(b) The record must contain:

1. (1) Resident’s name;
2. (2) Resident’s last address;
3. (3) Date the resident began residing at the facility;
4. (4) Name, office telephone number, and emergency telephone number of each physician or advanced practice nurse who treats the resident;
5. (5) Name, address, and telephone number of the responsible party, or if no responsible party, the person who should be contacted in the event of an emergency involving death of the resident;

6. (6) All identification numbers such as:

   1. (A) Medicaid;
   2. (B) Medicare or Medipak;
   3. (C) Social Security;
   4. (D) United States Veterans Benefits Administration; and
   5. (E) Date of birth;
7. (7) Any other information that the resident requests the assisted living facility to keep on record;
8. (8) A copy of the resident’s signed Residents’ Bill of Rights statement;
9. (9) A copy of the current occupancy admission agreement that includes the resident’s services plan updated within the specified timeframes and transfer/discharge plan, when applicable;
10. (10) On admission, and each time there is a change in services provided the resident, a written acknowledgement that the resident or his or her responsible party has been notified of the charges for the services provided;

11. (11)

    1. (A) Information about any specific health problem of the resident that might be necessary in a medical emergency.
    2. (B)

(i) Such records should specify any medication allergies.

1. (ii) If none, state “no known allergies”;
2. (12) A brief medical history;
3. (13) A list of all current medications, including strength and dosage, kept by the facility for the resident;
4. (14) Name of the resident or his or her responsible party’s preferred pharmacy;

5. (15)

   1. (A) An entry shall be made at any time the resident’s status changes or in the event of an unusual occurrence.

   2. (B) This documentation shall include:

      1. (i) Falls;
      2. (ii) Illness;
      3. (iii) Physician or advanced practice nurse visits;
      4. (iv) Problem with staff members or others;
      5. (v) Hospitalization;
      6. (vi) Physical injury sustained, whatever the circumstances; and
      7. (vii) Changes in the resident’s mental or physical condition;
6. (16) Copy of compliance agreement, if appropriate;
7. (17) A copy of court orders, letters of guardianship, or power of attorney, if applicable;
8. (18) Copy of any advance directive; and
9. (19) Discharge date.