# Cardiac Rehab Fit Out



## jar546 (Feb 25, 2011)

Cardiac patients scheduled to come to the rehab clinic to exercise, learn to cook healthy, etc.  Mostly machines for exercising but we noticed a few rooms not labeled and appear to have exam tables in them (in the drawings).  It is not located in the hospital, but a separate building off site.  There will be health care providers present and of course they will be assessed with vital signs at minimum before they start their program.

I have asked for the facility (hospital) to declare whether or not any of these areas are considered patient care areas and have given them the definition of patient care area in the NEC.

Does anyone else have experience with this type of out of hospital setup?

What were they designated?


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## globe trekker (Feb 25, 2011)

My experience with hospitals and medical care providing facilities is [ typically ], they do not want

to formally declare anything that will cost them money. Even if they indicate that the rooms are

"Patient Waiting Rooms" and will not be used for examinations, how will you, or anyone else,

constantly monitor them to ensure they do not install examination tables and electrical exam

equipment?

To what degree will "they be assessed with vital signs before they start". Don't cardiac patients

typically have a somewhat more thorough exam before starting any type of exercise program?

( i.e. - EKG's, etc. ).












Yeah, ya gotta nail `em down jar! Make `em declare "in writing", their intentions!

.


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## Coug Dad (Feb 28, 2011)

I, unfortunately, have personal experience with one about a year ago.  They are no different than a doctor's office or excercise room in a health club.


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## Dr. J (Feb 28, 2011)

NEC 517 will apply.  Like CD said - no different than a Doctor's office.


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## Bryan Holland (Mar 1, 2011)

YES, this is a health care facility.  Article 517 applies.  The patient care areas must comply with Part II of the Article.  All areas would be considered general care areas.  Essential electrical systems as required in Part III, Section 517.45 would also apply, including 14.3.4.2 and 4.6.2.2 of the NFPA 99.  Limited energy systems in the patient care area must meet 517.80; and 517.81 for the non-patient care areas.


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## jar546 (Mar 1, 2011)

I am predicting resistance on the Essential electrical systems requirement of Part III.

There are no beds in this facility and I am wondering why they are not trying to eliminate the Part II by declaring it an outpatient facility?


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## Coug Dad (Mar 1, 2011)

Jar,

They get a better reimbursement rate if it is classified as a healthcare occupancy.


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## jar546 (Mar 1, 2011)

Coug Dad said:
			
		

> Jar,They get a better reimbursement rate if it is classified as a healthcare occupancy.


I guess the extra electrical costs will easily be paid for then.


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## chris kennedy (Mar 1, 2011)

jar546 said:
			
		

> I am predicting resistance on the Essential electrical systems requirement of Part III.There are no beds in this facility and I am wondering why they are not trying to eliminate the Part II by declaring it an outpatient facility?


Because outpatient facilities are still covered under 517.



> Health Care Facilities. Buildings or portions of buildings in which medical, dental, psychiatric, nursing, obstetrical, or surgical care are provided. Health care facilities include, but are not limited to, hospitals, nursing homes, limited care facilities, clinics, medical and dental offices, and ambulatory care centers, whether permanent or movable.


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## Dr. J (Mar 1, 2011)

> I am predicting resistance on the Essential electrical systems requirement of Part III.


Size the wire larger to reduce the resistance.  (sorry, engineer joke)

No reason for them to blow a fuse (I'll stop now).  This is usually met in clinics by battery pack luminaires.  Only if critical care is present are receptacles on Essential required (again, no different than any other Dr. Office).


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## jar546 (Mar 1, 2011)

If there are no patient beds and no critical care areas then I am not sure what has to be compliant with article 700 other than emergency lighting.  There can't be life safety or critical so I am going to have to get my nose inside the NFPA 99 to see what is required for essential electrical systems for "other" health care facilities.


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## Bryan Holland (Mar 2, 2011)

Section 14.3.4.2 of the NFPA 99 states that other health care facilities shall conform to a Type 3 essential electrical distribution system.  Section 4.6 details Type 3 systems.

Section 4.6.2.2.2 states, "the system shall supply power for task illumination that is related to the safety of life and that is necessary for the safe cessation of procedures in progress.

As stated above, simple battery-power lighting units in the patient care areas would be compliant.  No other emergency back-up systems would be needed for this particular occupancy.


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## globe trekker (Mar 2, 2011)

For clarity, ...would the redundant grounding of receptacles in the "Exam Rooms / Areas",

as required by Art. 517.13(A) in the `08 NEC be required? Also, the luminaires if

installed lower than 7 1/2 ft. above the floor... ?

