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ASSIGN
483.10 Resident Rights

001

F550

COMMUNICATION AND ACCESS

 
 
 
 
 
 
 
 
 
 
 
 

002

F550

MAINTENANCE AND ENHANCEMENT

 
 
 
 
 
 
 
 
 
 
 
 

003

F550

RESIDENT INDIVIDUALITY

 
 
 
 
 
 
 
 
 
 
 
 

004

F550

CALL LIGHT RESPONSE

 
 
 
 
 
 
 
 
 
 
 
 

005

F550

APPROPRIATENESS OF CLOTHING

 
 
 
 
 
 
 
 
 
 
 
 

006

F550

WELL-GROOMED, APPROPRIATE CLOTHING

 
 
 
 
 
 
 
 
 
 
 
 

007

F550

DINING ASSISTANCE

 
 
 
 
 
 
 
 
 
 
 
 

008

F550

TOILETING ASSISTANCE

 
 
 
 
 
 
 
 
 
 
 
 

009

F550

HYGIENE

 
 
 
 
 
 
 
 
 
 
 
 

010

F550

CLOTHING PROTECTORS

 
 
 
 
 
 
 
 
 
 
 
 

011

F550

DINING INTERACTION

 
 
 
 
 
 
 
 
 
 
 
 

012

F550

ACTIVITIES

 
 
 
 
 
 
 
 
 
 
 
 

013

F550

CLOTHING LABELS

 
 
 
 
 
 
 
 
 
 
 
 

014

F550

RESIDENT PREFERENCE

 
 
 
 
 
 
 
 
 
 
 
 

015

F550

DINING

 
 
 
 
 
 
 
 
 
 
 
 

016

F550

RESIDENT PRIVACY

 
 
 
 
 
 
 
 
 
 
 
 

017

F550

DIGNITY WHILE STAFF SPEAKING TO RESIDENT

 
 
 
 
 
 
 
 
 
 
 
 

018

F550

POSTING CONFIDENTIAL INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

019

F550

DIGNITY & PRIVACY DURING PERSONAL CARE

 
 
 
 
 
 
 
 
 
 
 
 

020

F550

GROOMING PREFERENCE

 
 
 
 
 
 
 
 
 
 
 
 

021

F550

RESIDENT PRIVACY

 
 
 
 
 
 
 
 
 
 
 
 

022

F550

PERSONAL PROPERTY

 
 
 
 
 
 
 
 
 
 
 
 

023

F550

IDENTICAL POLICIES

 
 
 
 
 
 
 
 
 
 
 
 

024

F550

EQUAL ACCESS

 
 
 
 
 
 
 
 
 
 
 
 

025

F550

AUTONOMY AND CHOICE

 
 
 
 
 
 
 
 
 
 
 
 

026

F550

FACILITY RULES

 
 
 
 
 
 
 
 
 
 
 
 

027

F550

FREEDOM TO EXERCISE RIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

028

F551

LEGAL REPRESENTATION

 
 
 
 
 
 
 
 
 
 
 
 

029

F551

REPRESENTATIVE'S EXERCISE OF RIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

030

F551

DELEGATION OF RIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

031

F551

REPRESENTATIVE DECISIONS

 
 
 
 
 
 
 
 
 
 
 
 

032

F551

DELEGATED DECISIONS

 
 
 
 
 
 
 
 
 
 
 
 

033

F551

RESIDENT'S BEST INTERESTS

 
 
 
 
 
 
 
 
 
 
 
 

034

F551

STATE APPOINTED REPRESENTATION

 
 
 
 
 
 
 
 
 
 
 
 

035

F551

DECISION MAKING LIMITED

 
 
 
 
 
 
 
 
 
 
 
 

036

F551

RESIDENT PREFERENCES

 
 
 
 
 
 
 
 
 
 
 
 

037

F551

PARTICIPATE IN CARE PLANNING PROCESS

 
 
 
 
 
 
 
 
 
 
 
 

038

F552

RIGHT TO BE INFORMED AND PARTICIPATE

 
 
 
 
 
 
 
 
 
 
 
 

039

F552

INFORMED OF TOTAL HEALTH STATUS

 
 
 
 
 
 
 
 
 
 
 
 

040

F552

INFORMED PRIOR TO CARE / TREATMENT

 
 
 
 
 
 
 
 
 
 
 
 

041

F552

INFORMED OF RISKS AND BENEFITS OF TREATMENT

 
 
 
 
 
 
 
 
 
 
 
 

042

F553

PARTICIPATION IN CARE PLAN - TREATMENT

 
 
 
 
 
 
 
 
 
 
 
 

043

F553

CARE PLANS - STRENGTHS AND NEEDS

 
 
 
 
 
 
 
 
 
 
 
 

044

F553

CARE PLANS - RIGHT TO PARTICIPATE

 
 
 
 
 
 
 
 
 
 
 
 

045

F553

INFORMED OF CHANGES TO PLAN OF CARE

 
 
 
 
 
 
 
 
 
 
 
 

046

F553

CARE PLAN - RECEIPT OF SERVICES AND ITEMS

 
 
 
 
 
 
 
 
 
 
 
 

047

F553

CARE PLAN - RIGHT TO SIGN

 
 
 
 
 
 
 
 
 
 
 
 

048

F553

CARE PLAN - INFORMED AND RIGHT TO PARTICIPATE

 
 
 
 
 
 
 
 
 
 
 
 

049

F553

CARE PLAN - FACILITATE INCLUSION OF RESIDENT AND/OR REPRESENTATIVE

 
 
 
 
 
 
 
 
 
 
 
 

050

F553

CARE PLAN - STRENGTHS AND WEAKNESSES

 
 
 
 
 
 
 
 
 
 
 
 

051

F553

CARE PLANS - PERSONAL AND CULTURAL PREFERENCE

 
 
 
 
 
 
 
 
 
 
 
 

052

F554

SELF-ADMINISTRATION OF DRUGS

 
 
 
 
 
 
 
 
 
 
 
 

053

F555

RIGHT TO CHOOSE ATTENDING PHYSICIAN

 
 
 
 
 
 
 
 
 
 
 
 

054

F555

FREE CHOICE - ATTENDING PHYSICIAN

 
 
 
 
 
 
 
 
 
 
 
 

055

F555

LICENSED PHYSICIAN

 
 
 
 
 
 
 
 
 
 
 
 

056

F555

ALTERNATE PHYSICIAN

 
 
 
 
 
 
 
 
 
 
 
 

057

F555

ATTENDING PHYSICIAN INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

058

F555

INFORM OF PHYSICIAN CHANGE

 
 
 
 
 
 
 
 
 
 
 
 

059

F555

HONOR PHYSICIAN CHOICE

 
 
 
 
 
 
 
 
 
 
 
 

060

F557

RESPECT AND DIGNITY

 
 
 
 
 
 
 
 
 
 
 
 

061

F557

RETAIN PERSONAL POSSESSIONS

 
 
 
 
 
 
 
 
 
 
 
 

062

F557

PERSONAL POSSESSIONS

 
 
 
 
 
 
 
 
 
 
 
 

063

F558

CALL LIGHT ADAPTATION

 
 
 
 
 
 
 
 
 
 
 
 

064

F558

CALL LIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

065

F558

DINING ACCOMMODATIONS

 
 
 
 
 
 
 
 
 
 
 
 

066

F558

ADAPTIVE EQUIPMENT

 
 
 
 
 
 
