Section DHS 133.20 - Plan of care(1) REQUIREMENT. A plan of care, including physician's, advanced practice nurse prescriber's, or physician assistant's orders, shall be established for every patient accepted for care and shall be incorporated in the patient's medical record. An initial plan shall be developed within 72 hours of acceptance. The total plan of care shall be developed in consultation with the patient, home health agency staff, contractual providers, and the patient's physician, advanced practice nurse prescriber, or physician assistant and shall be signed and dated by the physician, advanced practice nurse prescriber, or physician assistant within 20 working days following the patient's admission for care.(2) CONTENTS OF PLAN. Each plan developed under sub. (1) shall include: (a) Measurable time-specific goals, with benchmark dates for review; and(b) The methods for delivering needed care, and an indication of which professional disciplines are responsible for delivering the care.(3) REVIEW OF PLAN. The total plan of care shall be reviewed by the attending physician, advanced practice nurse prescriber, or physician assistant, and appropriate agency personnel as often as required by the patient's condition, but no less often than every 60 days. The agency shall promptly notify the physician, the advanced practice nurse prescriber, or the physician assistant of any changes in the patient's condition that suggest a need to modify the plan of care.(4) ORDERS. Drugs and treatment shall be administered by the agency staff only as ordered by the attending physician, advanced practice nurse prescriber, or physician assistant. The nurse or therapist shall immediately record and sign and date oral orders and obtain the physician's, the advanced practice nurse prescriber's or physician assistant's countersignature and date within 20 working days.Wis. Admin. Code Department of Health Services § DHS 133.20
Cr. Register, May, 1984, No. 341, eff. 6-1-84; am. (4), Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (1), (3) and (4) Register November 2007 No. 623, eff. 12-1-07.Amended by, CR 16-077: am. (1), (3), (4) Register September 2017 No. 741, eff. 10/1/2017