{"ref":"GA-HSP-PR-02","title":"Informed Consent, Description of Services and Charges","category":"Client rights","summary":"Explains how the Agency gives each patient a description of the scope of services, the levels of care and any charges, and obtains written informed consent from the patient or authorized representative before admission, using one combined admission consent and service agreement. It also covers consent for later changes, refusal and withdrawal of consent.","inShort":["Before admission, explain what hospice will and will not provide, the levels of care and any charges.","Give the Description of Hospice Services (Form GA-HSP-GOV-06-A).","Get written consent (Form GA-HSP-PR-02-A) from the patient, or from the person with legal authority, before any care.","Write down who signed and what authority they have.","Explain and document any new service, level of care or charge before it starts.","Nobody is refused care or discharged because they cannot pay."],"primaryCitation":"Ga. Comp. R. & Regs. 111-8-37-.14(2)(c)","citations":["Ga. Comp. R. & Regs. 111-8-37-.14(2)(c)","Ga. Comp. R. & Regs. 111-8-37-.10(1)(b), (h), (o), (r)","Ga. Comp. R. & Regs. 111-8-37-.07(5)(d), (i)","Ga. Comp. R. & Regs. 111-8-37-.03(u)","Ga. Comp. R. & Regs. 111-8-37-.14(2)(h)"],"federalCitations":["42 CFR §418.52(a)(3), (c)(3), (c)(7)-(8)","42 CFR §418.24(b)(5)","42 CFR §418.301(c)","42 CFR §418.400","42 CFR §418.104(a)"],"surveyorAsks":["Show me the written informed consent for this patient, signed before admission.","What description of the scope of services did the patient receive, and does it say whether you offer palliative care for advanced and progressive disease?"],"forms":[{"ref":"GA-HSP-PR-02-A","title":"Hospice Admission Consent and Service Agreement"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (Ga. Comp. R. & Regs. 111-8-37-.14(2)(c))","5. Who May Give Consent","6. Information Given Before Consent","7. Obtaining Written Consent","8. Changes, Refusals and Withdrawal of Consent","9. Responsibilities","10. Records and Compliance Monitoring","11. Staff Training","12. References","13. Related Policies and Forms","14. Approval","15. Revision History"],"version":"1.0","sample":false,"pack":"ga-hospice","state":"Georgia","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}