201
KAR 20:470. Dialysis technician credentialing requirements and training program
standards.
RELATES
TO: KRS 314.035, 314.089, 314.091, 314.137, 314.991
STATUTORY
AUTHORITY: KRS 314.131(1), 314.137
NECESSITY,
FUNCTION AND CONFORMITY: KRS 314.137 requires the board to promulgate
administrative regulations to regulate dialysis technicians. This
administrative regulation establishes the requirements for dialysis technician
training programs and for credentialing dialysis technicians.
Section
1. Definitions. (1) "Approved dialysis technician training program"
means a program to train dialysis technicians that is approved by the board.
(2)
"Central venous catheter" means a catheter that is inserted in such a
manner that the distal tip is located in the superior vena cava.
(3)
"Dialysis technician applicant" means an individual who has applied
for a dialysis technician credential.
(4)
"Dialysis technician trainee" means an individual who is enrolled in
an approved dialysis technician training program.
(5)
"Supervision" means:
(a)
Initial and ongoing direction, procedural guidance, observation, and evaluation
by a registered nurse or physician; and
(b)
While a patient is being dialyzed the registered nurse or physician is in the
immediate clinical area.
Section
2. Requirements for Dialysis Technician Credential. (1)(a) An individual who
applies to be credentialed as a dialysis technician in order to engage in
dialysis care shall:
1.
File with the board the completed Application for Dialysis Technician
Credential;
2.
Have completed a dialysis technician training program or an out-of-state
dialysis training program pursuant to paragraph (b) of this subsection. Program
approval shall be based on criteria established in the Dialysis Technician Training
Program Guide;
3.
Pay the fee established in Section 12 of this administrative regulation;
4.
Provide a criminal record check report from the Kentucky Administrative Office
of the Courts, Courtnet Disposition System that is dated within six (6) months
of the submission date of the Application for Dialysis Technician Credential;
5.
Provide a completed Federal Bureau of Investigation (FBI) Applicant Fingerprint
Card and the fee required by the FBI that is within six (6) months of the submission
date of the Application for Dialysis Technician Credential;
6.
Provide to the board a certified copy of the court record of any misdemeanor or
felony conviction from any jurisdiction, except for:
a.
Traffic-related misdemeanors (other than DUI); or
b.
Misdemeanors older than five (5) years; and
7.
Provide to the board a letter of explanation that addresses each conviction
identified pursuant to subparagraph 6. of this paragraph.
(b)1.
If the dialysis technician applicant has completed an out-of-state dialysis
technician training program, the applicant shall submit the training program
curriculum and evidence of completion to the board.
2.a.
The board or its designee shall evaluate the applicant’s training program to
determine its comparability with the standards as established in Section 7 of
this administrative regulation.
b.
The board or its designee shall advise an applicant if the training program is
not comparable and specify what additional components shall be completed to
meet the requirements of Section 7 of this administrative regulation.
2.
A dialysis technician applicant who has completed an out-of-state dialysis
technician training program shall be required to complete that portion of a
board-approved dialysis technician training program related to specific
portions of the legal and ethical aspects of practice as established in the
Dialysis Technician Training Program Guide.
3.
An applicant shall submit evidence to the board of successful completion of the
following sections of the Dialysis Technician Training Program Guide:
a.
State and Federal Regulations Governing Dialysis;
b.
The Principles and Legal Aspects of Documentation, Communication and Patient Rights;
c.
The Roles of the Dialysis Technician and other Multidisciplinary Team Members;
and
d.
Principles Related to Patient Safety.
4.
A dialysis technician applicant who has completed an out-of-state dialysis
technician training program shall submit the completed Checklist for Dialysis
Technician Competency Validation signed by the applicant's immediate supervisor
in Kentucky. The Checklist for Dialysis Technician Competency Validation shall
be filed after the submission of the Application for Dialysis Technician Credential.
5.
A dialysis technician applicant who has completed an out-of-state dialysis
technician training program shall submit evidence of:
a.
Successful completion of a comprehensive, written final examination from a
board-approved dialysis technician training program; or
b.
Dialysis technician certification issued within the past two (2) years by the
Nephrology Nursing Certification Commission, the Board of Nephrology Examiners
Nursing and Technology, or the National Nephrology Certification Organization.
(2)
An individual shall be exempt from the credentialing requirement while enrolled
in an approved dialysis technician training program. The individual shall use
the title dialysis technician trainee.
