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Interdisciplinary Plan of Care, 15-Day Review and Attending Physician Copies

Sets out how the IDT establishes each patient's and family's interdisciplinary plan of care with the attending physician, patient and caregiver, what the plan must contain under Ohio and federal rules (including services, persons authorized to give drugs, opioid items and the bereavement plan), the review at least every 15 days, the copy sent to the attending physician with the date recorded, and caregiver education.

Preview: full text with a package
About this policy
Policy number
OH-HSP-IDG-02
Version
1.0
Main rule
OAC 3701-19-11(C)-(E)
Library
Ohio hospice · 60 policies
Category
Hospice care
Sections
19

In short

  • Every patient has one written plan of care, made with the attending physician, the patient and the caregiver.
  • The plan lists all services, how often they happen, the medicines and who may give them, and the opioid safety steps.
  • The team reviews and updates the plan at least every 15 days, and sooner when the patient changes.
  • Send the attending physician a copy of the plan and write down the date you sent it.
  • Teach the caregiver what the plan asks of them and write down what you taught.

What's inside

19 sections. The full text comes with the One-time Policy Pack.

Full text with a package
  • Terms of Reference
  • 1. Purpose
  • 2. Scope
  • 3. Definitions
  • 4. Policy Statement (ORC 3712.06(C); OAC 3701-19-11(C)-(E); 42 CFR §418.56)
  • 5. Establishing the Plan of Care
  • 6. Content of the Plan of Care
  • 7. Review and Revision
  • 8. Copies for the Attending Physician (OAC 3701-19-11(E))
  • 9. Contracted Providers and Inpatient Care
  • 10. Educating the Patient and Primary Caregiver
  • 11. Ohio Medicaid Coordination
  • 12. Responsibilities
  • 13. Records and Compliance Monitoring
  • 14. Staff Training
  • 15. References
  • 16. Related Policies and Forms
  • 17. Approval
  • 18. Revision History

An inspector may ask

  • Show me this patient's plan of care. Where does it list the services the Agency provides or arranges, and the scope and frequency of each?
  • When was the plan last reviewed by the team, and was the attending physician involved?

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