 
 
 
 
 
 

067

F558

PROVISION OF ELECTRICAL OUTLETS

 
 
 
 
 
 
 
 
 
 
 
 

068

F558

STAFF INTERACTION

 
 
 
 
 
 
 
 
 
 
 
 

069

F558

ASSISTIVE DEVICES

 
 
 
 
 
 
 
 
 
 
 
 

070

F558

PERSONAL HYGIENE ITEMS

 
 
 
 
 
 
 
 
 
 
 
 

071

F559

MARRIED COUPLES

 
 
 
 
 
 
 
 
 
 
 
 

072

F559

MARRIED COUPLES - ACCOMMODATIONS

 
 
 
 
 
 
 
 
 
 
 
 

073

F559

ROOMMATE CHOICE

 
 
 
 
 
 
 
 
 
 
 
 

074

F559

ROOM CHANGE - NOTICE

 
 
 
 
 
 
 
 
 
 
 
 

075

F560

PAYOR SOURCE - ACCOMMODATION OF NEEDS

 
 
 
 
 
 
 
 
 
 
 
 

076

F560

REASON FOR AND RIGHT TO REFUSE TRANSFER

 
 
 
 
 
 
 
 
 
 
 
 

077

F560

SNF TRANSFER - UNLICENSED SNF

 
 
 
 
 
 
 
 
 
 
 
 

078

F560

TRANSFER - DISTINCT PART FOR ELIGIBILITY

 
 
 
 
 
 
 
 
 
 
 
 

079

F560

TRANSFER - STAFF CONVENIENCE

 
 
 
 
 
 
 
 
 
 
 
 

080

F560

REFUSAL OF TRANSFERS - ELIGIBILITY

 
 
 
 
 
 
 
 
 
 
 
 

081

F561

INFORMED OF RESIDENT RIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

082

F561

RESTRICTION OF ACTIVITIES

 
 
 
 
 
 
 
 
 
 
 
 

083

F561

ACCEPT/DECLINE/MODIFY ACTIVITIES

 
 
 
 
 
 
 
 
 
 
 
 

084

F561

NOTIFICATION OF RESIDENT RIGHTS ON ADMISSION

 
 
 
 
 
 
 
 
 
 
 
 

085

F561

TIMES OF ACTIVITIES

 
 
 
 
 
 
 
 
 
 
 
 

086

F561

PROVIDERS OF HEALTH CARE SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

087

F561

PARTICIPATION

 
 
 
 
 
 
 
 
 
 
 
 

088

F561

RESIDENT'S PERSONAL CARE/DAILY ROUTINE

 
 
 
 
 
 
 
 
 
 
 
 

089

F561

SLEEP TIMES

 
 
 
 
 
 
 
 
 
 
 
 

090

F561

TIME AND BATHING METHOD PREFERENCE

 
 
 
 
 
 
 
 
 
 
 
 

091

F561

ASSISTANCE WITH ACTIVITIES

 
 
 
 
 
 
 
 
 
 
 
 

092

F561

RESIDENT CHOICES

 
 
 
 
 
 
 
 
 
 
 
 

093

F561

ROOMMATE CHOICE

 
 
 
 
 
 
 
 
 
 
 
 

094

F561

SMOKE FREE

 
 
 
 
 
 
 
 
 
 
 
 

095

F561

INTERACTION INSIDE/OUTSIDE OF FACILITY

 
 
 
 
 
 
 
 
 
 
 
 

096

F561

PARTICIPATION IN OTHER ACTIVITIES

 
 
 
 
 
 
 
 
 
 
 
 

097

F562

ACCESS TO REPRESENTATIVE OF THE SECRETARY

 
 
 
 
 
 
 
 
 
 
 
 

098

F562

ACCESS TO REPRESENTATIVE OF THE STATE

 
 
 
 
 
 
 
 
 
 
 
 

099

F562

ACCESS TO STATE OMBUDSMAN

 
 
 
 
 
 
 
 
 
 
 
 

100

F562

ACCESS TO RESIDENT'S PHYSICIAN

 
 
 
 
 
 
 
 
 
 
 
 

101

F562

ACCESS TO AGENCIES

 
 
 
 
 
 
 
 
 
 
 
 

102

F562

ACCESS TO AGENCIES FOR MENTALLY DISABLED

 
 
 
 
 
 
 
 
 
 
 
 

103

F562

ACCESS AND VISITATION - RESIDENT'S REPRESENTATIVE

 
 
 
 
 
 
 
 
 
 
 
 

104

F563

ACCESS AND VISITATION - CHOOSING

 
 
 
 
 
 
 
 
 
 
 
 

105

F563

ACCESS AND VISITATION - FAMILY OR OTHER RELATIVES

 
 
 
 
 
 
 
 
 
 
 
 

106

F563

ACCESS AND VISITATION - OTHER VISITORS

 
 
 
 
 
 
 
 
 
 
 
 

107

F563

ACCESS AND VISITATION - ANY ENTITY

 
 
 
 
 
 
 
 
 
 
 
 

108

F563

VISITATION - WRITTEN POLICIES AND PROCEDURES

 
 
 
 
 
 
 
 
 
 
 
 

109

F564

ACCESS AND VISITATION - POLICY AND PROCEDURE

 
 
 
 
 
 
 
 
 
 
 
 

110

F564

ACCESS AND VISITATION - RESTRICTIONS

 
 
 
 
 
 
 
 
 
 
 
 

111

F564

ACCESS AND VISITATION - NOT RESTRICT, LIMIT OR DENY

 
 
 
 
 
 
 
 
 
 
 
 

112

F564

ACCESS AND VISITATION - EQUAL PRIVILEGES

 
 
 
 
 
 
 
 
 
 
 
 

113

F565

PARTICIPATION IN RESIDENT GROUPS

 
 
 
 
 
 
 
 
 
 
 
 

114

F565

PRIVATE SPACE FOR RESIDENT & FAMILY GROUPS

 
 
 
 
 
 
 
 
 
 
 
 

115

F565

RESIDENT GROUPS - PRIVATE SPACE

 
 
 
 
 
 
 
 
 
 
 
 

116

F565

GROUP MEETING ATTENDANCE

 
 
 
 
 
 
 
 
 
 
 
 

117

F565

RESIDENT GROUPS - PERSON TO ASSIST

 
 
 
 
 
 
 
 
 
 
 
 

118

F565

STAFF PERSON DESIGNATED FOR GROUP MEETINGS

 
 
 
 
 
 
 
 
 
 
 
 

119

F565

RESIDENT COUNCIL - GRIEVANCE RESOLUTION

 
 
 
 
 
 
 
 
 
 
 
 

120

F565

DESIGNATED STAFF PERSON FOR GROUP MEETINGS

 
 
 
 
 
 
 
 
 
 
 
 

121

F565

RESIDENT & FAMILY COUNCIL MEETINGS

 
 
 
 
 
 
 
 
 
 
 
 

122

F565

RESIDENT GROUPS

 
 
 
 
 
 
 
 
 
 
 
 

123

F565

FAMILY GROUPS

 
 
 
 
 
 
 
 
 
 
 
 

124

F565

FAMILY MEETINGS

 
 
 
 
 
 
 
 
 
 
 
 

125

F566

WORK - REFUSAL

 
 
 
 
 
 
 
 
 
 
 
 

126

F566

WORK - COMPENSATION

 
 
 
 
 
 
 
 
 
 
 
 

