15 Miss. Code. R. 19-60-11.5.10

Current through October 31, 2024

Rule 15-19-60-11.5.10 - Consent Forms

1. A photocopy of an original government-issued identification containing the date of birth of the client shall be attached to the consent form. Consent forms shall be maintained at the establishment for a minimum of two (2) years, shall be produced and be made available at the request of the Department, and shall contain, at a minimum, the following information:

a. Name of Tattooist or Body Piercer and Department Certificate of Registration Number;

b. Name of supervisor, if the Tattooist or Body Piercer has a Provisional Certificate of Registration;

c. Name and address of Establishment;

d. Date of tattoo or body piercing;

e. Name of client;

f. Home address of client;

g. Home telephone number of client;

h. Sex of Client;

i. Date of Birth of client;

j. Description of location on the body to be tattooed or pierced;

k. Acknowledgment of the risks involved in a tattoo or body piercing;

l. Acknowledgment of the receipt of the printed aftercare responsibilities of the client;

m. Statement that the client is not under the influence of drugs or alcohol;

n. Signature of the client;

o. Signature of the Tattooist or Body Piercer; and

p. Signature of supervisor if required.

2. The consent form must contain a recommendation to the patron which states the Mississippi State Board of Health recommends that any tattooing or piercing involving the mucous membranes, such as the tongue or genitalia, be performed by a licensed physician or oral surgeon as appropriate.

3. The consent form must contain a warning to persons who are diabetic, HIV infected, or have End Stage Renal Disease that they are at higher risk of complications and should consult their personal physician prior to being tattooed or pierced.

4. The consent form must contain a warning to patrons that tattooing or piercing of persons with preexisting cardiac conditions, especially when piercing occurs on areas of the body involving the mucous membranes, may result in bacteria in the blood stream which can further damage the heart, and that such persons should seek permission from their physician prior to the tattooing or piercing procedure.

15 Miss. Code. R. 19-60-11.5.10

Miss. Code Ann. § 73-61-1 and Miss. Code Ann. § 73-61-3.

Amended 11/17/2023