Thanks!

.


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## raider1 (Mar 2, 2011)

globe trekker said:
			
		

> For clarity, ...would the redundant ground of receptacles in the "Exam Rooms / Areas",as required by Art. 517.13(A) in the `08 NEC be required?   Also, the luminaires if
> 
> installed lower than 7 1/2  ft. above the floor... ?
> 
> ...


Yes, 517.13 would apply to this occupancy.

Chris


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## peach (Mar 5, 2011)

make them use the green stuff for power... even if it's not designated as a patient care area.. it is.


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## raider1 (Mar 7, 2011)

peach said:
			
		

> make them use the green stuff for power... even if it's not designated as a patient care area.. it is.


Why make them use hospital grade AC cable in non-patient care areas?

Chris


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## Bryan Holland (Mar 7, 2011)

I have inspected several projects in recent times where the installer used HCF cables everywhere, even where not required.  I asked the same question Chris made above.  The contractor stated the cost was not much greater and it prevented any mistakes by his installers.  It sure makes for an easy inspection when you know only HCF cables and wiring methods are being used regardless.

Here in Florida, the Agency for Health Care Administration (AHCA) limits the use of flexible cables to specific instances.  Facilities under their jurisdiction almost always require metal raceways for ALL circuits to ALL locations.  Non metallic raceways are limited to underground portions only, in non-patient care areas.  517.13 is really hard to not comply with in hospitals and surgical centers here in Florida.


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## raider1 (Mar 7, 2011)

Bryan,

If the contractor choose to wire the entire building with HCF grade cable then great, but for the AHJ to tell them they need to even in areas that the code does not require the cable bothers me.

Chris


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## steveray (Mar 7, 2011)

I have heard the same as Bryan.....easier to just do it all the same.....I have even given heads up to new construction at a sports facility that was talking about P/T or doctor space adjacent....they put in health care cable in the common wall just in case...


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## GHRoberts (Mar 7, 2011)

Tables are often used in rehab. Rooms allow for privacy. (Our local hospital even has rehab in the cafeteria.)

Since many rehab facilities are in local malls, it appears that they have the more common electrical requirements. Nothing special.


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## peach (Mar 7, 2011)

If they don't designate the use of the room, you assume it's what?  I would rather assume its a PCA than be wrong... if it looks like a duck, it is probably GOING to be a duck.. or tell me otherwise.


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## raider1 (Mar 8, 2011)

peach said:
			
		

> If they don't designate the use of the room, you assume it's what?  I would rather assume its a PCA than be wrong... if it looks like a duck, it is probably GOING to be a duck.. or tell me otherwise.


If they haven't designated what the room will be used for they won't get a permit. I deal with this issue at plan review.

Chris


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## peach (Mar 9, 2011)

good plan.. thanks raider


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## raider1 (Mar 10, 2011)

peach said:
			
		

> good plan.. thanks raider


Not a problem, I have just been down this road before with owners. 

Chris


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## peach (Mar 16, 2011)

They really hate us in the field if the plan reviewer didn't do their job...

We love being hated..


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## globe trekker (Apr 5, 2011)

How would ya'll handle an Outpatient Physical Therapy office? I have physical

therapist that is desiring to move in to an existing tenant space. He "says"

there will not be any electrical equipment / devices in contact with his clients

( patients <--- ???? ), ...only battery operated "stuff", so no special electrical

wiring requirements ( Article 517 or NFPA 99 ). The Occupancy Group

designation will be a Type "B", small tenant space and that he is planning to

only plug in a telephone and a computer.

BTW, no plans have been submitted yet, just an initial "in-person" discussion

with a PT.

*An associated question:*  M.D. prescribes physical therapy / rehab on his

surgical work ( i.e. - a prescription  ).  P.T. receives such prescription from

client ( patient <---  ????  ).  Client / patient comes to P.T. place of

business to carry out doctor's orders and receive treatment / stretching /

examination of movements & capabilities.   Is this considered medical

treatment?   Are there any health care requirements from the NEC or

NFPA?

Ya'lls thoughts...

Thanks!  

.


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## Dr. J (Apr 6, 2011)

> Is this considered medical treatment?


That is the defining question.  If it is not medical treatment it is not a healthcare facility. Is the clinic or its practitioners licensed by the State under a health related regulation?  Does it accept Medicaid/Medicare/Health Insurance payments?  The Dr. "prescription" implies this is indeed medical treatment - it is not just a gym.

