AGENCY: Box Elder County (Utah). Pioneer Care Center

SERIES: 6673
TITLE: Patient care review records
DATES: 1994.
ARRANGEMENT: Chronological

DESCRIPTION: These are convenience copies of review forms submitted to the Division of Health Care Financing. The original form is used to verify that patients admitted to medical institutions need to be there and are receiving proper care. The copy is used to verify that the form was submitted and is held until the center receives another copy of the original from Health Care Financing indicating acceptance of the patient's care. The acceptance copy is then filed in the patient's case file (series 06547). This information is required by 42 Code of Federal Regulations (CFR) 456 subparts C and E (1989).

These files include Preadmission/Continued Stay Inpatient Care Transmittal forms, Patient Care Transmittal, Continued Stay Review, and contact note sheets. Information includes an evaluation for the recipient's need for assistance, a plan of care, medical review, and certification by a physician that inpatient care is needed. Personal identifiers include age, alcohol or drug addiction, appearance, assets and debts, civil/criminal court involvement, current and past addresses, date of birth, employer, home ownership, income, marital status, medical information, membership in groups, name, name of kin, personality inventory, physical characteristics, physical disabilities, psychiatric information, religious preference, sex, signature, social security number, telephone number, name of provider, provider identification number, name of the attending physician, and any changes to the patient's condition or plan of care.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 06/1991

FORMAT MANAGEMENT

Paper copy: Retain in Office until acceptance received and then destroy.

APPRAISAL

Administrative

This disposition is based solely on the administrative needs expressed by the care center.

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