's right
 to the individual's personal effects shall be respected. Each individual
 admitted to or treated in a facility must be provided with individual storage
 space for the individual's belongings as space permits. An individual's right
 to retain the individual's personal property may be restricted for the
 following reasons: 

1.

 To protect the health
 or safety of the individual or others;

2.

 To prevent the individual from using an
 item that would interfere with the orderly operation of the facility;

3.

 To protect the individual's valuable
 property when there is substantial risk that it will be lost or stolen;
 or

4.

 Where the property
 constitutes contraband.

(b)

 Each facility shall encourage and assist
 each individual to provide for the safekeeping of the individual's money in
 bank accounts, and the safekeeping of the individual's other valuables in safe
 places maintained by the facility.

(c)

 Whenever an individual's personal
 property is retained by the facility, a detailed notation listing the items
 retained by the facility shall be made in the individual's record. In addition,
 the individual shall be provided with a receipt if the individual so
 requests.

(d)

 At the time an
 individual is discharged, or as agreed to by the facility and the individual,
 all money and personal effects placed in the facility's custody shall be
 returned, except where possession of a certain item by an individual would be
 illegal.

(e)

 No staff member shall
 be responsible for the loss of or damage to an individual's property where
 reasonable efforts to assure the safety of that property have been
 made.

(f)

 An individual's personal
 effects may not be examined or searched after the individual's admission unless
 the individual (or the individual's guardian or parent, if applicable) consents
 to the search, or unless the chief medical officer or Regional Hospital
 Administrator, upon personal knowledge or information provided by staff members
 or other reliable persons, determines there is reasonable cause for believing
 the individual has an item or items that may be dangerous or whose possession
 is illegal. If a search is deemed necessary, the reasons for it must be
 recorded in the individual's record along with the date, time, and result of
 the search. The individual has a right to be present at any search and told the
 reason for the search, except when such search is deemed urgent for safety
 reasons and the individual or resident is not immediately available. Nothing in
 this section shall prevent the facility from making an inventory of items in
 the individual's possession at the time of their admission or from assisting
 the individual, as required by the individual's condition, in the care and
 upkeep of the individual's belongings. This section does not apply to locations
 in a facility where there is no reasonable expectation of privacy or upon
 return of an individual to a facility or to a unit of a facility.

(4)

 Communications and Visits. 

(a)

 Mail. Receiving and sending mail shall be
 governed as follows for individuals being treated on an inpatient basis in a
 hospital pursuant to O.C.G.A. Chapters 37-7, 37-3 and 37-4. 

1.

 Each individual shall be allowed to
 receive and send sealed, unopened correspondence, and no individual's
 correspondence shall be opened, delayed, held or censored by the facility,
 except under the following conditions: 

(i)

 If
 there are reasonable grounds to believe that incoming mail contains items or
 substances which may be dangerous to the individual or others, the chief
 medical officer or Regional Hospital Administrator may direct reasonable
 examination of such mail and disposal of items or substances found therein. All
 writings must be presented to the individual within 24 hours of inspection. A
 requirement that an individual open a package or letter in the presence of
 staff does not, where staff do not read any writings contained in the package
 or letter, constitute an examination for purposes of this regulation.

(ii)

 The Chief Medical Officer or Regional
 Hospital Administrator may apply to the court for a temporary order to restrict
 outgoing mail. The court, upon a showing of probable cause that such mail is
 dangerous to the individual or others, may grant a temporary restriction of the
 individual's mail privileges, provided that within 5 days after the issuance of
 such temporary order, the court holds a hearing to determine whether an order
 of restriction for an extended time shall issue. 

(I)

 In no event shall mail be restricted
 pursuant to such temporary order for more than 5 days.

(II)

 If the court determines the individual's
 outgoing mail is dangerous to the individual or others, it may order the mail
 restricted for a period not to exceed 30 days.

(III)

 The court order may be renewed as
 necessary for periods not to exceed 30 days, with a new hearing to take place
 each time.

(IV)

 The chief medical
 officer or Regional Hospital Administrator of the facility shall restrict
 communication as provided in the court order.

