§ 23-17.29-6. Notification and consent form requirements.
(a) The notification and consent form completed by the resident shall include, at a minimum,
the following information:
(1) The resident's signed consent to electronic monitoring or the signature of the resident
representative, if applicable. If a person other than the resident signs the consent
form, the form shall document the following:
(i) The date the resident was asked if the resident wants electronic monitoring to be
conducted;
(ii) Who was present when the resident was asked;
(iii) An acknowledgment that the resident did not affirmatively object; and
(iv) The source of authority allowing the resident representative to sign the notification
and consent form on the resident's behalf;
(2) The resident's roommate's signed consent or the signature of the roommate's resident
representative, if applicable. If a roommate's resident representative signs the consent
form, the form shall document the following:
(i) The date the roommate was asked if the roommate wants electronic monitoring to be
conducted;
(ii) Who was present when the roommate was asked;
(iii) An acknowledgment that the roommate did not affirmatively object; and
(iv) The source of authority allowing the resident representative to sign the notification
and consent form on the roommate's behalf;
(3) The type of electronic monitoring device to be used;
(4) Any installation needs, such as the mounting of a device to a wall or ceiling;
(5) A list of standard conditions or restrictions that the resident or a roommate may
elect to place on the use of the electronic monitoring device, including, but not
limited to:
(i) Prohibiting audio recording;
(ii) Prohibiting video recording;
(iii) Prohibiting broadcasting of audio or video;
(iv) Turning off the electronic monitoring device or blocking the visual recording component
of the electronic monitoring device for the duration of an exam or procedure by a
healthcare professional;
(v) Turning off the electronic monitoring device or blocking the visual recording component
of the electronic monitoring device while dressing or bathing is performed; and
(vi) Turning off the electronic monitoring device for the duration of a visit with a spiritual
adviser, ombudsman, attorney, financial planner, intimate partner, or other visitor;
(6) Any other condition or restriction elected by the resident or roommate on the use
of an electronic monitoring device;
(7) A statement of the circumstances under which a recording may be disseminated under
§ 23-17.29-10; and
(8) A signature box for documenting that the resident or roommate has withdrawn consent.
(b) Facilities must make the notification and consent form available to the residents
and inform residents of their option to conduct electronic monitoring of their rooms
or private living unit.
(c) The department shall prescribe the notification and consent form required in this
chapter no later than sixty (60) days after the effective date. If the department
has not prescribed such a form by that date, a resident may use a form that substantially
complies with this chapter until such time as a prescribed form is available. Nothing
in this section shall be construed to invalidate a notification and consent form that
was used prior to the department disseminating a prescribed form solely due to it
not being the form proscribed by the department.