PURPOSE: This rule establishes the policy and procedures to be followed by Missouri Rehabilitation Center to asswe the rights of patients to participate in and direct health care decisions affecting them.

1. (1) Unless the context clearly indicates otherwise, the following definitions shall be used in the interpretation of this rule:
2. (A) Advance health care directive means a written document executed by a competent individual which identifies his/her wishes regarding the withdrawing or withholding of life-sustaining treatment in the event s/he becomes incompetent; and
3. (B) Attorney-in-fact means a person or corporation appointed by a patient’s written power of attorney for health care to act as an agent for the patient if s/he becomes incompetent.
4. (2) Any competent adult patient shall have the right to make decisions regarding his/her health care including the right to refuse or accept medical treatment and to execute an advance health care directive.
5. (3) During the admission process at Missouri Rehabilitation Center a patient or her/his guardian or attorney-in-fact shall be asked to provide to hospital staff a copy of the patient’s advance health care directive if one exists. The center’s staff shall provide the patient or guardian or attorneyin-fact a copy of the center’s policy on the carrying out of advance health care directives. If an advance health care directive is produced, it shall be included in the patient’s medical record. No patient shall be refused admission because s/he does not have an advance health care directive. An Exhibit A form shall be completed for each person admitted to Missouri Rehabilitation center.
6. (4) Missouri Rehabilitation Center shall accept and honor the lawful advance health care directive of each patient.

7. (5) Individual employees ofMissouri Rehabilitation Center shall not be required to assist in carrying out a health care decision of an attorney-in-fact if that decision is contrary to the employee’s religious beliefs or moral convictions. At the employee’s request, s/he shall not be required to provide care to the patient.

   Judith K. Moriarty smetary Of Sfate 19 CSR 50-10 ,

Chapter lo-Missouri Rehabilitation Center m

Auth: section 192.005.2., RSMo (1986).* Original ruk?filedJan. x,1993, effective July 8, 1993.

Judith K. Moriarty (5/28/93) COOEOFSTATEREGULATlONS SBcletuy Of SflfD

19CSR50-lo--HEALTH

MISSOURI REHABILITATION CEh?‘ER ACKNOWLEDGMENT OF MRC POLICY

PATIENT/CLIENT SELF-DETERMINATION

The hospital policy on advance health care directives was explained to me. I understand I do not have to have one In order to be admitted to MRC but if I do, it will be made part of my medical record.

Witness

TO BE ASKED BY ADMISSION CLERK UPON ADMISSION;

1. 1. Was the patientfcltent asked if she/he has directive or wants information on preparing one?
2. 2. Was patient given hospital policy on patient self-determination?
3. 3. Did patient produce copy of Durable Power of Attorney for Health Care?
4. 4. Did patient produce copy of Living Will?
5. 5. Would patient like assistance from Social Service in explaining either of the above?

DOCUMENTS PRODUCED AFTER ADMISSION:

for Health Care

- Durable Power of Attorney

_ Living Will

THIS DOCUMENT WILL BE RETAINED AFTER SIGNATURE AS A PERMANENT PART OF THE MEDICAL RECORD. of Injury Prevention, Head Injury Rehabilitation

Patient/Representative

Date

Signature of Admn. Clerk

Signature of person obtaining document and local Health Services

EXHIBIT A

-Yes -No

_ Yes _ No

-Yes -No

-Yes -NO

-Yes -No

Date

Date

Judith K. Moriarty scmtary Of state