From 2008 NEC, Article 517:

_Health Care Facilities. Buildings or portions of buildings in which medical, dental, psychiatric, nursing, obstetrical, or surgical care are provided. Health care facilities include, but are not limited to, hospitals, nursing homes, limited care facilities, clinics, medical and dental offices, and ambulatory care centers, whether permanent or movable._

Nothing in this definition has to do with a particular type of treatment or examination or the devices used to treat or examine.  All that is needed to trigger 517 is that the space is used to provide medical care.

_Patient Care Area. Any portion of a health care facility wherein patients are intended to be examined or treated. Areas of a health care facility in which patient care is administered are classified as general care areas or critical care areas. The governing body of the facility designates these areas in accordance with the type of patient care anticipated and with the following definitions of the area classification._

_FPN: Business offices, corridors, lounges, day rooms, dining rooms, or similar areas typically are not classified as patient care areas._

_General Care Areas. Patient bedrooms, examining rooms, treatment rooms, clinics, and similar areas in which it is intended that the patient will come in contact with ordinary appliances such as a nurse call system, electric beds, examining lamps, telephones, and entertainment devices. _

_Critical Care Areas. Those special care units, intensive care units, coronary care units, angiography laboratories, cardiac catheterization laboratories, delivery rooms, operating rooms, and similar areas in which patients are intended to be subjected to invasive procedures and connected to line-operated, electromedical devices._

Here the NEC differentiates between General Care and Critical Care.  Once it is a Health Care Facility, anyplace patients are treated or examined is a patient care area.  The only thing the type of equipment the patient comes in contact with influences is whether it is general or critical care.  Note that "line operated" is specifically listed in critical care, but not in general care.  Thus even battery operated equipment is included under general care.  Only the total lack of contact with any "ordinary" appliances, not even a cell phone or Ipod (Amish health care???) might allow what is obviously a patient treatment or exam area to NOT follow NEC 517.


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## Dr. J (Apr 6, 2011)

> ...whether permanent or movable.


Ok how about this one:  A community "health fair", or flu shots in a community center or shopping mall?


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## globe trekker (Apr 6, 2011)

Dr. J.,

Thanks for the feedback!   Your references, out of the NEC,  are the ones that I have

been reviewing / contemplating.

Our state does not have any guidance as far as construction or facility [ medical ]

requirements, ...I just got off of the telephone with the state health department.

I am going to classify this Occupancy Group use as a Type "B", health care facility,

[ from Article 517.2 - Definitions, in the 2008 NEC  ].  Not sure that I can actually use

the "General Care Area" definition though!  The P.T. [ here ] stated that he would

only be using battery operated apparatus on his patients.   If I "HAVE TO" choose

either the General Care Area  or the Critical Care Area, I will choose the General

Care Area.  I do not see any special electrical requirements for an existing tenant

space, ...no need for altering the wiring that I can find.   Am I missing something?

Ya'lls thoughts...

.


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## GCtony (Jun 25, 2013)

Sorry about bringing back on old thread but I'm close to finding the answer to my question but not quite there.  I don't agree with the DP that's telling me "The County will require hospital grade per 517" I haven't gotten a clear answer from the electrical plans reviewer that may be doing the review. (it's in budgeting stage right now) Understandably, he doesn't want to give me an answer until I can show him some plans.

It's a B use in an older office building.  The tenant tests and treats people with allergies. The space was a similar use, doctor's office that does not have existing hospital grade anything.  Most of the space will remain as-is with a few new "exam and treatment" rooms being added.

1) Would this type of office be considered a general care facility or patient care facility?

2) Am I correct that neither would require green ac cable and hospital grade devises?

3) There's a room that will have a CT scanner (to scan a person's sinuses) would that room require hospital grade even though it's not critical care?

4) Is there anything that I need to consider in regards to lighting?

Sorry about the basic questions...I don't have access to an NEC code book. Does a link to 517 exist? I found this but I don't know how old it is. Contractors’ Code Letter | NECA-NEIS

Any help would be appriciated.


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## Paul Sweet (Jun 25, 2013)

Link to NFPA free codes for viewing:

List of NFPA codes & standards


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## cda (Jun 25, 2013)

I go to my allergist all the time, just regular doctors office

But he does not do ct's.  sure they are not doing some day surgery also???


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## JPohling (Jun 25, 2013)

patient care areas to receive green cable typical.  This is a "B" occupancy from what you have conveyed.


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## globe trekker (Jun 25, 2013)

JPohling (and others),

So that there is a clearer definition of "green cable",  please cite the applicable NEC Articles

& wiring types for the readers of this thread. Thank You !

.


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