(iii)

 Any restriction of incoming or outgoing
 mail under this section shall not exceed a period of 5 days, except that such
 restriction may be renewed by the chief medical officer or Regional Hospital
 Administrator for a period not to exceed 5 days, provided that such renewal
 periods in the aggregate shall not exceed the period specified in the court
 order when outgoing mail is restricted pursuant to such order. Prior to a
 renewal, the chief medical officer or Regional Hospital Administrator shall
 make a new determination that such mail continues to be dangerous to the
 individual or others.

(iv)

 Correspondence of the individual with the individual's attorney shall not be
 restricted under this Section, nor shall correspondence to an individual from a
 public official be restricted under this section.

(v)

 Each time an individual's incoming or
 outgoing mail is examined, written notice of the examination, and notice of the
 right to a full and fair hearing within 5 days after a temporary court order,
 shall be served on the individual and the individual's representatives as
 provided in § of these regulations. An
 individual (other than an individual whose status is involuntary) may waive in
 writing such notice to the individual's representatives. In addition, the
 circumstances surrounding the examination of any mail shall be recorded in the
 individual's clinical record. Each facility shall maintain policies that
 encourage the individuals' exercise of the individual's communication rights,
 including supply to indigent individuals of writing materials and postage in
 reasonable amounts.

(b)

 Telephone calls. 

1.

 Each individual has the right to make
 reasonable use of telephones. To assure this right, each facility shall: 

(i)

 Maintain locations for calling (including
 pay telephones where feasible) which allow for privacy;

(ii)

 Supply indigent individuals with funds
 or access to telephones for making a reasonable number of calls; and

(iii)

 Prohibit any monitoring of individual
 calls without consent from the individual except pursuant to a court order. A
 requirement that staff dial a particular number for an individual does not
 constitute monitoring of an individual's calls for purposes of this
 regulation.

2.

 The
 facility may place reasonable restrictions, such as those relating to the
 distance, time, length, and frequency of calls, upon the use of telephones by
 all individuals generally. In addition, reasonable restrictions may be placed
 upon an individual's use of telephones under the following conditions: 

(i)

 The restriction must be required by the
 type of seriousness of the individual's mental condition and must be ordered by
 the individual's attending physician;

(ii)

 The type and extent of the restriction,
 along with the specific reason for the restriction must be stated in the order;
 and

(iii)

 The order shall expire
 automatically 24 hours after it is given, unless it is terminated sooner, but
 additional 24-hour orders may be given according to the same procedure as that
 required for the original order.

3.

 The individual may consent in writing to
 restrictions to the use of the telephones.

4.

 Telephone communication of an individual
 with their attorney or private physician shall not be restricted in accordance
 with §§.

(c)

 Visitation. Visitation shall be governed
 as follows for individuals being treated on an individual basis in a hospital
 pursuant to O.C.G.A. Chapters 37-7, 37-3, and 37-4. 

1.

 Each individual admitted to a facility has
 the right to receive visitors daily or to refuse in writing to receive any
 visitors or particular visitors. Privacy, to the extent that it is possible,
 should be provided.

2.

 The facility
 may place reasonable restrictions, such as those relating to time and place,
 upon visitation by persons outside the facility for all individuals generally.
 Visiting hours shall be set for at least 4 hours daily, 2 hours of which shall
 be after 6 p.m. In addition, reasonable restrictions may be placed upon an
 individual's right of visitation under the following conditions: 

(i)

 The restriction must be required by the
 type of seriousness of the individual's mental or physical condition and must
 be ordered by the individual's attending physician;

(ii)

 The type and extent of the restriction,
 along with the specific reasons for the restriction, must be stated in the
 order; and

(iii)

 The order shall
 expire automatically 24 hours after it is given, unless it is terminated
 sooner, but additional 24-hour orders may be given according to the same
 procedure as that required for the original order.

3.

 The individual may consent in writing to
 restrictions on visitation.

4.

 Visitation by an individual's attorney or private physician shall not be
 restricted in accordance with §§. 