127

F566

WORK - DESCRIPTION

 
 
 
 
 
 
 
 
 
 
 
 

128

F566

WORK - PLAN OF CARE

 
 
 
 
 
 
 
 
 
 
 
 

129

F566

WORK - NATURE

 
 
 
 
 
 
 
 
 
 
 
 

130

F566

WORK - COMPENSATION

 
 
 
 
 
 
 
 
 
 
 
 

131

F566

WORK - ARRANGEMENT

 
 
 
 
 
 
 
 
 
 
 
 

132

F567

PROTECTION OF RESIDENT FUNDS

 
 
 
 
 
 
 
 
 
 
 
 

133

F567

MANAGEMENT OF FUNDS

 
 
 
 
 
 
 
 
 
 
 
 

134

F567

AUTHORIZATION TO MANAGE

 
 
 
 
 
 
 
 
 
 
 
 

135

F567

TRUST FUND - NOT REQUIRED

 
 
 
 
 
 
 
 
 
 
 
 

136

F567

MANAGEMENT OF PERSONAL FUNDS

 
 
 
 
 
 
 
 
 
 
 
 

137

F567

PROTECTION OF FUNDS - TRUST FUND OPTIONAL

 
 
 
 
 
 
 
 
 
 
 
 

138

F567

FUNDS IN EXCESS OF $50

 
 
 
 
 
 
 
 
 
 
 
 

139

F567

FUNDS

 
 
 
 
 
 
 
 
 
 
 
 

140

F567

RESIDENT FUNDS LESS THAN $50

 
 
 
 
 
 
 
 
 
 
 
 

141

F568

PERSONAL FUNDS - ONGOING BALANCE

 
 
 
 
 
 
 
 
 
 
 
 

142

F568

PERSONAL FUNDS - WHAT TRANSACTIONS ARE FOR

 
 
 
 
 
 
 
 
 
 
 
 

143

F568

PERSONAL FUNDS - WHEN TRANSACTIONS OCCURRED

 
 
 
 
 
 
 
 
 
 
 
 

144

F568

RECEIPTS FOR RESIDENT TRANSACTIONS

 
 
 
 
 
 
 
 
 
 
 
 

145

F568

ACCOUNTING

 
 
 
 
 
 
 
 
 
 
 
 

146

F568

COMMINGLING OF FUNDS

 
 
 
 
 
 
 
 
 
 
 
 

147

F568

QUARTERLY STATEMENTS

 
 
 
 
 
 
 
 
 
 
 
 

148

F568

TRUST ACCOUNT - RECEIPT OF QUARTERLY STATEMENT

 
 
 
 
 
 
 
 
 
 
 
 

149

F569

NOTICE OF BALANCES - SSI RESOURCE LIMIT

 
 
 
 
 
 
 
 
 
 
 
 

150

F569

NOTICE BALANCES - SSI RESOURCE LIMIT, ELIGIBILITY

 
 
 
 
 
 
 
 
 
 
 
 

151

F569

CONVEYANCE OF PERSONAL FUNDS

 
 
 
 
 
 
 
 
 
 
 
 

152

F570

ASSURANCE OF FINANCIAL SECURITY

 
 
 
 
 
 
 
 
 
 
 
 

153

F571

ITEMS COVERED BY MEDICARE - MEDICAID

 
 
 
 
 
 
 
 
 
 
 
 

154

F571

PERSONAL FUNDS (MEDICARE) - NURSING SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

155

F571

PERSONAL FUNDS (MEDICAID) - NURSING SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

156

F571

PERSONAL FUNDS (MEDICARE) - FOOD AND NUTRITION

 
 
 
 
 
 
 
 
 
 
 
 

157

F571

PERSONAL FUNDS (MEDICAID) - FOOD AND NUTRITION

 
 
 
 
 
 
 
 
 
 
 
 

158

F571

CHARGES FOR NON-COVERED ITEMS (MEDICAID)

 
 
 
 
 
 
 
 
 
 
 
 

159

F571

PERSONAL FUNDS (MEDICARE) - ACTIVITY PROGRAMS

 
 
 
 
 
 
 
 
 
 
 
 

160

F571

PERSONAL FUNDS (MEDICAID) - ACTIVITY PROGRAMS

 
 
 
 
 
 
 
 
 
 
 
 

161

F571

PERSONAL FUNDS (MEDICAID) - MAINTENANCE SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

162

F571

PERSONAL FUNDS (MEDICARE) - MAINTENANCE SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

163

F571

PERSONAL FUNDS (MEDICARE) - PERSONAL HYGIENE

 
 
 
 
 
 
 
 
 
 
 
 

164

F571

PERSONAL FUNDS (MEDICAID) - PERSONAL HYGIENE

 
 
 
 
 
 
 
 
 
 
 
 

165

F571

PERSONAL FUNDS (MEDICARE) - SOCIAL SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

166

F571

PERSONAL FUNDS (MEDICAID) - SOCIAL SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

167

F571

PERSONAL FUNDS (MEDICARE) - HOSPICE

 
 
 
 
 
 
 
 
 
 
 
 

168

F571

PERSONAL FUNDS (MEDICAID) - HOSPICE

 
 
 
 
 
 
 
 
 
 
 
 

169

F571

RESIDENT TRUST FUND - TELEPHONE

 
 
 
 
 
 
 
 
 
 
 
 

170

F571

RESIDENT TRUST FUND - TV - RADIO - COMPUTER - NOT INCLUDED

 
 
 
 
 
 
 
 
 
 
 
 

171

F571

PERSONAL COMFORT ITEMS

 
 
 
 
 
 
 
 
 
 
 
 

172

F571

COSMETIC AND GROOMING ITEMS

 
 
 
 
 
 
 
 
 
 
 
 

173

F571

PERSONAL CLOTHING

 
 
 
 
 
 
 
 
 
 
 
 

174

F571

PERSONAL READING MATTER

 
 
 
 
 
 
 
 
 
 
 
 

175

F571

GIFTS

 
 
 
 
 
 
 
 
 
 
 
 

176

F571

FLOWERS

 
 
 
 
 
 
 
 
 
 
 
 

177

F571

ENTERTAINMENT

 
 
 
 
 
 
 
 
 
 
 
 

178

F571

SPECIAL CARE SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

179

F571

PRIVATE ROOM

 
 
 
 
 
 
 
 
 
 
 
 

180

F571

SPECIALTY FOODS

 
 
 
 
 
 
 
 
 
 
 
 

181

F571

PRESCRIBED SPECIALTY FOOD

 
 
 
 
 
 
 
 
 
 
 
 

182

F571

OVERALL CULTURAL AND RELIGIOUS FACILITY MAKE-UP

 
 
 
 
 
 
 
 
 
 
 
 

183

F571

PERSONAL FUNDS (MEDICAID) - COVERED SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

184

F571

PERSONAL FUNDS (MEDICARE) - COVERED SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

185

F571

REQUESTS FOR ITEMS AND SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

186

F571

CHARGES FOR NON-COVERED ITEMS (MEDICARE)

 
 
 
 
 
 
 
 
 
 
 
 

187

F572

ACCESSIBILITY TO RESIDENT RIGHTS NOTICE

 
 
 
 
 
 
 
 
 
 
 
 

188

F572

RULES AND REGULATIONS

 
 
 
 
 
 
 
 
 
 
 
 

189

F572

PROVIDED TO RESIDENT

 
 
 
 
 
 
 
 
 
 
 
 

