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Flashcards in Physician Services Deck (22):

what is the first thing that must happen before a resident can be admitted into a SNF?

A physician must personally approve in writing a recommendation that an individual be admitted to a facility


Is it possible to be admitted into a SNF , and not be under the care of a physician?

No, Each resident must remain under the care of a physician


Who must order consultations

-Texas Only- 19.1201-1
By the attending physician


What must happen if the attending physician is unavailable?

Then another physician must tend to the medical , (and other care -Texas-19.1201), of the residents**

** If both the attending and the BACK UP are OUT then it falls to the ADMINISTRATOR to find someone to put in charge of RESIDENTS CARE.


If children are admitted into the facility can ANY MEDICAL doctor be there attending physician?

-Texas Only- 19.1201-3-
Yes, but must have a pediatrician, (or other doctor who is trained with children with complex medical needs) who participates in ALL aspects of medical care.


What must the physician do at each visit to the SNF?

1-Review and or Revise all orders relating to the Total care of Resident, including medications and treatments
2-Wite, Sign, and Date Progress notes and discharge summary

** Not required for : influenza and pneumococcal polysaccharide vaccines - FED ONLY:483.40-b-3


How soon must a physician: write sign and date a discharge summary?

-Texas Only-19.1202
With in 20 Days of being informed of the discharge.


What must happen in the clinical record if a resident is re-admitted after being discharged with in 30 days or more?

-Texas Only-19.1912
Must be treated as a NEW resident in the clinical record
1-New physician orders
2-New Assessment
3-New RAI


How often must a physician visit in a LICENSED only facility?

-Texas Only-19.1203
1-At least once a year and as necessary.
- must have a medical exam once a year
2-Orders must be reviewed and or revised every 60 days


How often must a resident be seen by a physician? Medicare? Medicaid?

(SNF)&(NF) (Medicare and Medicaid)
1-Every 30 , 60 , 90 days
2-After 90 Days then q60 Days
3-Doctor Must See Personally
4-Have a 10 DAY window from due date

(SNF) Medicare Only
1-After first visit, doctors CAN alternate visits with a physician assistant, nurse practitioner, or clinical nurse specialist )
(NF) Medicaid
1- Can have all visits done by PA/NP/CN/ unless dr. Required to be there.

** Also 30 day clock starts again after each visit. (Not from first visit or admission date) -- IF AP see Pt on the 8-5-14 , and the next visit is on 9-1-14, the the third visit must be 30 days from 9-1-14 not 60 days from 8-5-14.


When is it required that all visits be made by the physician personally(Face to Face)?


When REGULATION says PHYSICIAN must preform task personally OR
When delegation is PROHIBITED by STATE or POLICY
**This means in a SNF THE FIRST VISIT is still required, and then can be altered. for qOther visit.

At the OPTION of the STATE ALL tasks given to PHYSICIANS to complete can be handed over to a (physician assistant, nurse practitioner, or clinical nurse specialist)
***So if Permitted in TEXAS all visits to NF can be made by PA, NP, or CN


The facility must have a doctor on call for?

24 hours a day for emergencies


Is it ok for the physician to use a signature stamp?

-Both-19.1912-f-2. (F-386)
1-Only when there is a letter of intent that says: he will be the ONLY ONE who uses the STAMP,
2-and the sends a letter with matching SIGNATURE of the STAMP.


When is it ok to use psychoactive medication against consent?

-Texas Only-19.1207
Never, unless:
1-Medical emergency
2-Autrozed by LAW to consent.


How soon must a doctor report a reportable communicable disease?

-Texas Only-19.1601/19.1208
Immediately, and per facility Policy


How soon must a physician certify or re-certify admission into a nursing Home?

-Texas Only-19.1210
No later than 20 days after admission


Certification and or RE-certification for resident to be in a nursing home is signed when? And is kept where?

-Texas Only-19.1210
1-20 days after admission
2-The recipient's clinical record.


Can Medical Director be appointed agent for Advanced Directives?

NO. Most states forbid this


Who develops STOP ORDER procedures for DRUGS?

Medical Director and the PHARMISIST


Who is in charge of the adequacy and accuracy of Medical RECORDS?

Attending Physician


When Must Physician do Assessments?

72 hours after admission


In a Medicare facility: When is it not OK for a physician assistant, nurse practitioner, or clinical nurse specialist preform the duties of a physician?

when the regulations specify that the "physician must perform it personally"