Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help
Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help
Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help
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DISCHARGE RECORDS REVIEW<br />
(Select at least 3 records)<br />
Name of Resident & D/C Location<br />
Date of<br />
Discharge<br />
Summary Re-<br />
Caps Stay<br />
Summary<br />
Signed by<br />
MD<br />
Is There a D/C<br />
Plan of<br />
Care?<br />
1. Does D/C Plan cover pertinent issues? OR<br />
2. Is there an RN Pronouncement &<br />
Supporting Documentation?<br />
Other Comments<br />
(D/C to <strong>Home</strong>)<br />
(D/C to Hospital and didn’t return to<br />
the facility)<br />
(Expired in the facility)<br />
(D/C to Other)<br />
5.74
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