The individual record for each client must contain the following information: HEALTH INTENSIVE DAY TREATMENT PROGRAM FOR CHILDREN AND ADOLESCENTS FACILITIES

1. (1) Documentation of the IPP and the IEP (if required) and of their implementation;
2. (2) Progress notes which must be developed after each service contact, and which must include written documentation of client progress or changes which have occurred within the IPP;
3. (3) Documentation of all drugs prescribed or administered by the facility which indicates date prescribed, type, dosage, frequency, amount, and reason;
4. (4) Narrative summary review of all medications prescribed at least every six (6) months which includes specific reasons for continuation of each medication;
5. (5) Results of assessments required by Rule 0940-05-30-.03; and
6. (6) Discharge summary which states, if appropriate, client condition at the time of discharge and signature of person preparing the summary.

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504. Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.