5.

 The right to visitation does not establish
 the right to a visit by a person whose presence at the facility has been
 prohibited by the facility.

(d)

 Other. 

1.

 Each individual admitted to a facility
 shall have the right to regular social interaction with others, including
 persons of the opposite sex, subject only to the provisions of § of
 these regulations (seclusion) and to other reasonable regulations, such as
 those relating to time and place.

2.

 Each individual admitted to a facility
 shall have the right to attend religious services, but no individual may be
 compelled to attend such services. The individual should be assisted in the
 observance of the individual's religion to the extent possible.

Rule 82-5-1-.05 Personal Affairs

(1)

General.
 No individual,
 whether voluntary or involuntary, shall be deprived of any civil, political,
 personal, or property rights or be considered legally incompetent for any
 purpose without due process of law. Hospital staff may exercise
 clinically-informed discretion in deciding whether to assist an individual in
 exercising these rights. These rights include, but are not limited to: 

(a)

 The right to dispose of
 property;

(b)

 The right to execute
 legal instruments;

(c)

 The right to
 make purchases;

(d)

 The right to
 enter into contractual relationships;

(e)

 The right to register and vote;

(f)

 The right to marry and to obtain a
 separation, divorce, or annulment;

(g)

 The right to hold a driver's license;
 and

(h)

 The right to make a
 will.

(2)

 Legal Counsel. 

(a)

 Each individual admitted to a facility
 has the right to secure legal counsel to represent the individual in the
 individual's personal affairs during the individual's hospitalization. The
 individual should be assisted by staff members to the extent possible in
 securing legal counsel.

1.

 If the individual
 can afford legal counsel, the individual may secure counsel at the individual's
 own expense.

2.

 If the individual
 needs legal counsel for the individual's personal affairs but cannot afford
 such counsel, the individual may contact the local legal aid service for
 assistance.

3.

 Each facility shall
 post on every treatment unit the name, address, and telephone number of local
 lawyer referral services and local agencies which provide legal services to
 indigent persons.

(b)

 The
 securing of legal counsel for an individual at hearings concerning the
 individual's committal or treatment is not governed by these
 regulations.

(c)

 Each individual
 admitted to a facility shall have the right to have the individual's legal
 counsel visit the individual at the facility. The individual (or the
 individual's guardian or parent, if applicable) or the attorney shall provide
 the facility with the attorney's name, telephone number, and address. The staff
 shall require the attorney to produce proper identification and proof of
 current certification as an attorney upon the initial visit and thereafter as
 necessary. The attorney shall be allowed to visit the individual at the
 facility at any reasonable time, and subject to other reasonable regulations.
 The attorney shall be provided a private area in which to consult with the
 individual.

(d)

 Upon the
 individual's written authorization, the attorney shall be allowed to examine
 the individual's clinical record and shall also be allowed to interview staff
 who have treated the individual. However, an attorney for matters relating to
 the individual's presence at the facility by virtue of Title 37 or by virtue of
 a Court Order in a criminal case may view the individual's record during the
 period of the attorney's representation of the individual on such
 matters.

(3)

Voting.

(a)

 Each individual
 admitted to a facility who is entitled to vote shall be given the right to vote
 in primary, special, and general elections and in referenda.

(b)

 The Regional Hospital Administrator of
 each facility, or their designee, shall: 

1.

 At least 30 days prior to a national or statewide election, post notice of the
 election in each hospital treatment unit;

2.

 Notify individuals 18 years old and over
 of their right to register to vote, to obtain absentee ballots, and to cast
 ballots; and the notification shall be conducted to allow sufficient time for
 voter registration and acquisition of absentee ballots;

3.

 When clinically suitable and if staffing
 of the facility permits, allow residents to leave the premises to exercise
 voting privileges or to register to vote, and require personnel, where
 available, to accompany residents; otherwise voting by absentee ballot is
 sufficient;

4.

 Make arrangements
 with state and local officials to provide for voter registration and casting of
 ballots by interested individuals; and

5.

 Assist election officials in determining
 an individual's place of residence for voting purposes.