190

F572

FULL DISCLOSURE

 
 
 
 
 
 
 
 
 
 
 
 

191

F572

NOTICE OF RIGHTS AND RULES

 
 
 
 
 
 
 
 
 
 
 
 

192

F572

RIGHTS - RULES - CONDUCT

 
 
 
 
 
 
 
 
 
 
 
 

193

F572

NOTICE OF MEDICAID RIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

194

F572

MEDICAID RIGHTS AND OBLIGATIONS

 
 
 
 
 
 
 
 
 
 
 
 

195

F573

ACCESS TO RECORDS - BY RESIDENT

 
 
 
 
 
 
 
 
 
 
 
 

196

F573

ACCESS TO RECORDS - BY LEGAL REP

 
 
 
 
 
 
 
 
 
 
 
 

197

F573

ACCESS TO RESIDENT RECORDS - IN 24 HRS

 
 
 
 
 
 
 
 
 
 
 
 

198

F573

COST OF RECORDS

 
 
 
 
 
 
 
 
 
 
 
 

199

F573

INFORMATION IN UNDERSTANDABLE FORMAT

 
 
 
 
 
 
 
 
 
 
 
 

200

F574

LANGUAGE UNDERSTOOD

 
 
 
 
 
 
 
 
 
 
 
 

201

F574

PROTECTION OF FUNDS

 
 
 
 
 
 
 
 
 
 
 
 

202

F574

ESTABLISHING MEDICAID ELIGIBILITY

 
 
 
 
 
 
 
 
 
 
 
 

203

F574

OMBUDSMAN - STATE AGENCIES

 
 
 
 
 
 
 
 
 
 
 
 

204

F574

MEDICAID FRAUD CONTACT

 
 
 
 
 
 
 
 
 
 
 
 

205

F574

STATEMENT TO FILE COMPLAINT

 
 
 
 
 
 
 
 
 
 
 
 

206

F574

RESIDENT COMPLAINTS

 
 
 
 
 
 
 
 
 
 
 
 

207

F574

FILING A COMPLAINT

 
 
 
 
 
 
 
 
 
 
 
 

208

F574

INFORMATION AND CONTACT INFORMATION - STATE AND LOCAL ADVOCACY ORGANIZATIONS

 
 
 
 
 
 
 
 
 
 
 
 

209

F574

MEDICARE AND MEDICAID ELIGIBILITY

 
 
 
 
 
 
 
 
 
 
 
 

210

F574

AGING AND DISABILITY RESOURCE CENTER

 
 
 
 
 
 
 
 
 
 
 
 

211

F574

MEDICAID FRAUD UNIT

 
 
 
 
 
 
 
 
 
 
 
 

212

F574

CONTACT INFORMATION - FILING GRIEVANCE

 
 
 
 
 
 
 
 
 
 
 
 

213

F575

POSTINGS - STATE AGENCY

 
 
 
 
 
 
 
 
 
 
 
 

214

F575

POSTINGS - COMPLAINT WITH STATE SURVEY AGENCY

 
 
 
 
 
 
 
 
 
 
 
 

215

F576

TELEPHONE - ACCESS, PRIVACY

 
 
 
 
 
 
 
 
 
 
 
 

216

F576

TELEPHONES - ADA

 
 
 
 
 
 
 
 
 
 
 
 

217

F576

TELEPHONE - AVAILABILITY

 
 
 
 
 
 
 
 
 
 
 
 

218

F576

COMMUNICATION - INTERNAL AND EXTERNAL

 
 
 
 
 
 
 
 
 
 
 
 

219

F576

TELEPHONE - TTY AND TDD SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

220

F576

ACCESS - INTERNET

 
 
 
 
 
 
 
 
 
 
 
 

221

F576

SEND MAIL

 
 
 
 
 
 
 
 
 
 
 
 

222

F576

MAIL - SEND AND RECEIVE

 
 
 
 
 
 
 
 
 
 
 
 

223

F576

MAIL - PRIVACY

 
 
 
 
 
 
 
 
 
 
 
 

224

F576

MAIL - STATIONARY

 
 
 
 
 
 
 
 
 
 
 
 

225

F576

PRIVACY - ELECTRONIC COMMUNICATION

 
 
 
 
 
 
 
 
 
 
 
 

226

F576

ACCESS - ELECTRONIC COMMUNICATION

 
 
 
 
 
 
 
 
 
 
 
 

227

F576

ELECTRONIC COMMUNICATION - RESIDENTS EXPENSE

 
 
 
 
 
 
 
 
 
 
 
 

228

F576

ELECTRONIC COMMUNICATION - COMPLY WITH STATE AND FEDERAL LAW

 
 
 
 
 
 
 
 
 
 
 
 

229

F577

LOCATION - SURVEY RESULTS

 
 
 
 
 
 
 
 
 
 
 
 

230

F577

POSTING OF SURVEY RESULTS

 
 
 
 
 
 
 
 
 
 
 
 

231

F577

CLIENT ADVOCATE AGENCIES

 
 
 
 
 
 
 
 
 
 
 
 

232

F577

EXAMINATION OF SURVEY RESULTS

 
 
 
 
 
 
 
 
 
 
 
 

233

F577

SURVEY RESULTS POSTED

 
 
 
 
 
 
 
 
 
 
 
 

234

F577

AVAILABILITY OF SURVEY RESULTS, LOCATION

 
 
 
 
 
 
 
 
 
 
 
 

235

F577

THREE YEARS AVAILABLE UPON REQUEST

 
 
 
 
 
 
 
 
 
 
 
 

236

F577

POSTING OF AVAILABILITY

 
 
 
 
 
 
 
 
 
 
 
 

237

F577

CONFIDENTIALITY OF COMPLAINANTS - RESIDENTS

 
 
 
 
 
 
 
 
 
 
 
 

238

F578

CONSENT TO TREAT

 
 
 
 
 
 
 
 
 
 
 
 

239

F578

RIGHT TO REQUEST - REFUSE - DISCONTINUE TREATMENT

 
 
 
 
 
 
 
 
 
 
 
 

240

F578

ADVANCED DIRECTIVE ORDERS

 
 
 
 
 
 
 
 
 
 
 
 

241

F578

RIGHTS REGARDING TREATMENT

 
 
 
 
 
 
 
 
 
 
 
 

242

F578

RIGHT TO FORMULATE AN ADVANCE DIRECTIVE

 
 
 
 
 
 
 
 
 
 
 
 

243

F578

PRESENCE OF ADVANCED DIRECTIVE

 
 
 
 
 
 
 
 
 
 
 
 

244

F578

ADVANCED DIRECTIVE - UNDERSTANDING RIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

245

F578

MEDICALLY UNNECESSARY - MEDICALLY INAPPROPRIATE TREATMENT

 
 
 
 
 
 
 
 
 
 
 
 

246

F578

WRITTEN INFORMATION - RIGHT TO ACCEPT OR REFUSE

 
 
 
 
 
 
 
 
 
 
 
 

247

F578

ADVANCED DIRECTIVE POLICIES

 
 
 
 
 
 
 
 
 
 
 
 

248

F578

CONTRACT WITH OTHER ENTITIES

 
 
 
 
 
 
 
 
 
 
 
 

249

F578

ADVANCE DIRECTIVE - INCAPACITATED UPON ADMISSION

 
 
 
 
 
 
 
 
 
 
 
 

250

F578

FACILITY FOLLOW UP - INCAPACITATED RESIDENT

 
 
