TITLE 12. HEALTH
Title of Regulation: 12VAC5-410. Regulations for the
Licensure of Hospitals in Virginia (amending 12VAC5-410-442, 12VAC5-410-445,
12VAC5-410-650, 12VAC5-410-760, 12VAC5-410-1350).
Statutory Authority: §§ 32.1-127 and 32.1-127.001
of the Code of Virginia.
Public Hearing Information: No public hearings are
scheduled.
Public Comment Deadline: May 6, 2016.
Agency Contact: Erik Bodin, Director, Office of
Licensure and Certification, Department of Health, 9960 Mayland Drive,
Richmond, VA 23233, telephone (804) 367-2109, FAX (804) 527-4502, or email
erik.bodin@vdh.virginia.gov.
Basis: Section 32.1-127 of the Code of Virginia requires
the board to promulgate regulations including minimum standards for (i) the
construction and maintenance of hospitals, nursing homes, and certified nursing
facilities to ensure the environmental protection and the life safety of its
patients, employees, and the public; (ii) the operation, staffing, and
equipping of hospitals, nursing homes, and certified nursing facilities; (iii)
qualifications and training of staff of hospitals, nursing homes, and certified
nursing facilities, except those professionals licensed or certified by the
Department of Health Professions; (iv) conditions under which a hospital or
nursing home may provide medical and nursing services to patients in their
places of residence; and (v) policies related to infection prevention, disaster
preparedness, and facility security of facilities. Section 32.1-127.001 of the
Code of Virginia states, "Notwithstanding any law or regulation to the
contrary, the Board of Health shall promulgate regulations pursuant to § 32.1-127
for the licensure of hospitals and nursing homes that shall include minimum
standards for the design and construction of hospitals, nursing homes, and
certified nursing facilities consistent with the current edition of the Guidelines
for Design and Construction of Hospital and Health Care Facilities issued by
the American Institute of Architects Academy of Architecture for Health."
The American Institute of Architects Academy of Architecture for Health has
become the Facility Guidelines Institute (FGI) and the latest edition of
guidelines published by the FGI is the 2014 edition of Guidelines for Design
and Construction of Hospitals and Outpatient Facilities.
Purpose: This regulatory action is in response to a
petition for rulemaking. This action will bring the regulations into
conformance with the provisions of § 32.1-127.001 of the Code of Virginia,
which states that "Notwithstanding any law or regulation to the contrary,
the Board of Health shall promulgate regulations for the licensure of hospitals
and nursing homes that include minimum standards for design and construction
that are consistent with the current edition of the Guidelines for Design and
Construction of Hospital and Health Care Facilities issued by the American Institute
of Architects Academy of Architecture for Health." The American Institute
of Architects Academy of Architecture for Health has become the FGI and the
latest edition of guidelines published by the FGI is the 2014 edition of
Guidelines for Design and Construction of Hospitals and Outpatient Facilities
(guidelines). However, the regulations currently state that the Virginia
Uniform Statewide Building Code takes precedence over the guidelines and the
editions of the guidelines listed within the regulations are outdated. This
regulatory provision is contrary to the requirements of § 32.1-127.001.
The Virginia Department of Health (VDH) plans to amend various
regulatory sections pertaining to building and physical plant information and
building and construction codes for hospital facilities. The purpose of the
proposed amendments is to specify that the facilities shall be designed,
constructed, and renovated consistent with the 2014 edition of the guidelines
and remove language stating that the Virginia Uniform Statewide Building Code
takes precedence, thus bringing the regulations into compliance with the Code
of Virginia and promoting the public health, safety, and welfare.
Substance:
12VAC5-410-442 - Obstetric service design and equipment
criteria. Update the edition of the guidelines listed within the regulation and
the coinciding sections related to obstetric services.
12VAC5-410-445 - Newborn service design and equipment criteria.
Update the edition of the guidelines listed within the regulation and the
coinciding sections related to nursery services.
12VAC5-410-650 - General building and physical plant
information. Update the edition of the guidelines listed within the regulation
and remove language that states the Virginia Uniform Statewide Building Code
takes precedence. Add language stating that the facility's architect shall
certify that the facility conforms with the Virginia Statewide Building Code
and the FGI Guidelines.
12VAC5-410-760 - Long-term care nursing units. Update the
edition of the guidelines within the regulation and the coinciding section
related to skilled nursing care units. Add language stating that the facility's
architect shall certify that the facility conforms with the Virginia Statewide
Building Code and the FGI Guidelines.
