10A NCAC 13B .5004      PATIENT RECORDS

The patient record shall contain documentation of physical rehabilitation services utilized that include but is not limited to:

(1)           diagnosis to support the services requested;

(2)           assessment of patient's rehabilitative status;

(3)           re-assessment and progress of patient's rehabilitative status;

(4)           individualized plan of care and goals of rehabilitation; and

(5)           discharge plan.

History Note:        Authority G.S. 131E-79;

Eff. January 1, 1996;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. July 22, 2017.