(4)

 Employment Outside Facility. 

(a)

 Each facility shall encourage and assist
 an individual in securing suitable employment outside the facility, if the
 individual wishes to be so employed and if such employment will aid in the
 individual's treatment. The training of individuals for gainful employment
 shall also be encouraged through appropriate resources and referrals.

(b)

 All wages and benefits earned by
 employment outside the facility shall belong solely to the
 individual.

(5)

 Attorney's Access. 

(a)

 An attorney
 representing an individual in a matter relating to the individual's
 hospitalization shall have the right to visit and consult with the individual
 at the facility in accordance with § of
 these regulations.

(b)

 At
 reasonable times, and subject to the notification and identification provisions
 of § of
 these regulations, the individual's attorney for hospitalization matters shall
 have the right to interview the physician and staff members who attended or are
 now attending the individual, and the right to have the individual's records
 interpreted by them.

(c)

 The chief
 medical officer or Regional Hospital Administrator of each facility shall
 establish reasonable policies to make available to the individual's attorney
 all information not otherwise privileged in the possession of the facility
 which the attorney requires to advise and represent the individual concerning
 matters relating to the individual's presence at the facility by virtue of
 O.C.G.A. Title 37 or by virtue of a court order in a criminal
 case.

Rule 82-5-1-.06 Clinical Records

(1)

Contents.

(a)

 A clinical record shall be maintained at
 each facility for each individual treated at that facility, containing
 protected health information of the individual. The record shall contain
 information on all matters relating to the admission, care, treatment,
 discharge, and legal status of the individual, and shall include all medical
 and legal documents relating to the individual. The record shall not contain
 peer review or administrative documents such as incident reports and
 investigations of incidents or complaints. The record specifically shall
 contain at least the following: progress notes; documents describing or arising
 from the individual's history; the results of all psychiatric, psychological,
 and physical examinations; individualized service plans; evaluations other than
 evaluations developed at the direction of a court that is assessing an
 individual's competence or responsibility under O.C.G.A. Title 17, Chapter 7,
 which are not to be maintained in the medical record; orders for treatment;
 orders for physical restraints, seclusion, and other restrictions permitted by
 these regulations or other applicable law; clinical documentation of accidents
 and incidents and of follow-up care provided; court orders establishing
 guardianship of the individual if applicable; advance directives of the
 individual if possible; and court orders and other court documents received by
 the facility. When clinical records or parts of clinical records are released
 as provided in this section, copies of the clinical record should be released.
 If the record is electronic, a tangible copy may be produced as legally
 sufficient for purposes of disclosures, except as otherwise provided in this
 section. The name(s) or other identifying information of other individuals who
 are receiving or formerly received treatment or services may not be recorded in
 an individual's clinical record. The initials of another individual may be
 recorded if necessary.

(2)

Confidentiality.

(a)

 The Department shall create and enact
 policies that implement the rules relating to confidentiality contained in
 HIPAA and in federal substance abuse confidentiality laws and regulations.
 Staff shall comply with applicable confidentiality provisions established by
 Georgia law.

(3)

 Examination by individual. 

(a)

 Every
 individual currently or formerly admitted to a facility shall have the right to
 examine all clinical records kept in that individual's name by the Department
 or the facility where the individual is or was hospitalized or treated;
 provided, however, that if the individual is currently admitted to the
 facility, the individual shall not have the right to examine such clinical
 records if:

1.

 The disclosure of such records
 to the individual is determined, by the chief medical officer or Regional
 Hospital Administrator or the individual's attending physician or psychologist,
 to be detrimental to the individual's physical or mental health; and

2.

 A notation to that effect is made in the
 individual's record.

(b)

 Each facility shall assist individuals in reviewing their own records but may
 establish reasonable limitations, such as those relating to time, place, and
 frequency, upon such review.

(4)

 Correction by individual. 