12VAC5-410-1350 - Codes; fire safety; zoning; construction
standards. Update the edition of the guidelines within the regulation and
remove language that states the Virginia Uniform Statewide Building Code takes
precedence. Add language stating that the facility's architect shall certify
that the facility conforms with the Virginia Statewide Building Code and the
FGI Guidelines.
Issues: The primary advantages of the proposed
regulatory action to the public are increased facility and construction safety
protections in new or renovated hospitals. The primary disadvantage to the
public associated with the proposed action is the increased cost some
facilities may incur to renovate or construct their facilities in order to
comply with the regulations. This increased cost may be passed on to the
patient. VDH does not foresee any additional disadvantages to the public. The
primary advantage to the agency and the Commonwealth is the promotion of public
health and safety. There are no disadvantages associated with the proposed
regulations in relation to the agency or the Commonwealth.
Department of Planning and Budget's Economic Impact
Analysis:
Summary of the Proposed Amendments to Regulation. The State
Board of Health (Board) proposes to specify that renovation or construction of
hospitals be consistent with the 2014 Guidelines for Design and Construction of
Hospitals and Outpatient Facilities of the Facility Guidelines Institute.
Additionally, the Board proposes to amend other language for improved clarity.
Result of Analysis. The benefits likely exceed the costs for
all proposed changes.
Estimated Economic Impact. Section § 32.1-127.001 of the Code
of Virginia states that the Board shall promulgate regulations for the
licensure of hospitals that include minimum standards for design and
construction that are consistent with the current edition of the Guidelines for
Design and Construction of Hospital and Health Care Facilities issued by the
American Institute of Architects Academy of Architecture for Health. The American
Institute of Architects Academy of Architecture for Health has become the
Facility Guidelines Institute (FGI). Consequently the Board proposes to amend
this regulation to specify that renovations or construction be consistent with
the 2014 Guidelines for Design and Construction of Hospitals and Outpatient
Facilities of the Facility Guidelines Institute.1 The current
regulation references the 2010 and 2006 guidelines. Adopting the requirements
in the 2014 Guidelines would produce both cost increases and reductions.
Potential Cost Increases. The change in requirements associated
with adopting the 2014 edition would produce approximately the following cost
increases.2
|
Facility Type
|
Cost Change
|
Explanation
|
|
General hospital
|
1.88%
|
The bulk of this increase is due to changes required for
fume hood exhaust, family support and meditation rooms, private rooms for
intermediate care units, and lifts for bariatric rooms.
|
|
Children's hospital
|
2.37%
|
The bulk of the increase is due to the requirements for a
family lounge and a play area on top of the 1.88% increase for general
hospitals. (These requirements are compared to the 2010 general hospital
requirements as a separate children's hospital chapter is new in the 2014
edition.)
|
|
Psychiatric/rehab hospital
|
0.26%
|
The bulk of the increase is due to changes requiring drywall
ceilings in patient rooms and toilets.
|
|
Freestanding outpatient – urgent care/surgery/
imaging/endoscopy
|
0.17%
|
The bulk of the increase is due to changes requiring a
separate clean/decontamination room and a toilet in the recovery area in
endoscopy facilities.
|
|
Freestanding outpatient – neighborhood clinic/office
surgery/dialysis center
|
2.68%
|
The bulk of the increase is due to changes requiring a
soiled workroom in renal dialysis centers and a toilet at pre-procedure areas in
office surgical facilities.
|
Potential Cost Reductions. Several of the changes in
requirements in the 2014 Guidelines could yield reductions in the percentage of
cost increase and could provide significant benefits. The following describe
potential cost savings by section of the 2014 Guidelines.3
1.2-2 Functional Program. This section was revised to
clarify the requirements for a functional program and to help owners and
designers define the actual needs for a project to minimize additional costs
for construction of scope beyond programmed requirements or needs and to
minimize the need for scope changes later in a project.
1.2-3 Safety Risk Assessment. Combining a number of risk
assessments under one umbrella, this new tool clarifies what risks should be
assessed at the outset of a project and should help owners and designers define
the scope of a project to avoid overbuilding and to improve operational and
clinical results.