 
 
 
 
 
 
 
 
 
 

251

F579

BENEFITS

 
 
 
 
 
 
 
 
 
 
 
 

252

F579

INFO POSTED FOR APPLYING FOR MEDICARE/MEDICAID

 
 
 
 
 
 
 
 
 
 
 
 

253

F579

HOW TO APPLY FOR MEDICARE/MEDICAID

 
 
 
 
 
 
 
 
 
 
 
 

254

F580

NOTIFICATION OF ACCIDENTS

 
 
 
 
 
 
 
 
 
 
 
 

255

F580

NOTIFICATION OF SIGNIFICANT CHANGE

 
 
 
 
 
 
 
 
 
 
 
 

256

F580

NOTIFICATION OF ALTERED TREATMENT

 
 
 
 
 
 
 
 
 
 
 
 

257

F580

MD NOTIFICATION OF TRANSFER OR DISCHARGE

 
 
 
 
 
 
 
 
 
 
 
 

258

F580

NOTIFICATION OF TRANSFER OR DISCHARGE

 
 
 
 
 
 
 
 
 
 
 
 

259

F580

PHYSICIAN REQUESTED INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

260

F580

NOTIFICATION OF ROOM/ROOMMATE CHANGE

 
 
 
 
 
 
 
 
 
 
 
 

261

F580

NOTIFICATION OF CHANGE IN RESIDENT RIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

262

F580

RESIDENT IDENTIFICATION

 
 
 
 
 
 
 
 
 
 
 
 

263

F582

ITEMS AND SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

264

F582

COVERED ITEMS AND SERVICES (MEDICAID)

 
 
 
 
 
 
 
 
 
 
 
 

265

F582

NOTIFICATIONS - MEDICAID ELIGIBILITY

 
 
 
 
 
 
 
 
 
 
 
 

266

F582

NOT COVERED ITEMS AND SERVICES (MEDICAID)

 
 
 
 
 
 
 
 
 
 
 
 

267

F582

CHANGES TO ITEMS / SERVICES (MEDICAID)

 
 
 
 
 
 
 
 
 
 
 
 

268

F582

CHANGES TO STATE PLAN

 
 
 
 
 
 
 
 
 
 
 
 

269

F582

NOT COVERED ITEMS AND SERVICES - MEDICARE - MEDICAID

 
 
 
 
 
 
 
 
 
 
 
 

270

F582

CHANGES IN COVERAGE - ITEMS AND SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

271

F582

CHANGES IN CHARGES - 60 DAY NOTIFICATION

 
 
 
 
 
 
 
 
 
 
 
 

272

F582

REFUND OF DEPOSIT - CHARGES PAID

 
 
 
 
 
 
 
 
 
 
 
 

273

F582

REFUND WITHIN 30 DAYS

 
 
 
 
 
 
 
 
 
 
 
 

274

F582

ADMISSION CONTRACT

 
 
 
 
 
 
 
 
 
 
 
 

275

F583

PRIVACY AND CONFIDENTIALITY

 
 
 
 
 
 
 
 
 
 
 
 

276

F583

PERSONAL TREATMENTS

 
 
 
 
 
 
 
 
 
 
 
 

277

F583

PERSONAL TELEPHONE

 
 
 
 
 
 
 
 
 
 
 
 

278

F583

PERSONAL CARE

 
 
 
 
 
 
 
 
 
 
 
 

279

F583

PERSONAL VISITORS

 
 
 
 
 
 
 
 
 
 
 
 

280

F583

PERSONAL FAMILY

 
 
 
 
 
 
 
 
 
 
 
 

281

F583

PRIVACY - SEND AND RECEIVE

 
 
 
 
 
 
 
 
 
 
 
 

282

F583

PRIVACY - COMMUNICATIONS

 
 
 
 
 
 
 
 
 
 
 
 

283

F583

RELEASE OF RECORDS

 
 
 
 
 
 
 
 
 
 
 
 

284

F583

CONSENT OR REFUSAL OF RECORD RELEASE

 
 
 
 
 
 
 
 
 
 
 
 

285

F583

PRIVACY AND CONFIDENTIALITY

 
 
 
 
 
 
 
 
 
 
 
 

286

F583

RIGHT TO APPROVE RECORD RELEASE

 
 
 
 
 
 
 
 
 
 
 
 

287

F583

OMBUDSMAN REVIEW OF CLINICAL RECORDS

 
 
 
 
 
 
 
 
 
 
 
 

288

F583

OMBUDSMAN

 
 
 
 
 
 
 
 
 
 
 
 

289

F584

RECEIVING TREATMENT AND SUPPORT

 
 
 
 
 
 
 
 
 
 
 
 

290

F584

HOMELIKE ENVIRONMENT

 
 
 
 
 
 
 
 
 
 
 
 

291

F584

COMFORTABLE ENVIRONMENT

 
 
 
 
 
 
 
 
 
 
 
 

292

F584

HOMELIKE ENVIRONMENT

 
 
 
 
 
 
 
 
 
 
 
 

293

F584

PERSONAL BELONGINGS

 
 
 
 
 
 
 
 
 
 
 
 

294

F584

SAFE ENVIRONMENT

 
 
 
 
 
 
 
 
 
 
 
 

295

F584

PHYSICAL PLANT SAFETY

 
 
 
 
 
 
 
 
 
 
 
 

296

F584

PROTECTION FROM THEFT

 
 
 
 
 
 
 
 
 
 
 
 

297

F584

HOUSEKEEPING AND MAINTENANCE

 
 
 
 
 
 
 
 
 
 
 
 

298

F584

RESIDENT CARE EQUIPMENT

 
 
 
 
 
 
 
 
 
 
 
 

299

F584

ENVIRONMENT - ROOM FUNCTIONALITY

 
 
 
 
 
 
 
 
 
 
 
 

300

F584

ORDERLY ENVIRONMENT

 
 
 
 
 
 
 
 
 
 
 
 

301

F584

SANITARY ENVIRONMENT

 
 
 
 
 
 
 
 
 
 
 
 

302

F584

CLEAN BED LINENS

 
 
 
 
 
 
 
 
 
 
 
 

303

F584

CLEAN BATH LINENS

 
 
 
 
 
 
 
 
 
 
 
 

304

F584

PRIVATE CLOSET SPACE

 
 
 
 
 
 
 
 
 
 
 
 

305

F584

LIGHTING

 
 
 
 
 
 
 
 
 
 
 
 

306

F584

TEMPERATURE LEVELS

 
 
 
 
 
 
 
 
 
 
 
 

307

F584

TEMPERATURE LEVELS

 
 
 
 
 
 
 
 
 
 
 
 

308

F584

SOUND LEVELS

 
 
 
 
 
 
 
 
 
 
 
 

309

F584

SOUND LEVELS AT NIGHT

 
 
 
 
 
 
 
 
 
 
 
 

310

F585

GRIEVANCES, CONCERNS, COMPLAINTS

 
 
 
 
 
 
 
 
 
 
 
 

311

F585

VOICING GRIEVANCES

 
 
 
 
 
 
 
 
 
 
 
 

312

F585

GRIEVANCE, CONCERN, COMPLAINT - RESOLUTION

 
 
 
 
 
 
 
 
 
 
 
 

313

F585

COMPLAINT RESOLUTION, PROMPT EFFORTS

 
 
 
 
 
 
 
 
 
 
 
 

