6 Colo. Code Regs. § 1007-1-7-C

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1007-1-7-C - General Technical Requirements

7.15Quality Control of Diagnostic Equipment.

7.15.1 Each licensee shall establish written quality control procedures for all diagnostic equipment used for radionuclide studies.

7.15.2 As a minimum, quality control procedures and frequencies shall be:

7.15.2.1 Those recommended by equipment manufacturers; or

7.15.2.2 Procedures which have been approved by the Department.

7.15.3 The licensee shall conduct quality control of diagnostic equipment in accordance with written procedures.

7.15.4 A licensee shall retain a record of each quality control test required by the written quality control procedures for 3 years.

7.16Possession, use, and calibration of instruments used to measure the activity of unsealed radioactive material.

7.16.1 For direct measurements performed in accordance with 7.18, a licensee shall possess and use instrumentation to measure the activity of unsealed radioactive materials prior to administration to each patient or human research subject.

7.16.2 A licensee shall calibrate the instrumentation required in 7.16.1 in accordance with nationally recognized standards or the manufacturer's instructions.

7.16.3 In addition to the calibration required in 7.16.2, the licensee shall at a minimum also perform tests for constancy, linearity, and geometry dependence, as appropriate to demonstrate proper operation of the instrument.

7.16.4 A licensee shall retain a record of each instrument calibration and test required by 7.16 for 3 years. The record shall include the:

7.16.4.1 Model and serial number of the instrument;

7.16.4.2 Date of the calibration and other tests;

7.16.4.3 Results of the calibration and other tests; and

7.16.4.4 Name of the individual who performed the calibration and other tests.

7.17Calibration of survey instruments.

7.17.1 A licensee shall calibrate the survey instruments used to show compliance with Part 4 and Part 7 before first use, annually at intervals not to exceed 12 months, and following a repair that affects the calibration. A licensee shall:

7.17.1.1 Calibrate all scales with readings up to 10 mSv (1000 mrem) per hour with a radiation source;

7.17.1.2 Calibrate two separate readings on each scale or decade that will be used to show compliance; and

7.17.1.3 Conspicuously note on the instrument the date of calibration.

7.17.2 A licensee may not use survey instruments if the difference between the indicated exposure rate and the calculated exposure rate is more than 20 percent.

7.17.3 A licensee shall retain a record of each survey instrument calibration required by 7.17 for 3 years. The record shall include the:

7.17.3.1 Model and serial number of the instrument;

7.17.3.2 Date of the calibration;

7.17.3.3 Results of the calibration; and

7.17.3.4 Name of the individual who performed the calibration.

7.18Determination of dosages of unsealed radioactive material for medical use.

7.18.1 A licensee shall determine and record the activity of each dosage before medical use.

7.18.1.1 For photon-emitting radioactive material, this determination shall be within 30 minutes prior to medical use.

7.18.1.2 For all other radioactive material, this determination shall be within the period before medical use that is no greater than 10 percent of the physical half-life of the radioactive material.

7.18.2 For a unit dosage, the determination required by 7.18.1 shall be made by:

7.18.2.1 Direct measurement of radioactivity; or

7.18.2.2 A decay correction, based on the measurement made by:

(1) A manufacturer or preparer licensed pursuant to Part 3 of these regulations or equivalent provisions of an Agreement State, or NRC; or

(2) An NRC or Agreement State licensee for use in research in accordance with a Radioactive Drug Research Committee-approved protocol or an Investigational New Drug (IND) protocol accepted by FDA.

(3) A PET radioactive drug producer licensed under Part 3, Section 3.8.10 or equivalent NRC or Agreement State requirements.

7.18.3 For other than unit dosages, the determination by 7.18.1 shall be made by:

7.18.3.1 Direct measurement of radioactivity; or

7.18.3.2 Combination of measurement of radioactivity and mathematical calculations; or

7.18.3.3 Combination of volumetric measurements and mathematical calculations, based on the measurement made by:

(1) A manufacturer or preparer licensed pursuant to Part 3 of these regulations or equivalent provisions of an Agreement State, or NRC.

(2) A PET radioactive drug producer licensed under Part 3, Section 3.8.10 or equivalent NRC or Agreement State requirements.

7.18.4 Unless otherwise directed by the authorized user, a licensee shall not use a dosage if the dosage differs from the prescribed dosage by more than 20 percent.

