Periodic Review

(1) Schedule of Periodic Reviews. Every facility shall conduct a periodic review of each patient upon admission, and for patients whose hospitalizations are expected to be at least 90 days, during the first three months, during the second three months, and annually thereafter until discharge, except that for facilities licensed as Class VI, Limited Class VI and VII and for units of Department facilities that admit patients younger than 19 years old, such periodic reviews shall be conducted as clinically indicated but no less frequently than quarterly. (2) Notice to Patient and Family. Prior to the periodic review, the facility director or designee shall give reasonable advance written notice to each patient and his or her legally authorized representative. If there is no legally authorized representative, the director shall inform the patient that, unless the patient knowingly objects, notice of the periodic review shall also be given to his or her nearest relative giving the date of such review. (3) Thorough Clinical Examination. Each periodic review shall include a thorough clinical examination, which shall consist of: a mental status examination; a review of the patient’s clinical history, including a review of the treatment plan, of response to treatment, and of medications administered; and an evaluation of general behavior and social interaction by clinical personnel from the various disciplines providing treatment. At least once in every 12- month period, a thorough clinical examination shall also include a physical examination. (4) Evaluation of Capacity. For each periodic review, the legal capacity of a patient shall be evaluated to determine whether he or she has capacity to remain on, or to apply for, voluntary or conditional voluntary status, to render informed consent to customary and usual medical care or extraordinary treatment, including administration of antipsychotic medications, or to manage his or her own funds in accordance with the requirements of 104 CMR 30.01(4): Evaluation of Ability to Manage Funds. (a) If a patient on voluntary or conditional voluntary status is believed no longer to have capacity to remain on that status, and the patient remains in need of continued hospitalization, then the facility director shall take reasonable steps to obtain alternate authority for continued hospitalization by seeking an order of commitment pursuant to M.G.L. c. 123, §§ 7 and 8, or obtain consent of a legally authorized representative. (b) If the question of a patient’s capacity is raised by a periodic review or if the facility director has reason to believe that a patient who has been under the care of the facility, who is not under guardianship or conservatorship, is unable to care for his or her person or property, the facility director shall promptly take reasonable steps to initiate the process to obtain a legally authorized representative. (5) Consideration of Alternatives to Facility. For each periodic review the alternatives to hospitalization should be evaluated, with consideration being given to specific and available resources in the community which the patient could utilize. (6) Results of the Periodic Review. (a) Upon completion of every periodic review subsequent to admission, the person in charge of conducting the review shall prepare a full and complete record of all information presented at such review, including medical evidence or information, the reasons for a determination that a patient requires continued care and treatment at the facility, and the consideration given to alternatives to continued hospitalization. This written record of each periodic review shall become part of the patient’s medical record. (b) If upon completion of the periodic review, it is determined that the patient is in need of further care and treatment, the facility director or designee shall notify the patient and his or her legally authorized representative of that determination, and of the right to leave the facility if he or she was not committed under a court order. If there is no legally authorized representative, the director shall inform the patient that, unless the patient knowingly objects, notice of the determination shall also be given to his or her nearest relative. If said patient is not committed under a court order and does not choose further treatment as an inpatient, within 14 days of said notification the patient shall be discharged or shall be made the subject of a petition for a court ordered commitment. Following any review under the provisions of 104 CMR 27.11, or at any other time, any patient who is no longer in need of care as an inpatient shall, subject to the provisions of 104 CMR 27.09, be discharged.