{"ref":"GA-HH-DC-01","title":"Discharge Planning, Transfer, and Discharge Summaries","category":"Service delivery","summary":"Requires the Agency to plan for discharge from the start of care, help patients who are moving to another home health agency or to a skilled nursing, inpatient rehabilitation, or long-term care hospital choose a provider using quality and resource use data, send a copy of the record or an abstract with a patient who transfers, send the attending physician a summary report at discharge, and, if the Agency is Medicare-certified, send discharge and transfer summaries within the federal time frames.","inShort":["Planning for discharge starts at the first visit. Teach the patient and family what they will need to manage after we leave.","When a patient transfers to another agency or a facility, a copy of the record or a summary goes with them.","The patient’s doctor gets a discharge summary within 5 business days of discharge.","If a patient goes to a nursing facility or another agency, help them choose using quality information, and respect their choice."],"primaryCitation":"42 CFR §484.58","citations":["Ga. Comp. R. & Regs. 111-8-31-.08(c)","Ga. Comp. R. & Regs. 111-8-31-.08(e)","Ga. Comp. R. & Regs. 111-8-31-.09(a)","Ga. Comp. R. & Regs. 111-8-31-.09(d)"],"federalCitations":["42 CFR §484.58","42 CFR §484.110(a)(6)","42 CFR §484.55(d)(3)","42 CFR §484.60(c)(3)(ii)"],"surveyorAsks":["Show me where discharge planning started in this patient’s plan of treatment.","This patient went to a nursing facility. What did you send with the patient, and when?"],"forms":[{"ref":"GA-HH-DC-01-A","title":"Transfer and Discharge Summary"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §484.58 and Ga. Comp. R. & Regs. 111-8-31-.09(d))","5. Planning for Discharge From the Start of Care","6. Helping the Patient Choose a Post-Acute Provider","7. Information Sent With a Patient Who Transfers","8. Discharge and Transfer Summaries","9. Assessments at Transfer and Discharge","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"ga-hha","state":"Georgia","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}}