Medical Care Policies

Section 300 Section 300.1010  Medical Care Policies a)         Advisory Physician or Medical Advisory Committee 1)         There shall be an advisory physician, or a medical advisory committee composed of physicians, who shall be responsible for advising the administrator on the overall medical management of the residents and the staff of the facility.  If the facility employs a house physician, he may be the advisory physician.  (B) 2)         Additional for Skilled Nursing Facilities. There shall be a medical advisory committee composed of two (2) or more physicians who shall be responsible for advising the administrator on the overall medical management of the residents and the staff in the facility.  If the facility employs a house physician, the house physician may be one member of this committee. b)         The facility shall have and follow a written program of medical services which sets forth the following:  the philosophy of care and policies and procedures to implement it; the structure and function of the medical advisory committee, if the facility has one; the health services provided; arrangements for transfer when medically indicated; and procedures for securing the cooperation of residents' personal physicians.  The medical program shall be approved in writing by the advisory physician or the medical advisory committee.  (B) c)         Every resident shall be under the care of a physician. d)         All residents, or their guardians, shall be permitted their choice of a physician. e)         All resident shall be seen by their physician as often as necessary to assure adequate health care.  (Medicare/Medicaid requires certification visits.) f)         Physician treatment plans, orders and similar documentation shall have an original written signature of the physician.  A stamp signature, with or without initials, is not sufficient. g)         Each resident admitted shall have a physical examination, within five days prior to admission or within 72 hours after admission.  The examination report shall include at a minimum each of the following: 1)         An evaluation of the resident's condition, including height and weight, diagnoses, plan of treatment, recommendations, treatment orders, personal care needs, and permission for participation in activity programs as appropriate. 2)         Documentation of the presence or absence of tuberculosis infection by tuberculin skin test in accordance with Section 300.1025. 3)         Documentation of the presence or absence of incipient or manifest decubitus ulcers (commonly known as bed sores), with grade, size and location specified, and orders for treatment, if present.  (A photograph of incipient or manifest decubitus ulcers is recommended on admission.) 4)         Orders from the  physician regarding weighting of the resident, and the frequency of such weighing, if ordered. h)         The facility shall notify the resident's physician of any accident, injury, or significant change in a resident's condition that threatens the health, safety or welfare of a resident, including, but not limited to, the presence of incipient or manifest decubitus ulcers or a weight loss or gain of five percent or more within a period of 30 days.  The facility shall obtain and record the physician's plan of care for the care or treatment of such accident, injury or change in condition at the time of notification.  (B) i)          At the time of an accident or injury, immediate treatment shall be provided by personnel trained in first aid procedures. (B)