1. (1) A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician.

2. (2) Physician supervision. The facility must ensure that--

   1. (a) The medical care of each resident is supervised by a physician; and
   2. (b) Another physician supervises the medical care of residents when their attending physician is unavailable.

3. (3) Physician visits. The physician must--

   1. (a) Review the resident's total program of care, including medications and treatments, at each visit required by paragraph (4)(a) of this section;
   2. (b) Write, sign, and date progress notes at each visit; and
   3. (c) Sign and date all orders.

4. (4) Frequency of physician visits.

   1. (a) The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.
   2. (b) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.
   3. (c) Except as provided in paragraphs (4)(d) of this section, all required physician visits must be made by the physician personally.
   4. (d) At the option of the physician, required visit, may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner or clinical nurse specialist in accordance with paragraph (5)(a)1, 2, and 3 of this section.

5. (5) Availability of physicians for emergency care. The facility must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency.

   1. (a) Except as specified in paragraph (5)(b) of this section, a physician may delegate tasks to a physician assistant, nurse practitioner, or clinical nurse specialist who--

      1. 1. Agrees to and has signed specific Protocols established by the facility and the physician and is on file in the facility;
      2. 2. Is acting within the scope of practice as defined by State law; and
      3. 3. Is under the supervision of the physician.
   2. (b) A physician may not delegate a task when the regulations specify that the physician must perform it personally, or when the delegation is prohibited under State law or by the facility's own policies.

Author: Patricia E. Ivie

Statutory Authority: Code of Ala. 1975, §§22-21-20, et seq.

History: Repealed and Replaced: Filed July 19, 1996; effective August 23, 1996.