OAR 331-910-0085
Client Records
(1)
A licensee is responsible for maintaining and keeping copies of all client records. If client records are maintained by the facility the facility owner must provide the licensee with copies of those client records upon request. The record must include the following for each client:(a)
Name, address, telephone number and date of birth of client;(b)
Date of each service, procedure location on the body;(c)
Name and license number of the licensee providing service. If more than one licensee is providing services on one client the licensee must initial the date of each service performed;(d)
Special instructions or notations relating to the client’s medical or skin conditions including but not limited to diabetes, cold sores and fever blisters, psoriasis or eczema, pregnancy or breast-feeding/nursing;(e)
Complete list of the client’s sensitivities to medicines or topical solutions;(f)
History of the client’s bleeding disorders;(g)
Description of complications during procedure(s); and(h)
Signature from the client that they have received the following information in writing and verbally:(A)
All information related to the electrology service including possible reactions, side effects and potential complications of the service and consent to obtaining the electrology service; and(B)
After care instructions including care following service, possible side effects and complications and restrictions.(2)
A licensee may obtain advice from a physician regarding medical information needed to safeguard client and licensee. Advice from the physician must be documented in the client record.(3)
For the purpose of (1) and (2) of this rule records must be maintained at facility premises for a minimum of three years and must be made immediately available to the Office upon request.(4)
Client records must be typed or printed in a legible format or be electronically stored. Client records, which are not legible to the Office, will be treated as incomplete.
Source:
Rule 331-910-0085 — Client Records, https://secure.sos.state.or.us/oard/view.action?ruleNumber=331-910-0085.