1.2-5.4 Bariatric–Specific Design Considerations. The
percentage of the population that is obese varies considerably in different
regions in the United States, making it impossible to determine minimum
requirements for facilities and equipment to accommodate provision of care for
this portion of the population that would be appropriate everywhere. Therefore,
specific requirements were removed so that health care organizations can
determine the percentage of their patient population that needs these
accommodations. Allowing the decision on how much of a facility must be able to
accommodate persons of size to be customized to a locality should allow cost
savings in some areas.
2.1-5.1 Central Services. Requirements in this section
were clarified so sterile processing services can be provided in a manner that
meets local capabilities rather than having minimum requirements that may go
beyond what is needed in small hospitals. This would save costs by allowing a
customized approach for each location.
Conclusion. The estimated cost increases associated with
adopting the 2014 Guidelines are fairly small, and may be offset by cost
savings of other changes in the 2014 edition depending on the specifics of
individual hospital construction and renovation projects. The Board and the
architects and engineers associated with the Facility Guidelines Institute
believe that adopting the 2014 edition will increase patient and staff health
and safety. Thus, the proposal to specify that renovation or construction of
hospitals be consistent with the 2014 Guidelines will likely produce a net
benefit.
Businesses and Entities Affected. The proposed amendments
potentially affect the 106 licensed hospitals within the Commonwealth.
Localities Particularly Affected. The proposed amendments do
not disproportionately affect particular localities.
Projected Impact on Employment. The proposed amendments will
not likely significantly affect total employment.
Effects on the Use and Value of Private Property. The proposed
amendments are unlikely to significantly affect the use and value of private
property.
Real Estate Development Costs. Depending on the specific
attributes of the hospital construction or renovation project, the proposed
adoption of the 2014 Guidelines may increase or decrease total real estate
development costs. In any case, the change is not likely to be large.
Small Businesses:
Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia,
small business is defined as "a business entity, including its affiliates,
that (i) is independently owned and operated and (ii) employs fewer than 500
full-time employees or has gross annual sales of less than $6 million."
Costs and Other Effects. Depending on the specifics of
individual hospital construction and renovation projects, the proposed adoption
of the 2014 Guidelines may increase or decrease the cost of hospital
construction and renovation. In net, the proposed amendments are unlikely to
significantly increase costs for small businesses.
Alternative Method that Minimizes Adverse Impact. Depending on
the specifics of individual hospital construction and renovation projects, the
proposed adoption of the 2014 Guidelines may increase or decrease the cost of
hospital construction and renovation. For those projects that would have
increased costs due to requirements in the 2014 edition, there is no clear
alternative method that meets the intended policy goals at a lower cost.
Adverse Impacts:
Businesses: Depending on the specifics of individual hospital
construction and renovation projects, the proposed adoption of the 2014
Guidelines may increase or decrease the cost of hospital construction and
renovation. For those businesses that face increased costs, the increase will
likely be relatively moderate.
Localities: The proposed amendments are unlikely to
significantly adversely affect localities.
Other Entities: The proposed amendments are unlikely to
significantly adversely affect other entities.
_________________________________________________
Agency's Response to Economic Impact Analysis: The
Virginia Department of Health concurs with the economic impact analysis
conducted by the Department of Planning and Budget.
Summary:
The proposed amendments conform the regulation to § 32.1-127.001
of the Code of Virginia, which requires the State Board of Health to adopt
minimum standards for design and construction that are consistent with the
current edition of the Guidelines for Design and Construction of Hospital and
Health Care Facilities issued by the American Institute of Architects Academy
of Architecture for Health. The American Institute of Architects Academy of
Architecture for Health has become the Facility Guidelines Institute (FGI). The
latest edition of guidelines published by the FGI is the 2014 edition of
Guidelines for Design and Construction of Hospitals and Outpatient Facilities.
12VAC5-410-442. Obstetric service design and equipment
criteria.
A. Renovation or construction of a hospital's obstetric unit
shall be consistent with (i) section 2.1-4 2.2-2.11
of Part 2 of the 2006 2014 Guidelines for Design and Construction
of Health Care Hospitals and Outpatient Facilities of the American
Facility Guidelines Institute of Architects pursuant to § 32.1-127.001
of the Code of Virginia and (ii) the Virginia Uniform Statewide Building Code
(13VAC5-63).
B. Delivery rooms, LDR/LDRP; labor, delivery, and
recovery (LDR) rooms; labor, delivery, recovery, and postpartum (LDRP)
rooms,; and nurseries shall be equipped to provide emergency
resuscitation for mothers and infants.