(a)

 Every individual currently or formerly
 admitted to a facility shall have the right to request that any inaccurate
 information found in the individual's clinical record be corrected. A request
 from an individual currently admitted to a facility shall be made in writing to
 the person in charge of records at the facility or to another person designated
 by the superintendent. That person will consult the appropriate staff at the
 facility if needed. If the request is made orally to a staff member, that staff
 member will assist the individual in making the request to the appropriate
 person.

(b)

 Upon receipt of a
 request for correction of the record of an individual currently or formerly
 admitted to the facility, the person in charge of records at the facility or
 the person so designated shall within 5 days: 

1.

 Make the requested correction, and provide
 the individual with a copy of the corrected record; or

2.

 Notify the individual, in writing, of the
 inability to obtain amendment of the record and the reason therefore, and
 notify the individual that he may file a complaint regarding this refusal in
 accordance with § of
 these regulations; such notification shall be complete upon
 mailing.

(c)

 If
 amendments are made to the records of an individual currently or formerly
 admitted to a facility, they should be added to the record and the original
 record should be preserved.

(5)

Copies.

(a)

 It is the policy of the Department to
 provide routine information to the general public in compliance with the
 Georgia Open Records Act or DBHDD policy regarding medical records.

(b)

 Fees charged for copying services in
 State facilities shall comply with policies set by the Department.

(c)

 Waiver or reduction of fees may be
 granted where such action is in the public interest or when based on an
 individual's ability to pay.

(d)

 Staff members shall assist the individual in the selection of records for
 copying purposes. A policy of full disclosure and assistance shall be followed,
 while waste in copying practices is to be discouraged.

Rule 82-5-1-.07 Notice; Representatives and Guardians Ad Litem

(1)

Notice.

(a)

 To individual: Any time that notice is
 required to be given to an individual by these regulations or other applicable
 law, the date on which the notice is given shall be entered in the individual's
 clinical record. If the individual is unable to read or comprehend a notice
 sufficiently, a reasonable effort shall be made to explain the notice to
 them.

(b)

 To representatives: At
 any time that notice is required to be given to an individual's
 representatives, the notice shall be served on those persons designated in
 accordance with § of
 these regulations. The individual's guardian ad litem shall likewise be served.
 Unless otherwise provided, notice may be served in person or by first class
 mail. When notice is served by mail, a record shall be made of the date of
 mailing and shall be placed in the individual's clinical record. Service shall
 be complete upon mailing to the last known mailing address.

(c)

 Judicial orders. At any time a court
 enters an order affecting an individual pursuant to these regulations or other
 applicable law and serves said order on the Department, a copy of that order
 shall be served on the individual and the individual's representative as
 provided in subparagraphs (a) and (b) of this subsection, unless the order
 contains an accompanying certificate that such service has already been
 made.

(2)

 Representatives
 and Guardians Ad Litem.

(a)

 Selection. At the
 time an individual is admitted to a facility, the names and addresses of at
 least two representatives shall be entered in the individual's clinical record.
 The individual has the right to designate one representative. 

1.

 If the individual designates one
 representative, the facility shall designate the second, who shall be selected
 from the following persons in the order of listing: the individual's legal
 guardian, spouse, an adult child, parent, attorney, adult next of kin, or adult
 friend.

2.

 If the individual does
 not exercise the individual's right to designate one representative, the
 facility shall designate both of the individual's representatives, in
 accordance with the following rules.

(i)

 One
 of the representatives shall be selected from the following persons in the
 order of listing: the individual's legal guardian, spouse, an adult child,
 parent, attorney, adult next of kin, or adult friend.

(ii)

 The second representative shall be
 selected from the same list without regard to the order of listing, but shall
 not be the person who signed the petition allowed under the provisions of
 O.C.G.A. Chapters 37-3, 37-4, and 37-7.

3.

 If the facility is unable to secure at
 least two representatives after diligent search, or if an agency or agent of
 the State of Georgia is the guardian of the individual, that fact shall be
 entered in the individual's record and the facility shall apply to the court in
 the county of the individual's residence for the appointment of a guardian ad
 litem, which shall not be the Department.

4.