7.18.5 A license shall retain a record of the each dosage determination required by 7.18.1 for 3 years. The record shall contain the:

7.18.5.1 Name of the radioactive drug;

7.18.5.2 Patient's or human research subject's name, and identification number if one has been assigned;

7.18.5.3 Prescribed dosage;

7.18.5.4 Determined dosage; or a notation that the total activity is less than 1.1 MBq (30 µCi);

7.18.5.5 Date and time of the dosage determination; and

7.18.5.6 Name of the individual who determined the dosage.

7.19Authorization for calibration, transmission and reference sources.

7.19.1 Any person authorized by 7.3 for medical use of radioactive material may receive, possess, and use any of the following radioactive material for check, calibration, transmission and reference use:

7.19.1.1 Sealed sources, not exceeding 1.11 GBq (30 mCi) each, manufactured and distributed by a person licensed under Part 3, by NRC under 10 CFR 32.74 or equivalent Agreement State regulations;

7.19.1.2 Sealed sources, not exceeding 1.11 GBq (30 mCi) each, redistributed by a licensee authorized to redistribute the sealed sources manufactured and distributed by a person licensed under Part 3, by NRC under 10 CFR 32.74 or equivalent Agreement State regulations, providing the redistributed sealed sources are in the original packaging and shielding and are accompanied by the manufacturer's approved instructions;

7.19.1.3 Any radioactive material with a half-life not longer than 120 days or less in individual amounts not to exceed 0.56 GBq (15 mCi);

7.19.1.4 Any radioactive material with a half life longer than 120 days in individual amounts not to exceed the smaller of 7.4 MBq (200 uCi) or 1000 times the quantities in Part 3 Schedule 3B; or

7.19.1.5 Technetium-99m in amounts as needed.

7.19.2 Radioactive material in sealed sources authorized by this provision shall not be:

7.19.2.1 Used for medical use as defined in 7.2 except in accordance with the requirements in 7.40; or

7.19.2.1 Combined (i.e., bundled or aggregated) to create an activity greater than the maximum activity of any single sealed source authorized under 7.19.

7.19.3 A licensee using calibration, transmission, and reference sources in accordance with the requirements in 7.19.1 or 7.19.2 need not list these sources on a specific medical use license.

7.20 Requirements for possession of sealed sources and brachytherapy sources.

7.20.1 A licensee in possession of any sealed source or brachytherapy source shall follow the radiation safety and handling instructions supplied by the manufacturer or equivalent instructions approved by the Department and shall maintain the instructions for the duration of source use in a legible form convenient to users.

7.20.2 A licensee in possession of a sealed source shall:

7.20.2.1 Test the source for leakage before its first use unless the licensee has a certificate from the supplier indicating that the sources was tested within 6 months before transfer to the licensee; and

7.20.2.2 Test the source for leakage at intervals not to exceed 6 months or at intervals approved by the Department, an Agreement State, or the NRC in the Sealed Source and Device Registry.

7.20.2.3 A licensee shall retain records of leak tests required by 7.20.2 for 3 years. The records must include the model number, and serial number if one has been assigned, of each source tested; the identity of each source by radionuclide and its estimated activity; the results of the test; the date of the test; and the name of the individual who performed the test.

7.20.3 To satisfy the leak test requirements of 7.20, the licensee shall measure the sample so that the leak test can detect the presence of 185 Bq (0.005 uCi) of radioactive material in the sample.

7.20.4 If the leak test reveals the presence of 0.005 microcurie (185 Bq) or more of removable contamination, the licensee shall:

7.20.4.1 Immediately withdraw the sealed source from use and store, dispose or cause it to be repaired in accordance with the requirements of these regulations; and

7.20.4.2 File a written report with the Department within 5 days of receiving the leak test result, including the model number and serial number, if assigned, of the leaking source, the radionuclide and its estimated activity, the date and results of the test, and the action taken.

7.20.5 A licensee in possession of a sealed source or brachytherapy source, except for a gamma stereotactic radiosurgery source, shall conduct a semi-annual physical inventory of all such sources. The licensee shall retain each inventory record for 3 years. The inventory records must contain the model number of each source, and serial number if one has been assigned, the identity of each source by radionuclide and its estimated activity, the location of each source, and the name of the individual who performed the inventory.

7.21Report and notification of a medical event.