314

F585

GRIEVANCES - POLICY & PROCEDURE

 
 
 
 
 
 
 
 
 
 
 
 

315

F585

GRIEVANCES - PROMPT RESPONSE

 
 
 
 
 
 
 
 
 
 
 
 

316

F585

GRIEVANCE HOW TO FILE

 
 
 
 
 
 
 
 
 
 
 
 

317

F585

COPY OF GRIEVANCE POLICY

 
 
 
 
 
 
 
 
 
 
 
 

318

F585

GRIEVANCE POLICY - NOTIFICATION

 
 
 
 
 
 
 
 
 
 
 
 

319

F585

GRIEVANCE POLICY -ANONYMOUS GRIEVANCE

 
 
 
 
 
 
 
 
 
 
 
 

320

F585

GRIEVANCE POLICY - CONTACT INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

321

F585

GRIEVANCE POLICY - WRITTEN DECISION OF GRIEVANCE

 
 
 
 
 
 
 
 
 
 
 
 

322

F585

GRIEVANCE POLICY - COMPLETION OF GRIEVANCE

 
 
 
 
 
 
 
 
 
 
 
 

323

F585

GRIEVANCE POLICY - CONTACT INFORMATION OF INDEPENDENT ENTITIES

 
 
 
 
 
 
 
 
 
 
 
 

324

F585

GRIEVANCE POLICY - GRIEVANCE OFFICER IDENTIFIED

 
 
 
 
 
 
 
 
 
 
 
 

325

F585

GRIEVANCE POLICY - GRIEVANCE OFFICIAL LEADS INVESTIGATION

 
 
 
 
 
 
 
 
 
 
 
 

326

F585

GRIEVANCE POLICY - GRIEVANCE CONFIDENTIALITY

 
 
 
 
 
 
 
 
 
 
 
 

327

F585

GRIEVANCE POLICY - GRIEVANCE OFFICIAL - DECISIONS

 
 
 
 
 
 
 
 
 
 
 
 

328

F585

GRIEVANCE POLICY - COORDINATION WITH STATE AND FEDERAL AGENCIES

 
 
 
 
 
 
 
 
 
 
 
 

329

F585

GRIEVANCE POLICY - IMMEDIATE ACTION

 
 
 
 
 
 
 
 
 
 
 
 

330

F585

GRIEVANCE POLICY - REPORTING REQUIREMENTS

 
 
 
 
 
 
 
 
 
 
 
 

331

F585

GRIEVANCE POLICY - GRIEVANCE DECISION - DATE RECEIVED

 
 
 
 
 
 
 
 
 
 
 
 

332

F585

GRIEVANCE POLICY - GRIEVANCE DECISION - SUMMARY STATEMENT

 
 
 
 
 
 
 
 
 
 
 
 

333

F585

GRIEVANCE POLICY - STEPS TO INVESTIGATE

 
 
 
 
 
 
 
 
 
 
 
 

334

F585

GRIEVANCE POLICY - SUMMARY OF FINDINGS

 
 
 
 
 
 
 
 
 
 
 
 

335

F585

GRIEVANCE POLICY - GRIEVANCE CONFIRMATION

 
 
 
 
 
 
 
 
 
 
 
 

336

F585

GRIEVANCE POLICY - CORRECTIVE ACTION

 
 
 
 
 
 
 
 
 
 
 
 

337

F585

GRIEVANCE POLICY - DATE DECISION ISSUED

 
 
 
 
 
 
 
 
 
 
 
 

338

F585

GRIEVANCE POLICY - CONFIRMED BY FACILITY OR OUTSIDE ENTITY

 
 
 
 
 
 
 
 
 
 
 
 

339

F585

GRIEVANCE POLICY - MAINTAINING EVIDENCE 3 YEARS

 
 
 
 
 
 
 
 
 
 
 
 

340

F586

CONTACT WITH EXTERNAL ENTITIES

 
 
 
 
 
 
 
 
 
 
 
 
483.12 Freedom from Abuse, Neglect, and Exploitation

341

F600

FREEDOM FROM ABUSE, NEGLECT AND EXPLOITATION

 
 
 
 
 
 
 
 
 
 
 
 

342

F600

ABUSE - PHYSICAL ABUSE

 
 
 
 
 
 
 
 
 
 
 
 

343

F600

ABUSE - VERBAL ABUSE

 
 
 
 
 
 
 
 
 
 
 
 

344

F600

ABUSE - MENTAL ABUSE

 
 
 
 
 
 
 
 
 
 
 
 

345

F600

ABUSE - SEXUAL ABUSE

 
 
 
 
 
 
 
 
 
 
 
 

346

F600

ABUSE - CORPORAL PUNISHMENT

 
 
 
 
 
 
 
 
 
 
 
 

347

F600

ABUSE - NEGLECT

 
 
 
 
 
 
 
 
 
 
 
 

348

F602

ABUSE - MISAPPROPRIATION

 
 
 
 
 
 
 
 
 
 
 
 

349

F602

ABUSE - EXPLOITATION

 
 
 
 
 
 
 
 
 
 
 
 

350

F603

ABUSE - INVOLUNTARY SECLUSION

 
 
 
 
 
 
 
 
 
 
 
 

351

F604

PHYSICAL RESTRAINTS - ASSESSMENT

 
 
 
 
 
 
 
 
 
 
 
 

352

F604

PHYSICAL RESTRAINTS - PHYSICIAN'S ORDER

 
 
 
 
 
 
 
 
 
 
 
 

353

F604

PHYSICAL RESTRAINTS - MEDICAL SYMPTOM

 
 
 
 
 
 
 
 
 
 
 
 

354

F604

PHYSICAL RESTRAINTS - ALTERNATIVES

 
 
 
 
 
 
 
 
 
 
 
 

355

F604

PHYSICAL RESTRAINTS - LEAST RESTRICTIVE

 
 
 
 
 
 
 
 
 
 
 
 

356

F604

PHYSICAL RESTRAINTS - SUPERVISION

 
 
 
 
 
 
 
 
 
 
 
 

357

F604

PHYSICAL RESTRAINTS - INFORMED CONSENT

 
 
 
 
 
 
 
 
 
 
 
 

358

F604

PHYSICAL RESTRAINTS - RE-EVALUATE

 
 
 
 
 
 
 
 
 
 
 
 

359

F604

PHYSICAL RESTRAINTS - LENGTH AND TIME

 
 
 
 
 
 
 
 
 
 
 
 

360

F604

PHYSICAL RESTRAINTS - APPLICATION AND RELEASE

 
 
 
 
 
 
 
 
 
 
 
 

361

F604

PHYSICAL RESTRAINTS - RIGHT TO REFUSE

 
 
 
 
 
 
 
 
 
 
 
 

362

F604

PHYSICAL RESTRAINTS - ADL CARE

 
 
 
 
 
 
 
 
 
 
 
 

363

F604

PHYSICAL RESTRAINTS - POSITION CHANGE ALARMS

 
 
 
 
 
 
 
 
 
 
 
 

364

F604

PHYSICAL RESTRAINTS - SIDE RAILS

 
 
 
 
 
 
 
 
 
 
 
 

365

F604

PHYSICAL RESTRAINTS - RESPECT AND DIGNITY

 
 
 
 
 
 
 
 
 
 
 
 

366

F605

CHEMICAL RESTRAINTS - RESPECT AND DIGNITY

 
 
 
 
 
 
 
 
 
 
 
 