C. Equipment and supplies shall be assigned for exclusive use
in the obstetric and newborn units.
D. The same equipment and supplies required for the labor
room and delivery room shall be available for use in the LDR/LDRP rooms during
periods of labor, delivery, and recovery.
E. Sterilizing equipment shall be available in the obstetric
unit or in a central sterilizing department. Flash sterilizing equipment or
sterile supplies and instruments shall be provided in the obstetric unit.
F. Daily monitoring is required of the stock of necessary equipment
in the labor, delivery, and recovery LDR rooms (LDR) and labor,
delivery, recovery and postpartum (LDRP) LDRP rooms and nursery.
G. The hospital shall provide the following equipment in the
labor, delivery and recovery rooms and, except where noted, in the LDR/LDRP
rooms:
1. Labor rooms.
a. A labor or birthing bed with adjustable side rails.
b. Adjustable lighting adequate for the examination of
patients.
c. An emergency signal and intercommunication system.
d. A sphygmomanometer, stethoscope and fetoscope or doppler.
e. Fetal monitoring equipment with internal and external
attachments.
f. Mechanical infusion equipment.
g. Wall-mounted oxygen and suction outlets.
h. Storage equipment.
i. Sterile equipment for emergency delivery to include at
least one clamp and suction bulb.
j. Neonatal resuscitation cart.
2. Delivery rooms.
a. A delivery room table that allows variation in positions
for delivery. This equipment is not required for the LDR/LDRP rooms.
b. Adequate lighting for vaginal deliveries or cesarean
deliveries.
c. Sterile instruments, equipment, and supplies to include
sterile uterine packs for vaginal deliveries or cesarean deliveries,
episiotomies or laceration repairs, postpartum sterilizations and cesarean
hysterectomies.
d. Continuous in-wall oxygen source and suction outlets for
both mother and infant.
e. Equipment for inhalation and regional anesthesia. This
equipment is not required for LDR/LDRP rooms.
f. A heated, temperature-controlled infant examination and
resuscitation unit.
g. An emergency call system.
h. Plastic pharyngeal airways, adult and newborn sizes.
i. Laryngoscope and endotracheal tubes, adult and newborn
sizes.
j. A self-inflating bag with manometer and adult and newborn
masks that can deliver 100% oxygen.
k. Separate cardiopulmonary crash carts for mothers and
infants.
l. Sphygmomanometer.
m. Cardiac monitor. This equipment is not required for the
LDR/LDRP rooms.
n. Gavage tubes.
o. Umbilical vessel catheterization trays. This equipment is
not required for LDR/LDRP rooms.
p. Equipment that provides a source of continuous suction for
aspiration of the pharynx and stomach.
q. Stethoscope.
r. Fetoscope.
s. Intravenous solutions and equipment.
t. Wall clock with a second hand.
u. Heated bassinets equipped with oxygen and transport
incubator.
v. Neonatal resuscitation cart.
3. Recovery rooms.
a. Beds with side rails.
b. Adequate lighting.
c. Bedside stands, overbed tables, or fixed shelving.
d. An emergency call signal.
e. Equipment necessary for a complete physical examination.
f. Accessible oxygen and suction equipment.
12VAC5-410-445. Newborn service design and equipment criteria.
A. Construction and or renovation of a
hospital's nursery shall be consistent with sections 2.2—2.12.1 through
2.2—2.12.6.6 (i) section 2.2-2.12 of Part 2 of the 2010
2014 Guidelines for Design and Construction of Health Care Hospitals
and Outpatient Facilities of the Facilities Facility
Guidelines Institute (formerly of the American Institute of Architects) pursuant
to § 32.1-127.001 of the Code of Virginia and (ii) the Virginia Uniform
Statewide Building Code (13VAC5-63). Hospitals with higher-level nurseries
shall comply with sections 2.2—2.10.1 through 2.2—10.9.3 section 2.2-2.10
of Part 2 of the 2010 guideline 2014 edition of the guidelines as
applicable.