7.21.1 A licensee shall report any event as a medical event, except for an event that results from patient or human research subject intervention, in which:

7.21.1.1 The administration of radioactive material or radiation from radioactive material, except permanent implant brachytherapy, results in:

(1) A dose that differs from the prescribed dose or dose that would have resulted from the prescribed dosage by more than 0.05 Sv (5 rem) effective dose equivalent, 0.5 Sv (50 rem) to an organ or tissue, or 0.5 Sv (50 rem) shallow dose equivalent to the skin; and

(a) The total dose delivered differs from the prescribed dose by 20 percent or more;

(b) The total dosage delivered differs from the prescribed dosage by 20 percent or more or falls outside the prescribed dosage range; or

(c) The fractionated dose delivered differs from the prescribed dose, for a single fraction, by 50 percent or more.

(2) A dose that exceeds 0.05 Sv (5 rem) effective dose equivalent, 0.5 Sv (50 rem) to an organ or tissue, or 0.5 Sv (50 rem) shallow dose equivalent to the skin from any of the following:

(a) An administration of a wrong radioactive drug containing radioactive material or the wrong radionuclide for a brachytherapy procedure;

(b) An administration of a radioactive drug containing radioactive material by the wrong route of administration;

(c) An administration of a dose or dosage to the wrong individual or human research subject;

(d) An administration of a dose or dosage delivered by the wrong mode of treatment; or

(e) A leaking sealed source.

(3) A dose to the skin or an organ or tissue other than the treatment site that exceeds by:

(a) 0.5 Sievert (50 rem) or more the expected dose to that site from the procedure if the administration had been given in accordance with the written directive prepared or revised before administration; and

(b) 50 percent or more the expected dose to that site from the procedure if the administration had been given in accordance with the written directive prepared or revised before administration.

7.21.1.2 For permanent implant brachytherapy, the administration of radioactive material or radiation from radioactive material (excluding sources that were implanted in the correct site but migrated outside the treatment site) that results in:

(1) The total source strength administered differing by 20 % or more from the total source strength documented in the post-implantation portion of the written directive;

(2) The total source strength administered outside of the treatment site exceeding 20 % of the total source strength documented in the post-implantation portion of the written directive; or

(3) An administration that includes any of the following:

(a) The wrong radionuclide;

(b) The wrong individual or human research subject;

(c) Sealed source(s) implanted directly into a location discontiguous from the treatment site, as documented in the post-implantation portion of the written directive; or

(d) A leaking sealed source resulting in a dose that exceeds 0.5 Sv (50 rem) to an organ or tissue.

7.21.2 A licensee shall report any event resulting from intervention of a patient or human research subject in which the administration of radioactive material or radiation from radioactive material results, or will result in, unintended permanent functional damage to an organ or a physiological system, as determined by a physician.

7.21.3 The licensee shall notify by telephone the Department no later than the next calendar day after discovery of the medical event.

7.21.4 The licensee shall submit a written report to the Department within 15 days after discovery of the medical event.

7.21.4.1 The written report must include:

(1) The licensee's name;

(2) The name of the prescribing physician;

(3) A brief description of the event;

(4) Why the event occurred;

(5) The effect, if any, on the individual(s) who received the administration;

(6) What actions, if any, have been taken, or are planned to prevent recurrence; and

(7) Certification that the licensee notified the individual (or the individual's responsible relative or guardian), and if not, why not.

7.21.4.2 The report may not contain the individual's name or any other information that could lead to identification of the individual.

7.21.5 The licensee shall provide notification of the medical event to the referring physician and also notify the individual who is the subject of the medical event no later than 24 hours after its discovery, unless the referring physician personally informs the licensee either that he or she will inform the individual or that, based on medical judgment, telling the individual would be harmful. The licensee is not required to notify the individual without first consulting the referring physician. If the referring physician or the affected individual cannot be reached within 24 hours, the licensee shall notify the individual as soon as possible thereafter. The licensee may not delay any appropriate medical care for the individual, including any necessary remedial care as a result of the medical event, because of any delay in notification. To meet the requirements of 7.21.5, the notification of the individual who is the subject of the medical event may be made instead to that individual's responsible relative or guardian. If a verbal notification is made, the licensee shall inform the individual, or appropriate responsible relative or guardian, that a written description of the event can be obtained from the licensee upon request. The licensee shall provide such a written description if requested.

7.21.6 Aside from the notification requirement, nothing in this section affects any rights or duties of licensees and physicians in relation to each other, to individuals affected by the medical event, or to that individual's responsible relatives or guardians.