(3)
Upon approval, pursuant to subsection (1) of this section, of the Application
for Dialysis Technician Credential, the board shall initially issue the
dialysis technician credential for twenty-four (24) months following the month
of issuance. The credential shall lapse on the last day of the credentialing
period.
(4)(a)
An applicant for a dialysis technician credential may engage in dialysis care
as a dialysis technician applicant upon:
1.
Receipt by the board of the Application for Dialysis Technician Credential; and
2.
Meeting the requirements of subsection (6) of this section.
(b)
The dialysis technician applicant shall only practice dialysis care as an
applicant until:
1.
The credential is issued; or
2.
The application is denied by the board.
(5)
An Application for Dialysis Technician Credential submitted for initial
credentialing shall be valid for six (6) months from the date of receipt by the
board.
(6)
A felony or misdemeanor conviction shall be reviewed to determine, based on
Section 6(2)(c) of this administrative regulation, if:
(a)
The Application for Dialysis Technician Credential shall be processed with no
further action; or
(b)
The Application for Dialysis Technician Credential shall be processed only after:
1.
The applicant has entered into an agreed order with the board with terms and
conditions as agreed by the parties; or
2.
If the parties are unable to agree on terms and conditions, a hearing is held
pursuant to KRS 314.091 and 201 KAR 20:162, and a final decision is entered by
the board.
(7)
An applicant shall not be credentialed until a report is received from the FBI
pursuant to the request submitted pursuant to subsection (1)(a)5 of this
section and any conviction is addressed by the board.
Section
3. Renewal. (1) To be eligible for renewal of the credential, the dialysis
technician shall submit, no later than one (1) month prior to the expiration
date of the credential:
(a)
The completed Application for Renewal of the Dialysis Technician Credential;
and
(b)
The fee established in Section 12 of this administrative regulation.
(2)
Upon approval of the Application for Renewal of the Dialysis Technician
Credential, the credential shall be renewed for twenty-four (24) months. The
credential shall lapse on the last day of the credentialing period.
(3)
A dialysis technician shall report to the board at renewal the name of the
national certification program that has issued the technician's certification
and provide a copy of the certification certificate to the board.
Section
4. Reinstatement. (1) Before beginning practice as a dialysis technician or a
dialysis technician applicant, the individual shall meet the requirements of
this section. If the dialysis technician credential has lapsed for a period of
less than one (1) credentialing period, the individual may reinstate the
credential. The reinstatement shall be accomplished by:
(a)
Submitting the completed Application for Dialysis Technician Credential;
(b)
Paying the fee established in Section 12 of this administrative regulation; and
(c)
Providing a criminal record check report from the Kentucky Administrative
Office of the Courts, Courtnet Disposition System that is dated within six (6)
months of the submission date of the Application for Dialysis Technician
Credential.
(2)
If the dialysis technician credential has lapsed for more than one (1)
credentialing period, the dialysis technician may reinstate the credential. The
reinstatement shall be accomplished by:
(a)
Completing a dialysis technician training program approved by the board
pursuant to the criteria established in the Dialysis Technician Training
Program Guide before submitting the Application for Dialysis Technician
Credential. While enrolled in a training program, the individual shall be
referred to as a dialysis technician trainee;
(b)
Submitting the completed Application for Dialysis Technician Credential;
(c)
Paying the fee established in Section 12 of this administrative regulation;
(d)
Submitting the Checklist for Dialysis Technician Competency Validation signed
by the individual's immediate supervisor;
(e)
Providing a criminal record check report from the Kentucky Administrative
Office of the Courts, Courtnet Disposition System that is dated within six (6)
months of the submission date of the Application for Dialysis Technician
Credential; and
(f)
Providing a completed Federal Bureau of Investigation (FBI) Applicant Fingerprint
Card and the fee required by the FBI that is dated within six (6) months of the
submission date of the Application for Dialysis Technician Credential.
(3)
An Application for Dialysis Technician Credential submitted for reinstatement
shall be valid for six (6) months from the date of receipt by the board.
(4)
Upon approval of the Application for Dialysis Technician Credential pursuant to
Section 2(1) of this administrative regulation, the credential shall be
reinstated for twenty-four (24) months following the month of issuance. The
credential shall lapse on the last day of the credentialing period.
