(b)

1. (1) The plan shall include:

   1. (A) An assessment of the patient’s needs; and
   2. (B) Identification of the services, including the management of discomfort and symptom relief.
2. (2) It shall state in detail the scope and frequency of services needed to meet the patient’s and family’s needs.

(c) A written plan of care shall be:

1. (1) Developed by the attending physician, the medical director or physician designee, and interdisciplinary group prior to providing care; and

2. (2)

   1. (A) Reviewed and revised to reflect the patient’s and family’s current needs, by the:

(i) Attending physician;

1. (ii) Medical director or physician designee; and

   1. (iii) Interdisciplinary group.

   2. (B) The reviews shall be documented.

      1. (d) Content of plan.

2. (1) The plan must include:

   1. (A) Assessment of the individual’s needs; and
   2. (B) Identification of the services, including the management of discomfort and symptom relief.
3. (2) It must state in detail the scope and frequency of services needed to meet the patient’s and family’s needs.