7.21.7 A licensee shall:

7.21.7.1 Annotate a copy of the report provided to the Department with the:

(1) Name of the individual who is the subject of the event; and

(2) Identification number or if no other identification number is available, the social security number of the individual who is the subject of the event; and

7.21.7.2 Provide a copy of the annotated report to the referring physician, if other than the licensee, no later than 15 days after the discovery of the event.

7.22Notification to the Department of deceased patients or human research subjects containing radioactive material.

7.22.1 The licensee shall notify the Department by telephone immediately upon discovery that a patient or human research subject containing radioactive material has died, and it is possible that any individual could receive exposures in excess of Part 4, section 4.14 as a result of the deceased's body.

7.22.2 The licensee shall submit a written report to the Department within 30 days after discovery that the patient or human research subject referenced in 7.22.1 has died. The written report must include the:

7.22.2.1 Licensee's name;

7.22.2.2 Date of death;

7.22.2.3 Radionuclide, chemical and physical form and calculated activity at time of death; and

7.22.2.4 Names (or titles) and address(es) of known individuals who might have received exposures exceeding 5 mSv (500 mrem).

7.22.3 The licensee shall retain a record of each written report required by 7.22 for 3 years.

7.23 Report and notification of a dose to an embryo/fetus or a nursing child

7.23.1 A licensee shall report any dose to an embryo/fetus that is greater than 5 mSv (500 mrem) dose equivalent that is a result of an administration of radioactive material or radiation from radioactive material to a pregnant individual unless the dose to the embryo/fetus was specifically approved, in advance, by the authorized user.

7.23.2 A licensee shall report any dose to a nursing child, that was not specifically approved, in advance, by the authorized user, that is a result of an administration of radioactive material to a breast feeding individual that:

7.23.2.1 Is greater than 5 millisievert (500 mrem) total effective dose equivalent; or

7.23.2.2 Has resulted in unintended permanent functional damage to an organ or a physiological system of the child, as determined by a physician.

7.23.3 The licensee shall notify by telephone the Department no later than the next calendar day after discovery of a dose to the embryo/fetus or nursing child that requires a report in 7.23.1 or 7.23.2.

7.23.4 The licensee shall submit a written report to the Department within 15 days after discovery of a dose to the embryo/fetus or nursing child that requires a report in 7.23.1 or 7.23.2.

7.23.4.1 The written report must include:

(1) The licensee's name;

(2) The name of the prescribing physician;

(3) A brief description of the event;

(4) Why the event occurred;

(5) The effect on the embryo/fetus or the nursing child;

(6) What actions, if any, have been taken, or are planned, to prevent recurrence; and

(7) Certification that the licensee notified the pregnant individual or mother (or the mother's or child's responsible relative or guardian), and if not, why not.

7.23.4.2 The report must not contain the individual's or child's name or any other information that could lead to identification of the individual or child.

7.23.5 The licensee shall provide notification of the event to the referring physician and also notify the pregnant individual or mother, both hereafter referred to as the mother, no later than 24 hours after discovery of an event that would require reporting under 7.23.1 or 7.23.2, unless the referring physician personally informs the licensee either that he or she will inform the mother or that, based on medical judgment, telling the mother would be harmful. The licensee is not required to notify the mother without first consulting with the referring physician. If the referring physician or mother cannot be reached within 24 hours, the licensee shall make the appropriate notifications as soon as possible thereafter. The licensee may not delay any appropriate medical care for the embryo/fetus or for the nursing child, including any necessary remedial care as a result of the event, because of any delay in notification. To meet the requirements of 7.23.5, the notification may be made to the mother's or child's responsible relative or guardian instead of the mother, when appropriate. If a verbal notification is made, the licensee shall inform the mother, or the mother's or child's responsible relative or guardian, that a written description of the event can be obtained from the licensee upon request. The licensee shall provide such a written description if requested.

7.23.6 A licensee shall:

7.23.6.1 Annotate a copy of the report provided to the Department with the:

(1) Name of the pregnant individual or the nursing child who is the subject of the event; and

(2) Identification number or if no other identification number is available, the social security number of the individual who is the subject of the event.

7.23.7 A copy of the record required under 7.23.6 shall be provided to the referring physician, if other than the licensee, within 15 days after discovery of the event.

7.24Labeling of vials and syringes.

7.24.1 A licensee shall require each individual preparing or handling a vial that contains a radiopharmaceutical to keep the vial in a vial radiation shield.