(5)
An applicant shall not be credentialed until a report is received from the FBI
pursuant to the request submitted pursuant to subsection (2)(f) of this section
and any conviction is addressed by the board.
Section
5. Scope of Practice. (1) The scope of practice of a dialysis technician shall
include the following and shall be performed under the direct, on-site
supervision of a registered nurse or a physician:
(a)
Preparation and cannulation of peripheral access sites (arterial-venous
fistulas and arterial-venous grafts);
(b)
Initiating, delivering, or discontinuing dialysis care;
(c)
Administration of the following medications only:
1.
Heparin 1:1000 units or less concentration either to prime the pump, initiate
treatment, or for administration throughout the treatment, in an amount
prescribed by a physician, physician’s assistant, or advanced registered nurse
practitioner. The dialysis technician shall not administer heparin in
concentrations greater than 1:1000 units;
2.
Normal saline via the dialysis machine to correct dialysis-induced hypotension
based on the facility’s medical protocol. Amounts beyond that established in
the facility’s medical protocol shall not be administered without direction
from a registered nurse or a physician; and
3.
Intradermal lidocaine, in an amount prescribed by a physician, physician’s
assistant, or advanced practice registered nurse;
(d)
Assistance to the registered nurse in data collection;
(e)
Obtaining a blood specimen via a dialysis line or a peripheral access site;
(f)
Responding to complications that arise in conjunction with dialysis care; and
(g)
Performance of other acts as delegated by the registered nurse pursuant to 201
KAR 20:400.
(2)
The scope of practice of a dialysis technician shall not include:
(a)
Dialysis care for a patient whose condition is determined by the registered
nurse to be critical, fluctuating, unstable, or unpredictable;
(b)
The connection and disconnection of patients from, and the site care and
catheter port preparation of, percutaneously or surgically inserted central
venous catheters; and
(c)
The administration of blood and blood products.
Section
6. Discipline of a Dialysis Technician. (1) A dialysis technician, an employer
of dialysis technicians, or any person having knowledge of facts shall report
to the board a dialysis technician who may have violated any provision of this
administrative regulation.
(2)
The board shall have the authority to discipline a dialysis technician for:
(a)
Failure to safely and competently perform the duties of a dialysis technician
as established in Section 5 of this administrative regulation;
(b)
Practicing beyond the scope of practice as established in Section 5 of this
administrative regulation;
(c)
Conviction of any felony, or a misdemeanor involving drugs, alcohol, fraud,
deceit, falsification of records, a breach of trust, physical harm or
endangerment to others, or dishonesty under the laws of any state or of the
United States. The record of conviction or a copy thereof, certified by the
clerk of the court or by the judge who presided over the conviction, shall be
conclusive evidence. A "conviction" shall include pleading no contest,
entering an Alford plea, or entry of a court order suspending the imposition of
a criminal penalty to a crime;
(d)
Obtaining or attempting to obtain a credential by fraud or deceit;
(e)
Abusing controlled substances, prescription medications, or alcohol;
(f)
Personal misuse or misappropriation for use of others of any drug placed in the
custody of the dialysis technician for administration;
(g)
Falsifying or in a negligent manner making incorrect entries or failing to make
essential entries on essential records;
(h)
Having a dialysis technician credential disciplined by another jurisdiction on
grounds sufficient to cause a credential to be disciplined in this
Commonwealth;
(i)
Practicing without filing an Application for Dialysis Technician Credential or
without holding a dialysis technician credential;
(j)
Abuse of a patient;
(k)
Theft of facility or patient property;
(l)
Having disciplinary action on a professional or business license;
(m)
Violating any lawful order or directive previously entered by the board;
(n)
Violating any applicable requirement of 201 KAR Chapter 20;
(o)
Having been listed on the nurse aide abuse registry with a substantiated
finding of abuse, neglect, or misappropriation of property; or
(p)
Having violated the confidentiality of information or knowledge concerning any
patient, except as authorized or required by law.
(3)
The discipline may include the following:
(a)
Immediate temporary suspension of the credential, following the procedure established
in KRS 314.089;
(b)
Reprimand of the credential;
(c)
Probation of the credential for a specified period of time, with or without
limitations and conditions;
(d)
Suspension of the credential for a specified period of time;
(e)
Permanent revocation of the credential; or
(f)
Denying the Application for Dialysis Technician Credential.
(4)
The board shall follow the procedures established in and have the authority established
in KRS 314.091, 201 KAR 20:161, and 201 KAR 20:162 for management and
resolution of complaints filed against a dialysis technician.
