Form Cms-437- Psychiatric Unit Criteria Worksheet Page 6
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REGULATION
GUIDANCE
YES NO
EXPLANATORY STATEMENT
A1174
(iii) Provide active treatment measures; and
Is the distribution of staff consistent with particular
patient needs?
Is staffing sufficient to carry out treatment plans?
A1175
(iv) Engage in discharge planning.
Does the record indicate that staff has participated
in discharge planning?
Are staff aware of discharge plans for the patients
they are working with?
A1180
(2) Director of Inpatient Psychiatric Services;
Medical Staff. Inpatient psychiatric services must
be under the supervision of a clinical director, service
chief, or equivalent who is qualified to provide the
leadership required for an intensive treatment program.
The number and qualifications of doctors of medicine
and osteopathy must be adequate to provide essential
psychiatric services.
A1181
(i) The clinical director, service chief, or equivalent must
meet the training and experience requirements for
examination by the American Board of Psychiatry
and Neurology or the American Osteopathic Board
of Neurology and Psychiatry.
A1182
(ii) The director must monitor and evaluate the quality
Are there appropriate professional staff available to
and appropriateness of services and treatment
provide necessary medical and treatment services?
provided by the medical staff.
Does the unit have policies and procedures to direct
medical and direct care staff in situations when
patients become agitated and aggressive, posing a
potential threat to self or others?
Number of Physicians
FULL-TIME
PART-TIME
CONSULTING
SPECIALTY
(A)
(B)
(C)
Psychiatry
Neurology
Other*
Other*
*Specify
Form CMS-437 (04/06)
6
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Parent category: Medical