7.24.2 Each syringe and vial that contains a radioactive drug shall be labeled to identify the radioactive drug, to include the isotope and amount of radioactivity. Each syringe shield and vial shield shall also be labeled unless the label on the syringe or vial is visible when shielded.

7.25 Surveys for contamination and ambient exposure rate.

7.25.1 Surveys required by 7.25.2 and 7.25.3 are in addition to surveys required by Part 4.

7.25.2 Daily Survey Requirements

7.25.2.1 At the end of each day of use, a licensee shall survey with an exposure rate instrument, all areas where radioactive drugs containing radioactive material requiring a written directive were prepared for use or administered.

(1) A licensee does not need to perform the surveys required by 7.25.2.1 in an area where patients or human research subjects are confined when they cannot be released pursuant to 7.26.

7.25.2.2 At the end of each day of use, a licensee shall survey for removable contamination all areas where generators and bulk radioactive drugs are prepared for use. An instrument capable of detecting 33.3 becquerels (2000 dpm) of contamination on each wipe sample shall be used.

7.25.3 Weekly Survey Requirements

7.25.3.1 At least once each week, a licensee shall survey, with an exposure rate instrument, all areas where radioactive drugs or radioactive wastes are stored.

7.25.3.2 At least once each week, a licensee shall survey for removable contamination in all areas where radioactive materials other than sealed sources as defined in Part 7 are stored. An instrument capable of detecting 33.3 becquerels (2000 dpm) of contamination on each wipe sample shall be used.

7.25.4 A licensee shall establish action levels for the surveys required by 7.25.2 and 7.25.3 and shall require that the individual performing the survey immediately notify the Radiation Safety Officer if action levels are exceeded.

7.25.5 A licensee shall retain a record of each survey required by 7.25.1, 7.25.2 and 7.25.3 for 3 years. The record must include:

7.25.5.1 The date of the survey;

7.25.5.2 The results of the survey;

7.25.5.3 The instrument used to make the survey (including, if applicable, that the instrument was checked for consistent response with a dedicated check source prior to each daily use); and

7.25.5.4 The name of the individual who performed the survey.

7.26Release of individuals containing unsealed radioactive material or implants containing radioactive material.

7.26.1 A licensee may authorize the release from the licensee's control of any individual who has been administered radioactive drugs or permanent implants containing radioactive material if the total effective dose equivalent to any other individual from exposure to the released individual is not likely to exceed 5 mSv (0.5 rem).¹

¹ Appendix U of U.S. Nuclear Regulatory Commission NUREG-1556, Vol. 9, "Consolidated Guidance About Materials Licenses: Program Specific Guidance About Medical Licenses" describes methods for calculating doses to other individuals and contains tables of activities not likely to cause doses exceeding 5 mSv (0.5 rem).

7.26.2 A licensee shall provide the released individual or the individual's parent or guardian with instructions, including written instructions on the actions recommended to maintain doses to other individuals as low as is reasonably achievable if the total effective dose equivalent to any other individual is likely to exceed 1 mSv (0.1 rem).

7.26.2.1 If the total effective dose equivalent to a nursing infant or child could exceed 1 mSv (0.1 rem) assuming there were no interruption in breast-feeding, the instructions shall also include:

(1) Guidance on the interruption or discontinuation of breast-feeding; and

(2) Information on the potential consequences, if any, of failure to follow the guidance.

7.26.3 If the total effective dose equivalent to a nursing infant or child could exceed 5 mSv (0.5 rem) from continued breast-feeding, the licensee shall maintain a record that the instructions required by 7.26.2 were provided to a breast-feeding woman.

7.26.4 The licensee shall maintain a record of the basis for authorizing the release of an individual in accordance with 7.26, if the total effective dose equivalent is calculated by:

7.26.4.1 Using the retained activity rather than the administered activity;

7.26.4.2 Using an occupancy factor less than 0.25 at 1 meter;

7.26.4.3 Using the biological or effective half-live; and

7.26.4.4 Considering the shielding by tissue.

7.26.5 The records required by 7.26.3 and 7.26.4 must be retained for 3 years after the date of release of the individual.

7.26.6 Reports of Patient Departure Prior to Authorized Release.

7.26.6.1 The licensee shall notify the Department by telephone immediately upon discovery that a patient or human research subject has departed from the licensee's facility without authorization under 7.26.