 On application of any person or on its own
 motion, the court may also appoint a guardian ad litem for an individual for
 whom representatives have been named whenever the appointment of a guardian ad
 litem is deemed necessary for protection of the individual's rights. Such
 guardian ad litem shall act as the representative of the individual on whom
 notice is to be served under the applicable provision of law and shall have the
 powers granted to representatives by those provisions.

(b)

 Powers. 

1.

 Representatives shall have the power to
 receive the notices required to be sent to them by these regulations and other
 applicable law, and the power to consult with the facility staff to the extent
 allowed by law and policy.

2.

 Guardians ad litem shall have the power to receive the notices required to be
 sent to them by these regulations or other applicable law. The guardian ad
 litem's power shall accord with the limited purpose stated in the order of the
 court, and the guardian ad litem's appointment shall expire automatically after
 90 days or after a lesser time stated in the order. The responsibility of the
 guardian ad litem shall not extend beyond the specific purpose of the
 appointment, and the authority of the guardian ad litem will not generally
 extend to acting on behalf of the individual with regard to matters such as
 consent for placement or medical treatment.

Rule 82-5-1-.08 Remedies for Violations

(1)

 Complaint Procedures. 
 
Any individual (or the individual's guardian or parent of a
 minor individual, if applicable) or the individual's representative or any
 staff member may file a complaint alleging that an individual's rights under
 these regulations or other applicable law have been violated by staff members
 or persons under their control. A person who considers filing such a complaint
 is encouraged to resolve the matter informally by discussing it first with the
 staff members or other persons involved, with the Personal Advocate, with a
 member of the Human Rights Committee, or similar mechanism. Such complaints,
 when arising, shall be governed by policy established and maintained by the
 Department in a manner that is consistent with the standards set forth in this
 section. Such policy shall establish procedures consistent with the
 following:

(a)

 The Department shall
 establish and maintain policies that set forth procedures by which individuals
 may file complaints relating to individuals' rights. The Department shall
 establish and maintain multiple means by which all individuals are notified of
 the ways they may file a complaint.

1.

 Each
 facility that is subject to these regulations shall appoint a Personal Advocate
 whose responsibilities will include involvement with the Complaint process as
 set forth in these regulations and as set forth in Department policy.

2.

 Each facility that is subject to these
 regulations shall establish and maintain a Human Rights Committee, at least two
 members of which shall not be employees of the facility. The responsibilities
 of the Human Rights Committee shall include review of the manner in which the
 facility addresses complaints that are the subject of this regulation.

(b)

 The Department shall
 establish policies that set forth the manner and timeframe in which a
 disinterested staff member, designated by position, investigates each
 unresolved complaint, as well as timeframes in which each complaint
 investigation must be completed and the manner in which the conclusion of the
 investigator is delivered to the individual.

(c)

 The Department shall establish policies
 that set forth the manner and timeframe in which an individual may appeal the
 conclusion of the investigator. Any such appeal must be reviewed by a
 disinterested staff member, appointed by the Regional Hospital Administrator,
 who is qualified by training and experience to review such an appeal. Policy
 shall set forth timeframes during which evaluation of any such appeal must be
 completed and the manner in which the conclusion of the reviewer will be
 delivered to the individual. The Regional Hospital Administrator must approve
 the resolution of the appeal before it is provided to the individual.

(d)

 The Department shall establish policies
 that set forth the manner and timeframe in which an individual may appeal to
 the Commissioner the resolution an initial appeal. Any such appeal must be
 reviewed by a disinterested DBHDD staff member appointed by the Commissioner
 who is qualified by training and experience to review such an appeal. Policy
 shall set forth timeframes during which evaluation of any such appeal must be
 completed and the manner in which the conclusion of the staff member who has
 reviewed the appeal will be delivered to the individual. The Commissioner or
 the Commissioner's designee must approve the resolution of the appeal to the
 Commissioner before the resolution is provided to the individual.

(e)

 No appeal under this regulation is
 subject to judicial review.

(f)

 The
 individual is not required to use the procedure established by this section in
 lieu of other available legal remedies.

(2)

 General Provisions. 

