42 C.F.R. § 456.380 Individual written plan of care.
Title 42 - Public Health
(a) Before admission to an ICF or before authorization for payment, a physician must establish a written plan of care for each applicant or recipient. (b) The plan of care must include— (1) Diagnoses, symptoms, complaints, and complications indicating the need for admission; (2) A description of the functional level of the individual; (3) Objectives; (4) Any orders for— (i) Medications; (ii) Treatments; (iii) Restorative and rehabilitative services; (iv) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and modification of the plan of care; and (6) Plans for discharge. (c) The team must review each plan of care at least every 90 days.
Title 42: Public Health
PART 456—UTILIZATION CONTROL
Subpart F—Utilization Control: Intermediate Care Facilities
Plan of Care
§ 456.380 Individual written plan of care.