(5)
In addition to the provisions of subsection (3) of this section, the board may
impose a civil penalty of up to $10,000.
Section
7. Dialysis Technician Training Program Standards. (1) Program administrator. Each
dialysis technician training program shall have a registered nurse who holds a
current Kentucky license, temporary work permit, or multistate privilege, with
at least one (1) year of experience in dialysis care, who shall be
administratively responsible for planning, development, implementation, and
evaluation of the dialysis technician training program.
(a)
The name, title, and credentials identifying the educational and professional
qualifications of the program administrator shall be provided to the board.
(b)
A change in the program administrator shall be reported to the board within
thirty (30) days of the change.
(2)
Faculty qualifications.
(a)
The dialysis technician training program shall be taught by multidisciplinary
faculty with expertise in the subject matter.
(b)
The name, title, and credentials identifying the educational and professional
qualifications of each didactic and clinical instructor shall be provided to
the board.
(3)
The dialysis technician training program shall be based upon the Dialysis
Technician Training Program Guide.
(4)
The dialysis technician training program syllabus shall include:
(a)
Prerequisites for admission to the program;
(b)
Program outcomes. The outcomes shall provide statements of measurable
competencies to be demonstrated by the learner; supportive content identified;
(d)
Content. The content shall be described in outline format with corresponding
time frame and testing schedules;
(e)
Teaching methods. The activities of both instructor and learner shall be specified.
These activities shall be congruent with stated objectives and content and
shall reflect application of adult learning principles;
(f)
Instructional or reference materials. All required instructional reference
materials shall be identified; and
(g)
Evaluation. There shall be:
1.
Clearly defined criteria for evaluating the learner's achievement of program
outcomes; and
2.
A process for annual program evaluation by trainees, program administrator, faculty,
and employers.
(5)
Any proposed substantive changes to the dialysis technician training program
syllabus after initial submission shall be submitted to the board in writing
and shall not be implemented without approval from the board pursuant to the
criteria established in the Dialysis Technician Training Program Guide.
(6)
Trainee clinical practice requirements. The dialysis technician trainee
enrolled in a dialysis technician training program shall practice dialysis care
incidental to the training program only under the supervision of a faculty
member or the faculty member’s designee.
(7)
The dialysis technician training program shall be at least 400 hours in length.
A minimum of 200 hours shall be didactic.
(8)
Completion requirements. Requirements for successful completion of the dialysis
technician training program shall be clearly specified.
(a)
The requirements shall include demonstration of clinical competency and
successful completion of a comprehensive, written final examination.
(b)
The final examination shall be administered only during the final forty (40)
hours of the training program.
(c)
There shall be a statement of policy regarding a trainee who fails to
successfully complete the training program.
(9)
The program shall establish a written records retention plan describing the
location and length of time records shall be maintained. At a minimum, the following
records shall be maintained by the program:
(a)
Provider name, dates of program offerings, and sites of the training program;
(b)
The program code number issued by the board; and
(c)
Trainee roster, with a minimum of name, date of birth, Social Security number,
and program completion date.
(10)
An individual who successfully completes the training program shall receive a
certificate of completion that documents the following:
(a)
Name of individual;
(b)
Title of training program, date of completion, and location;
(c)
Provider’s name;
(d)
The program code number issued by the board; and
(e)
Name and signature of program administrator.
(11)
The program shall submit the List of Dialysis Technician Training Program
Graduates within three (3) working days of the program completion date.
(12)(a)
The program shall notify the board in writing within thirty (30) days of a
training program closure.
(b)
The notification shall include:
1.
The date of closing;
2.
A copy of the program trainee roster from the date of the last renewal to the
date of closing;
3.
The location of the program's records as established in subsection (9) of this
section; and
4.
The name and address of the custodian of the records.
(13)
A dialysis technician training program that conducts either the didactic
portion or the clinical portion in this state shall be required to be approved
by the board pursuant to the criteria established in the Dialysis Technician
Training Program Guide, and the program shall meet the requirements of this section.
Section
8. Dialysis Technician Training Program Initial Approval. (1) To receive
initial approval, a dialysis technician training program shall:
(a)
File a completed Application for Dialysis Technician Training Program Approval;
and
(b)
Pay the fee established in Section 12 of this administrative regulation.