(a)

 Whenever the Human Rights Committee or
 the Personal Advocate becomes aware of a situation that appears to require
 immediate action to protect the welfare and safety of any individual, the
 Committee or the Personal Advocate shall immediately notify the nearest
 available staff member with authority to correct the situation. In any
 situation that requires immediate action to protect an individual's welfare or
 safety, the Regional Hospital Administrator may be notified instead. If
 adequate corrective action is not taken by that staff member, the Committee or
 the Personal Advocate shall immediately notify the Regional Hospital
 Administrator, or if necessary, the Director or the Commissioner of the
 Department.

(b)

 No person shall be
 subject to any form of discipline or reprisal solely because they sought a
 remedy through, or participated in, the procedures established by this
 section.

(c)

 Obstruction of the
 investigation or disposition of a complaint by any person shall be reported to
 the Regional Hospital Administrator, who shall take action to eliminate the
 obstruction. Staff members are subject to adverse action in accordance with
 personnel procedures of the Department for engaging in such
 obstruction.

(d)

 This complaint
 procedure does not replace or invalidate any other Department policy or
 procedure pertaining to reporting requirements, disciplinary matters, or the
 like.

(e)

 Staff members who are
 involved in a complaint shall not be involved in processing that
 complaint.

(3)

 Judicial
 Supervision. 

(a)

 Any individual (or the
 individual's guardian or parent of a minor individual, if applicable) or the
 individual's representative may file a petition in the appropriate court
 alleging that: 

1.

 The individual is being
 unjustly denied a right or privilege granted by these regulations or other
 applicable law; or

2.

 A procedure
 authorized by these regulations or other applicable law is being abused;
 or

3.

 The individual objects to the
 treatment being administered to the individual.

(b)

 Upon the filing of such a petition, the
 court shall have the authority to conduct a judicial inquiry and to issue
 appropriate orders to correct any abuse of these regulations or other
 applicable law. The individual, the individual's representatives, or the
 individual's attorney may appeal any such order of the probate court or of the
 court's hearing officer to the superior court of the county in which the
 proceeding was held, and may appeal any such order of the Juvenile Court to the
 Court of Appeals and to the Supreme Court.

(c)

 At any time and without notice, a person
 detained by a facility, or a relative or friend on behalf of such person, may
 petition as provided by law for a writ of habeas corpus to question the cause
 and legality of detention and to request any court of competent jurisdiction on
 its own initiative to issue a writ of release. In the case of any such petition
 for the release of a person detained in a facility pursuant to a court order
 under O.C.G.A. § 
17-7-130
 or O.C.G.A. § 
17-7-1
­31, a copy of the
 petition, along with proper certificate of service, shall also be served upon
 the presiding judge of the court ordering such detention and the prosecuting
 attorney for such court; service may be made by certified mail, return receipt
 requested.

(4)

 Medication
 Prior to Hearings. The individual has a right to appear and testify at hearings
 free from any side effects or adverse effects of medication as is reasonably
 possible. The individual's attorney, if any, should be informed of any
 medication the individual is receiving at the time of the hearing.

Rule 82-5-1-.09 Severability

In the event that any rule, sentence, clause or phrase of any
 of the rules and regulations in this Chapter may be construed by any court of
 competent jurisdiction to be invalid, illegal, unconstitutional, or otherwise
 unenforceable, such determination or adjudication shall in no manner affect the
 remaining rules or portions thereof. The remaining rules or portions thereof
 shall remain in full force and effect as if such rule or portions thereof
 determined, declared, or adjudicated invalid or unconstitutional were not
 originally part of these rules.

Rule 82-5-1-.01 Legal Authority
Rule 82-5-1-.02 Purpose, Implementation, and Definitions
Rule 82-5-1-.03 Treatment
Rule 82-5-1-.04 Treatment Environment
Rule 82-5-1-.05 Personal Affairs
Rule 82-5-1-.06 Clinical Records
Rule 82-5-1-.07 Notice; Representatives and Guardians Ad Litem
Rule 82-5-1-.08 Remedies for Violations
Rule 82-5-1-.09 Severability