B. The hospital shall provide the following equipment in the
general level nursery and all higher level nurseries, unless additional
equipment requirements are imposed for the higher level nurseries:
1. Resuscitation equipment as specified for the delivery room
in 12VAC5-410-442 G 2 shall be available in the nursery at all times;
2. Equipment for the delivery of 100% oxygen concentration,
properly heated, blended, and humidified, with the ability to measure oxygen
delivery in fractional inspired concentration (FI02). The oxygen analyzer shall
be calibrated every eight hours and serviced according to the manufacturer's
recommendations by a member of the hospital's respiratory therapy department or
other responsible personnel trained to perform the task;
3. Saturation monitor (pulse oximeter or equivalent);
4. Equipment for monitoring blood glucose;
5. Infant scales;
6. Intravenous therapy equipment;
7. Equipment and supplies for the insertion of umbilical
arterial and venous catheters;
8. Open bassinets, self-contained incubators, open radiant
heat infant care system or any combination thereof appropriate to the service
level;
9. Equipment for stabilization of a sick infant prior to
transfer that includes a radiant heat source capable of maintaining an infant's
body temperature at 99°F;
10. Equipment for insertion of a thoracotomy tube; and
11. Equipment for proper administration and maintenance of
phototherapy.
C. The additional equipment required for the intermediate
level newborn service and for any higher service level is:
1. Pediatric infusion pumps accurate to plus or minus 1
milliliter (ml) per hour;
2. On-site supply of PgE1;
3. Equipment for 24-hour cardiorespiratory monitoring for
neonatal use available for every incubator or radiant warmer;
4. Saturation monitor (pulse oximeter or equivalent) available
for every infant given supplemental oxygen;
5. Portable x-ray machine; and
6. If a mechanical ventilator is selected to provide assisted
ventilation prior to transport, it shall be approved for the use of neonates.
D. The additional equipment required for the specialty level
newborn service and a higher newborn service is as follows:
1. Equipment for 24-hour cardiorespiratory monitoring with
central blood pressure capability for each neonate with an arterial line;
2. Equipment necessary for ongoing assisted ventilation
approved for neonatal use with on-line online capabilities for
monitoring airway pressure and ventilation performance;
3. Equipment and supplies necessary for insertion and
maintenance of chest tube for drainage;
4. On-site supply of surfactant;
5. Computed axial tomography equipment (CAT) or magnetic
resonance imaging equipment (MRI);
6. Equipment necessary for initiation and maintenance of
continuous positive airway pressure (CPAP) with ability to constantly measure
delineated pressures and including alarm for abnormal pressure (i.e., vent with
PAP mode); and
7. Cardioversion unit with appropriate neonatal paddles and
ability to deliver appropriate small watt discharges.
E. The hospital shall document that it has the appropriate
equipment necessary for any of the neonatal surgical and special procedures it
provides that are specified in its medical protocol and that are required for
the specialty level newborn service.
F. The additional equipment requirements for the subspecialty
level newborn service are:
1. Equipment for emergency gastrointestinal, genitourinary,
central nervous system, and sonographic studies available 24 hours a day;
2. Pediatric cardiac catheterization equipment;
3. Portable echocardiography equipment; and
4. Computed axial tomography equipment (CAT) and magnetic
resonance imaging equipment (MRI).
G. The hospital shall document that it has the appropriate
equipment necessary for any of the neonatal surgical and special procedures it
provides that are specified in the medical protocol and are required for the
subspecialty level newborn service.
Part III
Standards and Design Criteria for New Buildings and Additions, Alterations and
Conversion of Existing Buildings
12VAC5-410-650. General building and physical plant
information.
A. All construction of new buildings and additions,
renovations, alterations or repairs of existing buildings for occupancy as a
hospital shall conform to state and local codes, zoning and building
ordinances, and the Virginia Uniform Statewide Building Code (13VAC5-63).
In addition, hospitals shall be designed and constructed according
to consistent with Part 1 and sections 2.1—1 through 2.2—8 of
Part 2 of the 2010 2014 Guidelines for Design and Construction of
Health Care Hospitals and Outpatient Facilities of the Facilities
Facility Guidelines Institute (formerly of the American Institute of
Architects). However, the requirements of the Uniform Statewide Building Code
and local zoning and building ordinances shall take precedence pursuant
to § 32.1-127.001 of the Code of Virginia.
B. All buildings shall be inspected and approved as
required by the appropriate building regulatory entity. Approval shall be a
Certificate of Use and Occupancy indicating the building is classified for its
proposed licensed purpose. Architectural drawings and specifications for
all new construction or for additions, alterations, or renovations to any
existing building shall be dated, stamped with professional seal, and signed by
the architect. The architect shall certify that the drawings and specifications
were prepared to conform to the Virginia Uniform Statewide Building Code
(13VAC5-63) and be consistent with Part 1 and Part 2 of the 2014 Guidelines for
Design and Construction of Hospitals and Outpatient Facilities of the Facility
Guidelines Institute. The certification shall be forwarded to the OLC.