367

F605

CHEMICAL RESTRAINTS - ASSESSMENT

 
 
 
 
 
 
 
 
 
 
 
 

368

F605

CHEMICAL RESTRAINTS - MEDICAL SYMPTOM

 
 
 
 
 
 
 
 
 
 
 
 

369

F605

CHEMICAL RESTRAINTS - ALTERNATIVES

 
 
 
 
 
 
 
 
 
 
 
 

370

F605

CHEMICAL RESTRAINTS - EXCESSIVE DOSE - DURATION

 
 
 
 
 
 
 
 
 
 
 
 

371

F605

CHEMICAL RESTRAINTS - GDR

 
 
 
 
 
 
 
 
 
 
 
 

372

F605

CHEMICAL RESTRAINTS - MONITOR AND ADJUST

 
 
 
 
 
 
 
 
 
 
 
 

373

F605

CHEMICAL RESTRAINTS - INFORMED CONSENT

 
 
 
 
 
 
 
 
 
 
 
 

374

F605

CHEMICAL RESTRAINTS - RE-EVALUATE

 
 
 
 
 
 
 
 
 
 
 
 

375

F605

CHEMICAL RESTRAINTS - DISCIPLINE AND CONVENIENCE

 
 
 
 
 
 
 
 
 
 
 
 

376

F606

PRIOR EMPLOYMENT SCREENING

 
 
 
 
 
 
 
 
 
 
 
 

377

F606

SCREENING STAFF

 
 
 
 
 
 
 
 
 
 
 
 

378

F606

REGISTRY & LICENSING BOARD VERIFICATION

 
 
 
 
 
 
 
 
 
 
 
 

379

F606

SCREENING STAFF - NO ABUSE FINDINGS

 
 
 
 
 
 
 
 
 
 
 
 

380

F606

ABUSE REPORTING

 
 
 
 
 
 
 
 
 
 
 
 

381

F606

ABUSE REPORTING POLICY & PROCEDURES

 
 
 
 
 
 
 
 
 
 
 
 

382

F606

REPORTING STAFF

 
 
 
 
 
 
 
 
 
 
 
 

383

F607

PROHIBITION OF ABUSE - POLICY AND PROCEDURE

 
 
 
 
 
 
 
 
 
 
 
 

384

F880

RESIDENT CARE - RESIDENT FACEMASKS

 
 
 
 
 
 
 
 
 
 
 
 

385

F880

TRANSMISSION BASED PRECAUTIONS - MOVEMENT IN FACILITY

 
 
 
 
 
 
 
 
 
 
 
 

386

F607

ABUSE POLICY - NEGLECT

 
 
 
 
 
 
 
 
 
 
 
 

387

F607

ABUSE POLICY - MISAPPROPRIATION

 
 
 
 
 
 
 
 
 
 
 
 

388

F607

ABUSE POLICY - NEGLECT

 
 
 
 
 
 
 
 
 
 
 
 

389

F607

ABUSE POLICY - EXPLOITATION

 
 
 
 
 
 
 
 
 
 
 
 

390

F607

ABUSE POLICY - STAFF TREATMENT OF RESIDENTS

 
 
 
 
 
 
 
 
 
 
 
 

391

F607

ABUSE POLICY - INVESTIGATIONS

 
 
 
 
 
 
 
 
 
 
 
 

392

F607

ABUSE POLICY - PROHIBITIONS

 
 
 
 
 
 
 
 
 
 
 
 

393

F607

ABUSE POLICY - TRAINING

 
 
 
 
 
 
 
 
 
 
 
 

394

F607

QAPI - ABUSE

 
 
 
 
 
 
 
 
 
 
 
 

395

F608

POLICY AND PROCEDURE - REPORTING CRIMES

 
 
 
 
 
 
 
 
 
 
 
 

396

F608

POLICY AND PROCEDURE - NOTIFICATION TO COVERED INDIVIDUALS

 
 
 
 
 
 
 
 
 
 
 
 

397

F608

POLICY AND PROCEDURE - REPORTING ENTITY

 
 
 
 
 
 
 
 
 
 
 
 

398

F608

POLICY AND PROCEDURE - REPORT TIMING

 
 
 
 
 
 
 
 
 
 
 
 

399

F608

POLICY AND PROCEDURE - POSTING OF EMPLOYEE RIGHTS

 
 
 
 
 
 
 
 
 
 
 
 

400

F608

POLICY AND PROCEDURE - RETALIATION

 
 
 
 
 
 
 
 
 
 
 
 

401

F609

REPORTING - TO WHOM AND WHEN

 
 
 
 
 
 
 
 
 
 
 
 

402

F609

REPORTING NON SERIOUS INJURY

 
 
 
 
 
 
 
 
 
 
 
 

403

F609

REPORTING REQUIREMENTS FOR INJURY

 
 
 
 
 
 
 
 
 
 
 
 

404

F609

ABUSE - REPORT RESULTS - 5 DAYS

 
 
 
 
 
 
 
 
 
 
 
 

405

F610

ABUSE - VIOLATIONS INVESTIGATED

 
 
 
 
 
 
 
 
 
 
 
 

406

F610

ABUSE - PREVENTION DURING INVESTIGATION

 
 
 
 
 
 
 
 
 
 
 
 

407

F610

ABUSE - REPORTING RESULTS

 
 
 
 
 
 
 
 
 
 
 
 

408

F610

ABUSE - CORRECTIVE ACTION

 
 
 
 
 
 
 
 
 
 
 
 
483.15 Admission, Transfer, and Discharge

409

F620

ADMISSION POLICY

 
 
 
 
 
 
 
 
 
 
 
 

410

F620

ADMISSION - ADMISSION AGREEMENT - WAIVING MEDICARE OR MEDICAID

 
 
 
 
 
 
 
 
 
 
 
 

411

F620

APPLY FOR MEDICARE OR MEDICAID

 
 
 
 
 
 
 
 
 
 
 
 

412

F620

WAIVE FACILITY LIABILITY - PERSONAL PROPERTY

 
 
 
 
 
 
 
 
 
 
 
 

413

F620

ADMISSION POLICY - PAYMENT GUARANTEE, ADMISSION CONDITION

 
 
 
 
 
 
 
 
 
 
 
 

414

F620

ADMISSION POLICY - PAYMENT GUARANTEE, CONTINUED STAY

 
 
 
 
 
 
 
 
 
 
 
 

415

F620

ADMISSION POLICY - PAYMENT GUARANTEE, EXPEDITED ADMISSION

 
 
 
 
 
 
 
 
 
 
 
 

416

F620

ADMISSION - ADDITIONAL COSTS, ADMISSION/STAY

 
 
 
 
 
 
 
 
 
 
 
 

417

F620

ADMISSION - AGREEMENT - SERVICES NOT INCLUDED

 
 
 
 
 
 
 
 
 
 
 
 

418

F620

DONATIONS - ORIGIN

 
 
 
 
 
 
 
 
 
 
 
 

419

F620

ADMISSIONS POLICY - DONATIONS

 
 
 
 
 
 
 
 
 
 
 
 

420

F620

STATE - STRICTER ADMISSION STANDARDS

 
 
 
 
 
 
 
 
 
 
 
 

421

F620

SERVICE LIMITATIONS

 
 
 
 
 
 
 
 
 
 
 
 

422

F620

COMPOSITE DISTINCT PART DISCLOSURE

 
 
 
 
 
 
 
 
 
 
 
 

