1. a) A multi-disciplinary team shall be responsible for preparing and evaluating a care plan to meet the needs of the patient. This care plan shall include at a minimum all of the following items:

   1. 1) Examinations on inpatient or outpatient basis.
   2. 2) Review of prescriptions, medications, and ancillary treatments.
   3. 3) Backup for support services provided by other health care professionals.
   4. 4) Nursing needs assessment.
   5. 5) Education and training of family and caregivers on care and treatment.
   6. 6) Psychosocial services to ADRD patient and caregivers.
   7. 7) Evaluation of home environment of ADRD patient and caregivers.
   8. 8) Counseling caregivers and family members.
   9. 9) Identification of health care, support services, and other community based services to assist caregivers.
2. b) Persons who may be or who have been clinically diagnosed as probably having Alzheimer's disease and related disorders shall be referred by the multi-disciplinary team to social service agencies and other sources of care in response to identified needs.

(Source: Amended at 25 Ill. Reg. 11159, effective September 1, 2001)