(a)  The interdisciplinary treatment team shall develop an individual treatment plan for each patient within seven days after admission. The plan shall include evaluation findings and information about the following:

(1)           prior level of function;

(2)           current functional limitations;

(3)           specific service needs;

(4)           treatment, supports and adaptations to be provided;

(5)           specified treatment goals;

(6)           disciplines responsible for implementation of separate parts of the plan; and

(7)           anticipated time frames for the accomplishment of specified long-term and short-term goals.

(b)  The treatment plan shall be reviewed by the interdisciplinary team at least every other week. All members of the interdisciplinary team, or a representative of their discipline, shall attend each meeting. Documentation of each review shall include progress toward defined goals and identification of any changes in the treatment plan.

(c)  The treatment plan shall include provisions for all of the services identified as needed for the patient in the comprehensive inpatient rehabilitation evaluation completed in accordance with Rule .5404 of this Section.

(d)  Each patient shall have a designated case manager who shall be responsible for the coordination of the patient's individualized treatment plan. The case manager shall be responsible for promoting the program's responsiveness to the needs of the patient and shall participate in all team conferences concerning the patient's progress toward the accomplishment of specified goals. Any of the professional staff involved in the patient's care may be the designated case manager for one or more cases.


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

Eff. March 1, 1996;

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