R9-10-608. Care Plan

A. An administrator shall ensure that a care plan is developed for each patient: 1. Based on the: a. Assessment of the: i. Patient; and ii. Patient’s family, if applicable; b. Hospice service agency’s or inpatient hospice facility’s scope of service; 2. With participation from a: a. Physician, b. Registered nurse, and c. Another personnel member as designated in R9-10- 612(A)(4); and 3. That includes: a. The patient’s diagnosis; b. The patient’s health care directives; c. The patient’s cognitive awareness of self, location, and time; d. The patient’s functional abilities and limitations; e. Goals for pain control and symptom management; f. The type, duration, and frequency of services to be provided to the patient and, if applicable, the patient’s family; g. Treatments the patient is receiving from a health care institution or health care professional other than the hospice, if applicable; h. Medications ordered for the patient; i. Any known allergies; j. Nutritional requirements and preferences; and k. Specific measures to improve the patient’s safety and protect the patient against injury. B. An administrator shall ensure that: 1. A request for participation in a patient’s care plan is made to the patient or patient’s representative; 2. An opportunity for participation in the patient’s care plan is provided to the patient, patient’s representative, or patient’s family; and 3. The request in subsection (B)(1) and the opportunity in subsection (B)(2) are documented in the patient’s medical record. C. An administrator shall ensure that: 1. Hospice services are provided to a patient and, if applicable, the patient’s family according to the patient’s care plan; 2. A patient’s care plan is reviewed and updated: a. Whenever there is a change in the patient’s condition that indicates a need for a change in the type, duration, or frequency of the services being provided; b. If the patient’s physician orders a change in the care plan; and c. At least every 30 calendar days; and 3. A patient’s physician authenticates the care plan with a signature within 14 calendar days after the care plan is initially developed and whenever the care plan is reviewed or updated.