{"ref":"CA-HH-DC-01","title":"Discharge Planning, Transfer and Discharge Summaries, and Completion of Discharged Records","category":"Service delivery","summary":"Sets out how the Agency plans each patient’s discharge from the start of care (the discharge and referral plan in the plan of treatment, 22 CCR §74697(b)(12)); involves social workers (§74713(c)(6)); records the discharge statement with the date, reason, and condition on discharge (§74735(a)(9)); completes the records of discharged patients within 30 days (§74731(c)); and, if the Agency is Medicare-certified, runs an effective discharge planning process using quality and resource use data (42 CFR §484.58), sends the discharge summary within 5 business days and transfer summaries within 2 business days (§484.110(a)(6)), and updates the comprehensive assessment at discharge (§484.55(d)(3)).","inShort":["Plan for discharge from the first day: teach the patient and family so they can manage on their own.","If a patient goes to the hospital or another provider, send the transfer summary within 2 business days.","When a patient is discharged, write the date, the reason, and the patient’s condition in the record.","The discharge summary goes to the patient’s doctor within 5 business days.","Finish all notes and signatures quickly. The whole record must be complete within 30 days of discharge."],"primaryCitation":"42 CFR §484.58","citations":["22 CCR §74697(b)(12)","22 CCR §74713(c)(6)","22 CCR §74735(a)(9)","22 CCR §74731(c)","22 CCR §74719(b)(3)(F)","22 CCR §74735(a)(5)"],"federalCitations":["42 CFR §484.58","42 CFR §484.110(a)(6)","42 CFR §484.60(c)(3)(ii)","42 CFR §484.60(d)(5)","42 CFR §484.55(d)(3)"],"surveyorAsks":["Show me the discharge and referral plan in this patient’s plan of treatment.","Show me the discharge statement for a recently discharged patient: date, reason, and condition on discharge."],"forms":[{"ref":"CA-HH-DC-01-A","title":"Discharge or Transfer Summary"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §484.58)","5. Planning Discharge From the Start of Care","6. Deciding on Discharge","7. Helping the Patient Choose a Post-Acute Provider","8. The Discharge Visit","9. Transfers","10. The Discharge Statement and Discharge Summary","11. Completing the Record","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"ca-hha","state":"California","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}