Observations
Based on a review of client records, the facility failed to document the name of the person, agency, or organization to whom the disclosure is made on a consent to release information form in one of seven client records reviewed.
Client # 5 was admitted on April 6, 2024 and was discharged on November 26, 2024. The release of information form to a primary care physician was signed by the client on April 6, 2024; however, the form did not include the name of the person, agency, or organization to whom the disclosure would be made to.
This finding was reviewed with facility staff during the licensing process.
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Plan of Correction
The facility failed to document the name of the person, agency, or organization to whom the disclosure is made on a consent to release information form in one of seven client records reviewed. Client # 5 was admitted on April 6, 2024 and was discharged on November 26, 2024. The release of information form to a primary care physician was signed by the client on April 6, 2024; however, the form did not include the name of the person, agency, or organization to whom the disclosure would be made to. The clinical supervisor will ensure the name of the person, agency, or organization to whom the disclosure is made on a consent to release information form is documented. This will be done through staff training and regular file checks. The facility will be compliant by 2/28/2025. |