DHS 157.61(2)(a)4.4. The affected individuals are instructed on the revised program before the changes are implemented. DHS 157.61(3)(a)(a) A licensee who permits the receipt, possession, use or transfer of radioactive material by an individual under the supervision of an authorized user shall do all the following: DHS 157.61(3)(a)1.1. Instruct the supervised individual in the licensee’s written radiation protection procedures, written directive procedures, requirements of this chapter and license conditions regarding the use of radioactive material. DHS 157.61(3)(a)2.2. Require the supervised individual to follow the instructions of the supervising authorized user for medical uses of radioactive material, written radiation protection procedures established by the licensee, requirements of this chapter and license conditions regarding the medical use of radioactive material. DHS 157.61(3)(b)(b) A licensee who permits the preparation of radioactive material for medical use by an individual under the supervision of an authorized nuclear pharmacist or physician who is an authorized user shall do all of the following: DHS 157.61(3)(b)1.1. Instruct the supervised individual in the preparation of radioactive material for medical use, as appropriate to that individual’s involvement with radioactive material. DHS 157.61(3)(b)2.2. Require the supervised person to follow the instructions of the supervising authorized user or authorized nuclear pharmacist regarding the preparation of radioactive material for medical use, the written radiation protection procedures established by the licensee and the regulations of this chapter, and license conditions. DHS 157.61(3)(c)(c) A licensee who permits supervised activities under pars. (a) and (b) is responsible for the acts and omissions of the supervised individual. DHS 157.61(4)(a)1.1. A written directive must be dated and signed by an authorized user prior to administration of I-131 sodium iodide greater than 1.11 Megabecquerels (30 microcuries), any therapeutic dosage of unsealed radioactive material or any therapeutic dose of radiation from radioactive material. DHS 157.61(4)(a)2.2. If, because of the emergent nature of the patient’s condition, a delay in providing a written directive would jeopardize the patient’s health, an oral directive from an authorized user is acceptable provided the information contained in the oral directive is documented immediately in writing in the patient’s record and a written directive is prepared within 48 hours of the oral directive. DHS 157.61(4)(a)3.3. A written revision to an existing written directive may be made provided that the revision is dated and signed by an authorized user prior to the administration of the dosage of radioactive drug containing radioactive material, the brachytherapy dose, the gamma stereotactic radiosurgery dose, the teletherapy dose or the next fractional dose. DHS 157.61(4)(a)4.4. If, because of the patient’s condition, a delay to provide a written revision to an existing written directive would jeopardize the patient’s health, an oral revision to an existing written directive will be acceptable, provided that the oral revision is documented immediately in the patient’s record and a revised written directive is signed by the authorized user within 48 hours of the oral revision. DHS 157.61(4)(b)(b) The written directive shall contain the patient or human research subject’s name and all of the following information: DHS 157.61(4)(b)1.1. For the administration of a dosage of a radioactive drug, the name, dosage and administration route of the radioactive drug. DHS 157.61(4)(b)2.2. For each anatomically distinct treatment site exposed to gamma stereotactic radiosurgery, total dose, treatment site and number of target settings per treatment. DHS 157.61(4)(b)3.3. For teletherapy, the total dose, dose per fraction, number of fractions, treatment site and overall treatment period. DHS 157.61(4)(b)4.4. For high dose rate remote afterloading brachytherapy: the radionuclide, treatment site, dose per fraction, number of fractions and total dose. DHS 157.61(4)(b)5.a.a. Before implantation, the written directive shall include the treatment site, the radionuclide, and the total source strength. DHS 157.61(4)(b)5.b.b. After implantation but before the patient leaves the post-treatment recovery area, the written directive shall include the treatment site, the number of sources implanted, the total source strength implanted, and the date. DHS 157.61(4)(b)6.6. For all other brachytherapy including low dose rate, medium dose rate and pulsed dose rate afterloaders: DHS 157.61(4)(b)6.a.a. Before implantation, the written directive shall include the treatment site, radionuclide, and dose. DHS 157.61(4)(b)6.b.b. After implantation but before completion of the procedure, the written directive shall include the radionuclide, treatment site, number of sources, and total source strength and exposure time (or the total dose), and date. DHS 157.61(5)(5) Procedures for administrations requiring a written directive.