(2)
Board approval for a dialysis technician training program that meets the
requirements of this administrative regulation shall be granted for a two (2)
year period from the date of approval.
(3)
Upon approval, the board shall issue a program code number.
Section
9. Continued Board of Approval of a Dialysis Technician Training Program. (1)
To receive continued approval, a dialysis technician training program shall:
(a)
File a completed Application for Dialysis Technician Training Program Approval;
(b)
Submit an annual program evaluation summary report and any actions taken as a
result of the evaluation as required by Section 7(4)(g) of this administrative
regulation;
(c)
Submit a list of current faculty including the name, title, and credential
identifying the educational and professional qualifications of each instructor;
(d)
Submit a copy of the program trainee roster for the past two (2) years as
required by Section 7(9)(c) of this administrative regulation; and
(e)
Pay the fee established in Section 12 of this administrative regulation.
(2)
The completed Application for Dialysis Technician Training Program Approval
shall be submitted at least two (2) months prior to the end of the current
approval period.
(3)
Continued approval shall be based on compliance with the standards established
in Section 7 of this administrative regulation.
(4)
Continued approval shall be granted for a two (2) year period.
(5)
If a program fails to maintain continued approval, the approval shall lapse.
Section
10. Reinstatement of Dialysis Technician Training Programs. A program with
lapsed approval that seeks to reinstate that approval shall:
(1)
File a completed Application for Dialysis Technician Training Program Approval;
and
(2)
Pay the fee established in Section 12 of this administrative regulation.
Section
11. Board Actions on Dialysis Technician Training Programs. (1) A
representative of the board may make a site visit to a dialysis technician
training program to evaluate compliance with 201 KAR Chapter 20.
(2)
The board shall prepare a report of the site visit, identifying deficiencies
for the training program if applicable, and shall include recommendations and
requirements to be met in order to maintain compliance with standards.
(3)
The program administrator shall submit to the board a response to the site
visit report.
(4)
Based on the report of deficiencies, the training program's response, and any
other relevant evidence, the board shall grant approval, continue approval,
continue approval with stipulations, or propose to deny or withdraw approval of
the program.
(5)
A dialysis technician training program administrator may request a review of a
board decision concerning approval. A review shall be conducted using the
following procedure:
(a)
A written request for the review shall be filed with the board within thirty
(30) days after the date of notification of the board action that the dialysis
technician training program administrator contests.
(b)
The board, or the board’s designee, shall conduct a review. The dialysis
technician training program administrator may appear in person to present
reasons why the board's decision should be set aside or modified.
(c)
The dialysis technician training program administrator shall be notified of the
board’s decision.
(6)
The board shall deny or withdraw approval of a program after an administrative
hearing conducted pursuant to KRS Chapter 13B.
Section
12. Fees. (1) The application fee for the initial credential shall be seventy
(70) dollars.
(2)
The credential renewal fee shall be seventy (70) dollars.
(3)
The credential reinstatement fee shall be $100.
(4)
The dialysis technician training program initial approval fee shall be $950.
(5)
The dialysis technician training program continued approval fee shall be $800.
(6)
The dialysis technician training program reinstatement fee shall be $950.
(7)
An additional fee of twenty-five (25) dollars shall be charged for an
Application for Renewal of Dialysis Technician Credential that is filed after
the deadline for filing.
(8)
An additional fee of $150 shall be charged for an Application for Dialysis
Technician Training Program Approval that is filed after the deadline for
continued approval filing.
(9)
A fee of ten (10) dollars shall be charged for issuing a duplicate of the
credential.
(10)
A check submitted to the board for payment of a fee that is returned by the
bank for nonpayment shall be assessed a return check fee of thirty-five (35)
dollars.
(11)
A fee of ten (10) dollars shall be charged for written verification of a
dialysis technician credential. If submitted in list format, a fee of ten (10)
dollars for the first name shall be assessed and a fee of one (1) dollar shall
be assessed for each additional name.
(12)
A fee of twenty-five (25) dollars shall be charged for a duplicate application
form that is issued due to the failure to maintain a current mailing address as
required by Section 13 of this administrative regulation.
(13)
A fee of thirty five (35) dollars shall be charged for a name change and the
issuance of a new credential.
(14)
All fees shall be nonrefundable.
Section
13. Miscellaneous Requirements. (1) Any person credentialed by the board as a
dialysis technician shall maintain a current mailing address with the board and
immediately notify the board in writing of a change of mailing address.
