DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS  
BUREAU OF COMMUNITY AND HEALTH SYSTEMS  
LICENSING HEALTH FACILITIES OR AGENCIES  
Filed with the secretary of state on March 25, 2024  
These rules become effective immediately after filing with the secretary of state unless adopted  
under section 33, 44, or 45a(9) of the administrative procedures act of 1969, 1969 PA 306, MCL  
24.233, 24.244, or 24.245a. Rules adopted under these sections become effective 7 days after  
filing with the secretary of state.  
(By authority conferred on the department of licensing and regulatory affairs by sections 20115,  
20131, 20132, 20141, 20171, 21419, 21521, 21523, 21561, 21562, 21563, 21615, 21741, and  
21795 of the public health code, 1978 PA 368, MCL 333.20115, 333.20131, 333.20132,  
333.20141, 333.20171, 333.21419, 333.21521, 333.21523, 333.21561, 333.21562, 333.21563,  
333.21615, 333.21741, and 333.21795, and Executive Reorganization Order Nos. 1994-1, 1996-  
1, 1997-4, 2003-1, 2009-20, 2011-4, and 2015-1, MCL 333.26322, 330.3101, 333.26324,  
445.2011, 333.26366, 445.2030, and 400.227)  
R 325.45101, R 325.45103, and R 325.45193 of the Michigan Administrative Code are  
amended, and R 325.45341 and R 325.45343 are rescinded, as follows:  
R 325.45101 Applicability.  
Rule 101. (1) Rules 325.45103 to 325.45323 are applicable to all of the following:  
(a) Freestanding surgical outpatient facility.  
(b) Hospice.  
(c) Hospital.  
(d) Nursing care facility.  
(2) Rules 325.45331 to 325.45339 are only applicable to a freestanding surgical outpatient  
facility.  
(3) Rules 325.45345 to 325.45367 are only applicable to a hospice.  
(4) Rules 325.45369 to 325.45375 are only applicable to a hospital.  
(5) Rules 325.45377 to 325.45385 are only applicable to a nursing care facility.  
R 325.45103 Definitions; A to F.  
Rule 103. (1) As used in these rules:  
(a) “Anesthesia” means a state of loss of feeling or sensation and is normally used to denote the  
loss of sensation to pain that is purposely induced using a specific gas or drug to permit the  
performance of surgery or other painful procedure.  
(b) “Anesthesiologist” means a physician who specializes in the field of anesthesiology and  
who may or may not be a diplomate of the physician’s specialty board.  
March 11, 2024  
2
(c) “Anesthetic” means a drug, gas, or other agent used to abolish the sensation of pain. There  
are 3 classifications as follows:  
(i) “General anesthetic” means an anesthetic agent that produces a temporary loss of  
consciousness by the administration of a gas; oral, intramuscular, or intravenous drugs; or a  
combination of these methods.  
(ii) “Local anesthetic” means a drug whose action is limited to an area of the body around the  
site of its application.  
(iii) “Spinal,” “epidural,” or “caudal” anesthetic means the injection of a local anesthetic into  
the spinal canal epidural area to produce a loss of sensitivity to the body areas at and below the  
sensory nerve distribution at the level of the injection.  
(d) “Anesthetist” means an individual who is qualified to administer anesthetic.  
(e) “Applicant” means an individual applying to the department for a health facility or agency  
license.  
(f) “Article 15” means article 15 of the code, MCL 333.16101 to 333.18838.  
(g) “Article 17” means article 17 of the code, MCL 333.20101 to 333.22260.  
(h) “Bereavement services” means emotional, psychosocial, or spiritual support services  
provided to the family before or after the death of the patient to assist the family in coping with  
issues related to grief, loss, or adjustment.  
(i) “Building change” means alterations to an existing building involving a change in the  
interior configuration or intended use, including alterations to the mechanical, electrical, or  
plumbing systems. This term does not include routine maintenance or replacement with  
comparable mechanical, electrical, or plumbing equipment that does not alter the current  
physical structure.  
(j) “Business day” means a day other than a Saturday, Sunday, or any legal holiday.  
(k) “Change of ownership” means the transfer of a health facility or agency from 1 owner to  
another if the licensee changes. This term does not include a transfer of a health facility or  
agency from 1 owner to another if the licensee does not change.  
(l) “Code” means the public health code, 1978 PA 368, MCL 333.1101 to 333.25211.  
(m) “Complainant” means an individual who files a complaint with the department alleging  
that a person has violated the code, an order issued under the code, or administrative rules  
promulgated thereunder.  
(n) “Correction notice” means a notice from the department to a health facility or agency  
specifying violations of the code or these rules, corrective action to be taken, and the period in  
which the corrective action is to be completed.  
(o) “Department” means the department of licensing and regulatory affairs.  
(p) “Discharge” means that term as defined in section 21702 of the code, MCL 333.21702. In  
addition, as used in these rules, “discharge” means the voluntary or involuntary movement of a  
patient out of any type of health facility or agency.  
(q) “Freestanding surgical outpatient facility” or “FSOF” means a facility as defined in section  
20104 of the code, MCL 333.20104. Characteristics of a freestanding surgical outpatient facility  
include, but are not limited to, patient encounters with a physician, dentist, podiatrist, or other  
provider primarily for performing surgical procedures or related diagnosis, consultation,  
observation, and postoperative care, and the owner or operator may make the facility available to  
other physicians, dentists, podiatrists, or other providers who comprise its professional staff.  
This term does not include a private office of a physician, dentist, podiatrist, or other health  
professional whose patients are limited to those of the individual licensed professional  
3
maintaining and operating the office or the combined patients of individually licensed  
professionals practicing together in a legally constituted professional corporation, association, or  
partnership and sharing office space, if the private office is maintained and operated by a  
licensed health professional in accordance with usual practice patterns according to the type of  
practice and patient encounters in the office are for diagnosis and treatment and are not limited  
primarily to the performance of surgical procedures and related care.  
(2) Unless otherwise specified, a term defined in the code has the same meaning when used in  
these rules.  
R 325.45193 Surgical patient record; required information; informed consent.  
Rule 193. (1) In addition to R 325.45191, a freestanding surgical outpatient facility and a  
hospital shall keep and maintain in the surgical patient record all of the following:  
(a) Name of the surgeon.  
(b) Name of the anesthesiologist or anesthetist, if other than the surgeon, if applicable.  
(c) Preoperative study and diagnosis details if medically necessary.  
(d) Provider notes including preoperative and postoperative vital signs and other relevant  
observations to document the patient’s stabilized condition at the time of discharge.  
(e) Product name and dosage of any sedative and anesthetic used.  
(f) Method of anesthesia and any pertinent information concerning results or reactions.  
(g) Operation and treatment notes and consultations.  
(h) The postoperative diagnosis, including pathological findings.  
(i) Social or social service information relevant to the case.  
(j) Surgeon's operative note including all of the following:  
(i) Name of each procedure performed.  
(ii) Duration of procedure and any unusual problems or occurrences encountered.  
(iii) Surgeon's description of gross appearance of any tissues removed.  
(k) Summary of instructions given for follow-up observation and care.  
(2) The facility shall obtain informed consent from a patient, or the responsible relative or  
guardian in the case of an unemancipated minor, before the performance of a surgical procedure  
and maintain the signed written consent form or forms in the patient's record.  
R 325.45341 Rescinded.  
R 325.45343 Rescinded.  
;