The provider shall designate at least one substitute who is available on short notice to care for the children at the provider’s registered family child care home. Approval by Office. An individual designated as a substitute may not be used in that capacity unless the office has approved the individual. If information received by the office indicates that an individual designated as a substitute may present a risk to the health, safety, or welfare of children in care, the office may disapprove the use of that substitute. The office shall notify the provider of its decision to approve or disapprove a substitute within 30 days of the request being submitted. Use of Substitutes. A provider may use a substitute to: Provide care for children during a temporary absence of the provider; and Assist in providing care while the provider is present. Unless the office approves an additional number of days in advance, the use of substitutes to provide care in the provider's absence is limited to a total of not more than 20 working days in any 12-month period, counting only days on which substitute care is provided for more than 2 hours. A substitute shall: Be 18 years old or older; Be familiar with the requirements of this subtitle; Complete, sign, and submit to the office the required forms for substitutes, including: A medical evaluation completed within the past 12 months; and Permission to examine records of abuse and neglect of children and adults; Apply for a federal and State criminal background check at a designated law enforcement office in the State; If residing or having resided in a state other than Maryland within 5 years before being hired as a substitute: Apply for a state criminal background check to be performed by a duly authorized entity within that state; and Request the non-Maryland state entity performing the criminal background check to transmit the result of that background check directly to the Agency; and Present no risk to the health, safety, or welfare of children. Before allowing a substitute to provide or to assist in providing care, the provider shall orient the substitute to child health and safety matters, including, but not limited to: The location of the: Telephone and emergency telephone numbers; First aid supplies; and Child emergency forms; Medication administration information for each child authorized to receive medication; Modified diet information for each child placed on a modified diet; Emergency evacuation procedures; Permissible and appropriate child discipline procedures; Authorized child release procedures; and Procedures for documenting and reporting child injuries and accidents. During the provider's absence, a substitute is responsible for meeting the requirements of this subtitle regarding the: Supervision and protection of each child in care; and Operation of the family child care home.