(2)(a)
Holding a credential shall constitute consent by the dialysis technician to
service of notices or orders of the board. Notices and orders shall be sent to
the mailing address on file with the board.
(b)
Any notice or order of the board mailed or delivered to the mailing address on
file with the board shall constitute valid service of the notice or order.
(3)(a)
Any dialysis technician credentialed by the board shall, within ninety (90)
days of entry of the final judgment, notify the board in writing of any
misdemeanor or felony conviction in this or any other jurisdiction. A
conviction shall include pleading no contest, entering an Alford plea, or entry
of a court order suspending the imposition of a criminal penalty to a crime.
(b)
Upon learning of any failure to notify the board pursuant to this subsection,
the board shall initiate an action for immediate temporary suspension until the
person submits the required notification.
(4)
Any dialysis technician credentialed by the board shall immediately notify the
board in writing if any professional or business license that is issued to the
person by any agency of the commonwealth or any other jurisdiction:
(a)
Is surrendered or terminated under threat of disciplinary action;
(b)
Is refused, limited, suspended, or revoked; or
(c)
If renewal of continuance is denied.
(5)
If the board has reasonable cause to believe that any dialysis technician is
unable to practice with reasonable skill and safety or has abused alcohol or
drugs, it shall require the person to submit to a chemical dependency
evaluation or a mental or physical examination by a practitioner it designates.
(a)
Holding a credential shall constitute:
1.
Consent by the dialysis technician to a chemical dependency evaluation, mental
examination, or physical examination if directed in writing by the board. The
direction to submit to an evaluation or examination shall contain the basis for
the board’s concern that the technician is unable to practice safely and
effectively; and
2.
Waiver of objections to the admissibility of the examining practitioner’s
testimony or examination reports on the grounds of privileged communication.
(b)
The dialysis technician shall bear the cost of chemical dependency evaluation,
mental examination, or physical examination ordered by the board.
(c)
Upon failure of the dialysis technician to submit to a chemical dependency
evaluation, mental examination, or physical examination ordered by the board,
unless due to circumstances beyond the person’s control, the board shall
initiate an action for immediate temporary suspension pursuant to KRS 314.089
or deny an application until the person submits to the required examination.
(d)
If a chemical dependency evaluation, mental examination, or physical
examination pursuant to this subsection results in a finding that indicates
that the dialysis technician is unable to practice with reasonable skill and
safety or has abused alcohol or drugs, the dialysis technician shall be subject
to disciplinary procedures as established in Section 6 of this administrative
regulation.
Section
14. Due process procedures, including appeal, pertaining to this administrative
regulation shall be conducted in accordance with KRS Chapter 13B.
Section
15. Incorporation by Reference. (1) The following materials are incorporated by
reference:
(a)
"Application for Dialysis Technician Training Program Approval",
Kentucky Board of Nursing, 6/06;
(b)
"Application for Dialysis Technician Credential", Kentucky Board of
Nursing, 12/09;
(c)
"Application for Renewal of Dialysis Technician Credential", Kentucky
Board of Nursing, 9/07;
(d)
"Checklist for Dialysis Technician Competency Validation", Kentucky
Board of Nursing, 9/07;
(e)
"Dialysis Technician Training Program Guide", August 14, 2001,
Kentucky Board of Nursing; and
(f)
"List of Dialysis Technician Training Program Graduates", Kentucky
Board of Nursing, 9/07.
(2)
This material may be inspected, copied, or obtained, subject to applicable
copyright law, at the Kentucky Board of Nursing, 312 Whittington Parkway, Suite
300, Louisville, Kentucky 40222-5172, Monday through Friday, 8 a.m. to 4:30
p.m. (28 Ky.R. 723; Am. 1115; eff. 10-17-2001; 29 Ky.R. 2952; eff. 8-13-2003;
31 Ky.R. 1195; 1402; eff. 2-22-2005; 33 Ky.R. 872; eff. 11-15-2006; 34 Ky.R.
1100; 1707; eff. 2-1-2008; 36 Ky.R. 1984; 2031-A; eff. 5-7-2010; 37 Ky.R. 438;
eff. 10-20-2010; Am. 37 Ky.R. 1748; eff. 4-1-2011; 2915; eff. 8-17-2011; 40
Ky.R. 1869; 2416; eff. 6-6-2014.)
