Section 390.1030 Physician Services

a)         General Requirements for Physician Services

1)         The services of a physician licensed to practice medicine in Illinois shall be available to every resident in the facility. (A, B)

2)         Physician services are to include a complete physical examination at least annually and formal arrangements to provide for medical and behavior emergencies on a 24 hour seven day week basis. (B)

b)         The resident shall be permitted his choice of a physician. If the resident is a minor or under guardianship, the appropriate person shall have this privilege.

c)         The resident shall be seen by a physician as often as necessary to assure adequate medical care. (Medicare/Medicaid requires certification visits.) (A, B)

d)         Physicians shall participate, when appropriate, in the continuing interdisciplinary evaluation of individual residents, for the purposes of initiating, monitoring, and following-up of individualized habilitation programs for treatment.

e)         Physician Signature Requirements

1)         All physician orders, plans of treatment, Medicare/Medicaid Certification and recertification statements and similar documents must have the original written signature of the physician.

2)         The use of a physician's rubber stamp signature with or without initials is not acceptable.

f)         Each resident admitted shall have a complete physical examination, including stool culture, within two weeks prior to admission. There shall be another physical examination (which need not include a stool culture) conducted by the physician who will be attending the resident in the facility within 72 hours after admission to the facility unless the preadmission examination has been conducted by the same physician. In any case, the facility shall have the results of a stool culture before a resident is admitted. This examination shall include an evaluation of the resident's condition, including height and weight, and recommendations for care of the resident including personal care needs and permission for participation in the activity and developmental program. This examination shall also include documentation of the presence or the absence of tuberculosis infection by tuberculin skin test in accordance with Section 390.1035. The report shall also include documentation of the presence or absence of incipient or manifest decubitus ulcers (commonly known as bed sores) with grade, size and location specified, and orders for treatment if present. (A photograph of incipient or manifest decubitus ulcers is recommended on admission.) The report shall also include orders from the physician regarding weighing of the resident, and the frequency of such weighing, if ordered. (See Section 390.1620(a)) (B)

g)         The admission information for a resident shall include summary of present medical findings, medical history, mental and physical functioning capacity, diagnosis and prognosis when available and; it shall also include orders for medications, treatments, restorative (re)habilitation services, diet, specific procedures recorded for the health and safety of the resident, activities and plans for continuing care and discharge. If this information is not received with the resident at the time of admission, it must be received within 48 hours.

h)         All admissions to or continued care in the facility shall be upon the recommendation of a physician.

i)          The provisions of subsections (f), (g) and (h) of this Section will not apply in the use of emergency admissions. In such a case, the physician shall meet the criteria in these standards within 72 hours.

j)          Physician Notification

1)         The facility shall immediately notify the physician of any significant accident, injury, or unusual change in a resident's condition that threatens the health, safety or welfare of a resident, including, but not limited to, the presence of incipient or manifest decubitus ulcers or a weight loss or gain of five percent or more within a period of 30 days.  (B)

2)         The facility shall obtain and record the physician's plan of care for the care or treatment of such accident, injury or change in condition at the time of notification.

k)         At the time of an accident, immediate first aid treatment shall be provided by personnel trained in medically approved first aid procedures. (B)

(Source: Amended at 15 Ill. Reg. 1878, effective January 25, 1991)