423

F621

EQUAL ACCESS - POLICIES & PRACTICES

 
 
 
 
 
 
 
 
 
 
 
 

424

F621

EQUAL ACCESS - CHARGES

 
 
 
 
 
 
 
 
 
 
 
 

425

F621

EQUAL ACCESS - STATE PLAN SERVICES

 
 
 
 
 
 
 
 
 
 
 
 

426

F621

ROOM CHANGES - DISTINCT PART

 
 
 
 
 
 
 
 
 
 
 
 

427

F622

RESIDENT'S WELFARE

 
 
 
 
 
 
 
 
 
 
 
 

428

F622

IMPROVED HEALTH

 
 
 
 
 
 
 
 
 
 
 
 

429

F622

SAFETY ENDANGERMENT

 
 
 
 
 
 
 
 
 
 
 
 

430

F622

HEALTH ENDANGERMENT

 
 
 
 
 
 
 
 
 
 
 
 

431

F622

APPEAL PENDING

 
 
 
 
 
 
 
 
 
 
 
 

432

F622

NON-PAYMENT

 
 
 
 
 
 
 
 
 
 
 
 

433

F622

FACILITY CEASES TO OPERATE

 
 
 
 
 
 
 
 
 
 
 
 

434

F622

TRANSFER DOCUMENTATION - RECEIVING PROVIDER

 
 
 
 
 
 
 
 
 
 
 
 

435

F622

TRANSFER DOCUMENTATION - BASIS OF TRANSFER

 
 
 
 
 
 
 
 
 
 
 
 

436

F622

PHYSICIAN DOCUMENTATION - NEEDS NOT MET

 
 
 
 
 
 
 
 
 
 
 
 

437

F622

PHYSICIAN DOCUMENTATION - IMPROVED HEALTH

 
 
 
 
 
 
 
 
 
 
 
 

438

F622

TRANSFER DOCUMENTATION - RESIDENT NEEDS

 
 
 
 
 
 
 
 
 
 
 
 

439

F622

PHYSICIAN DOCUMENTATION - ENDANGERMENT

 
 
 
 
 
 
 
 
 
 
 
 

440

F622

RECEIVING PROVIDER - REPRESENTATIVE INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

441

F622

RECEIVING PROVIDER - PRACTITIONER CONTACT INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

442

F622

RECEIVING PROVIDER - ADVANCE DIRECTIVE INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

443

F622

RECEIVING PROVIDER - SPECIAL INSTRUCTIONS

 
 
 
 
 
 
 
 
 
 
 
 

444

F622

RECEIVING FACILITY - CARE PLAN GOALS

 
 
 
 
 
 
 
 
 
 
 
 

445

F622

RECEIVING PROVIDER - COPY OF NECESSARY INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

446

F623

NOTICE - NOTIFICATION IN ADVANCE

 
 
 
 
 
 
 
 
 
 
 
 

447

F623

NOTICE - REASONS RECORDED

 
 
 
 
 
 
 
 
 
 
 
 

448

F623

NOTICE - REASON

 
 
 
 
 
 
 
 
 
 
 
 

449

F623

NOTICE - EFFECTIVE DATE

 
 
 
 
 
 
 
 
 
 
 
 

450

F623

NOTICE - LOCATION

 
 
 
 
 
 
 
 
 
 
 
 

451

F623

NOTICE - RIGHT TO APPEAL

 
 
 
 
 
 
 
 
 
 
 
 

452

F623

NOTICE - OMBUDSMAN INFO

 
 
 
 
 
 
 
 
 
 
 
 

453

F623

NOTICE- AGENCY FOR PROTECTION OF DEVELOPMENTAL DISABILITY

 
 
 
 
 
 
 
 
 
 
 
 

454

F623

NOTICE TIMING - 30-DAY

 
 
 
 
 
 
 
 
 
 
 
 

455

F623

NOTICE TIMING - ADVANCED NOTICE

 
 
 
 
 
 
 
 
 
 
 
 

456

F623

NOTICE TIMING - SAFETY ENDANGERMENT

 
 
 
 
 
 
 
 
 
 
 
 

457

F623

NOTICE TIMING - HEALTH ENDANGERMENT

 
 
 
 
 
 
 
 
 
 
 
 

458

F623

NOTICE TIMING - IMPROVED HEALTH

 
 
 
 
 
 
 
 
 
 
 
 

459

F623

NOTICE TIMING - URGENT MEDICAL NEED

 
 
 
 
 
 
 
 
 
 
 
 

460

F623

NOTICE TIMING - LESS THAN 30 DAYS

 
 
 
 
 
 
 
 
 
 
 
 

461

F623

NOTICE CONTENT - REASON

 
 
 
 
 
 
 
 
 
 
 
 

462

F623

NOTICE CONTENT - EFFECTIVE DATE

 
 
 
 
 
 
 
 
 
 
 
 

463

F623

NOTICE CONTENT- LOCATION

 
 
 
 
 
 
 
 
 
 
 
 

464

F623

NOTICE CONTENT - RIGHT TO APPEAL

 
 
 
 
 
 
 
 
 
 
 
 

465

F623

NOTICE CONTENT - OMBUDSMAN INFO

 
 
 
 
 
 
 
 
 
 
 
 

466

F623

NOTICE CONTENT - DEV. DISABILITY

 
 
 
 
 
 
 
 
 
 
 
 

467

F623

NOTICE CONTENT - MENTAL ILLNESS

 
 
 
 
 
 
 
 
 
 
 
 

468

F623

CHANGES TO THE NOTICE

 
 
 
 
 
 
 
 
 
 
 
 

469

F623

FACILITY CLOSURE

 
 
 
 
 
 
 
 
 
 
 
 

470

F624

ORIENTATION FOR TRANSFER AND DISCHARGE

 
 
 
 
 
 
 
 
 
 
 
 

471

F625

BED HOLD POLICY AND RETURN

 
 
 
 
 
 
 
 
 
 
 
 

472

F625

STATE BED HOLD NOTICE - POLICY

 
 
 
 
 
 
 
 
 
 
 
 

473

F625

BED HOLD NOTICE - BED PAYMENT POLICY

 
 
 
 
 
 
 
 
 
 
 
 

474

F625

BED HOLD PERIODS - POLICY

 
 
 
 
 
 
 
 
 
 
 
 

475

F625

BED HOLD - OMBUDSMAN INFORMATION

 
 
 
 
 
 
 
 
 
 
 
 

476

F625

BED HOLD NOTICE - WRITTEN POLICY - DURATION - RETURN

 
 
 
 
 
 
 
 
 
 
 
 

477

F626

POLICY - RETURN TO FACILITY

 
 
 
 
 
 
 
 
 
 
 
 

478

F626

ADMISSION - RETURN TO FACILITY - FIRST AVAILABLE BED

 
 
 
 
 
 
 
 
 
 
 
 

479

F626

ADMISSION - RETURN TO FACILITY - READMISSION PROBLEMS

 
 
 
 
 
 
 
 
 
 
 
 

480

F626

ADMISSION - RETURN TO FACILITY - EXCEEDED BED HOLD

 
 
 
 
 
 
 
 
 
 
 
 

481

F626

RETURN TO FACILITY

 
 
 
 
 
 
 
 
 
 
 
 

482

F626

UNABLE TO RETURN TO FACILITY

 
 
 
 
 
 
 
 
 
 
 
 

483

F626

RESIDENT RETURN - DISTINCT PART