7.26.6.2 The licensee shall submit a written report to the Department within 30 days after discovery of the unauthorized departure. The written report must include:

(1) The licensee's name;

(2) The date and time of the unauthorized departure;

(3) The projected date and time when release would have occurred;

(4) The address of the patient's or human research subject's home or anticipated destination following departure;

(5) The radionuclide, chemical and physical form and calculated activity at time of release;

(6) The apparent reason(s) for the departure prior to authorized release; and

(7) A description of any changes in the licensee's patient release criteria or patient instructions that are designed to avoid a recurrence of such an event.

7.27Mobile nuclear medicine service technical requirements.

A licensee providing mobile nuclear medicine service shall:

7.27.1 Transport to each client's address of use only syringes or vials containing prepared drugs or radioactive materials that are intended for reconstitution of radioactive drug kits;

7.27.2 Bring into each client's address of use all radioactive material to be used and, before leaving, remove all unused radioactive material and associated radioactive waste;

7.27.3 Secure or keep under constant surveillance and immediate control all radioactive material when in transit or at a client's address of use;

7.27.4 Check instruments used to measure the activity of unsealed radioactive material for proper function before medical use at each client's address or on each day of use, whichever is more frequent. At a minimum, the check for proper function shall include a constancy check;

7.27.5 Check survey instruments for consistent response with a dedicated check source before use at each client's address;

7.27.6 Prior to leaving a client's address of use, perform area surveys and survey for removable contamination in all areas of use, to ensure compliance with Part 4 of these regulations; and

7.27.7 Retain a record of each survey required by 7.27.6 for 3 years. The record must include the date of the survey, the results of the survey, the instrument used to make the survey, and the name of the individual who performed the survey.

7.28Storage of Volatiles and Gases.

7.28.1 A licensee shall store volatile radioactive materials and radioactive gases in a radiation shield and container.

7.28.2 A licensee shall store and use a multi-dose container in a properly functioning fume hood.

7.28.3 A licensee who administers radioactive aerosols or gases shall do so with a system that will keep airborne concentrations within the limits prescribed in Part 4 of these regulations.

7.28.3.1 The system shall either be directly vented to the atmosphere through an air exhaust or provide for collection and decay or disposal of the aerosol or gas in a shielded container.

7.28.3.2 A licensee shall check the operation of collection systems monthly. Records of these checks shall be maintained for 3 years.

7.29Decay-in-storage.

7.29.1 A licensee may hold radioactive material with a physical half-life of less than or equal to 120 days for decay-in-storage before disposal without regard to its radioactivity if it:

7.29.1.1 Monitors radioactive material at the surface before disposal and determines that its radioactivity cannot be distinguished from the background radiation level with an appropriate radiation detection survey meter set on its most sensitive scale and with no interposed shielding; and

7.29.1.2 Removes or obliterates all radiation labels, except for radiation labels on materials that are within containers and that will be managed as biomedical waste after they have been released from the licensee; and

7.29.2 Records of Decay-in-Storage.

A licensee shall retain a record of each disposal permitted under 7.29.1 as follows:

7.29.2.1 A licensee shall maintain records of the disposal of licensed materials, as required by 7.29, for 3 years. The record must include the date of the disposal, the survey instrument used, the background radiation level, the radiation level measured at the surface of each waste container, and the name of the individual who performed the survey.

6 CCR 1007-1-7-C

Colorado Register, Vol 37, No. 14. July 25, 2014, effective 8/14/2014

38 CR 02, January 25, 2015, effective 2/14/2015

38 CR 05, March 10, 2015, effective 3/30/2015

38 CR 12, June 25, 2015, effective 7/15/2015

38 CR 14, July 25, 2015, effective 8/14/2015

39 CR 02, January 25, 2016, effective 2/14/2016

39 CR 16, August 25, 2016, effective 9/14/2016

39 CR 22, November 25, 2016, effective 12/15/2016

40 CR 11, June 10, 2017, effective 6/30/2017

40 CR 20, October 25, 2017, effective 11/14/2017

42 CR 24, December 25, 2019, effective 1/14/2020

43 CR 14, July 25, 2020, effective 8/14/2020

43 CR 18, September 25, 2020, effective 10/15/2020

44 CR 11, June 10, 2021, effective 7/15/2021

44 CR 14, July 25, 2021, effective 8/14/2021

45 CR 22, November 25, 2022, effective 12/15/2022