12VAC5-410-760. Long-term care nursing units.
Construction and renovation of long-term care nursing units,
including intermediate and skilled nursing care nursing units, shall conform
to be designed and constructed consistent with section 2.1—3.9
2.2-2.15 of Part 2 of the 2006 2014 Guidelines for
Design and Construction of Health Care Hospitals and Outpatient
Facilities of the American Facility Guidelines Institute of
Architects pursuant to § 32.1-127.001 of the Code of Virginia.
Architectural drawings and specifications for all new
construction or for additions, alterations, or renovations to any existing building
shall be dated, stamped with professional seal, and signed by the architect.
The architect shall certify that the drawings and specifications were prepared
to conform to the Virginia Uniform Statewide Building Code (13VAC5-63) and be
consistent with section 2.2-2.15 of Part 2 of the 2014 Guidelines for
Design and Construction of Hospitals and Outpatient Facilities of the Facility
Guidelines Institute. The certification shall be forwarded to the OLC.
Part V
Design Standards for New Outpatient Surgical Hospitals and Additions and
Alterations to Existing Outpatient Surgical Hospitals
Article 1
General Considerations
12VAC5-410-1350. Codes; fire safety; zoning; construction
Local and state codes and standards.
A. All construction of new buildings and additions
alterations or repairs to existing buildings for occupancy as a
"free-standing" outpatient hospital shall conform to state and local
codes, zoning and building ordinances, and the Statewide Virginia
Uniform Statewide Building Code (13VAC5-63).
In addition, hospitals shall be designed and constructed according
to consistent with Part 1 and sections 3.1-1 through 3.1-8 3.1
and 3.7 of Part 3 of the 2010 2014 Guidelines for Design and
Construction of Health Care Hospitals and Outpatient Facilities of
the Facilities Facility Guidelines Institute (formerly of the
American Institute of Architects). However, the requirements of the Uniform
Statewide Building Code and local zoning and building ordinances shall take
precedence pursuant to § 32.1-127.001 of the Code of Virginia.
Architectural drawings and specifications for all new
construction or for additions, alterations, or renovations to any existing
building shall be dated, stamped with professional seal, and signed by the
architect. The architect shall certify that the drawings and specifications
were prepared to conform to the Virginia Uniform Statewide Building Code
(13VAC5-63) and be consistent with Part 1 and sections 3.1 and 3.7 of Part 3 of
the 2014 Guidelines for Design and Construction of Hospitals and Outpatient
Facilities of the Facility Guidelines Institute. The certification shall be
forwarded to the OLC.
B. All buildings shall be inspected and approved as
required by the appropriate building regulatory entity. Approval shall be a
Certificate of Use and Occupancy indicating the building is classified for its
proposed licensed purpose.
C. B. The use of an incinerator shall require
permitting from the nearest regional office of the Department of Environmental
Quality.
D. C. Water shall be obtained from an approved
water supply system. Outpatient surgery centers shall be connected to sewage
systems approved by the Department of Health or the Department of Environmental
Quality.
E. D. Each outpatient surgery center shall
establish a monitoring program for the internal enforcement of all applicable
fire and safety laws and regulations.
F E. All radiological machines shall be
registered with the Office of Radiological Health of the Virginia Department of
Health. Installation, calibration and testing of machines and storage
facilities shall comply with 12VAC5-480 12VAC5-481, Virginia
Radiation Protection Regulations.
G. F. Pharmacy services shall comply with
Chapter 33 (§ 54.1-3300 et seq.) of Title 54.1 of the Code of Virginia and
18VAC110-20, Regulations Governing the Practice of Pharmacy.
DOCUMENTS INCORPORATED BY REFERENCE (12VAC5-410)
Guidelines for Design and Construction of Health Care Hospitals
and Outpatient Facilities, 2014 Edition, Facilities Facility
Guidelines Institute (formerly of the American Institute of Architects),
Washington, D.C., 2010 Edition, http://www.fgiguidelines.org
VA.R. Doc. No. R13-23; Filed February 15, 2016, 12:07 p.m.