1. Description of identified needs and date identified based upon the (i) UAI; (ii) admission physical examination; (iii) interview with resident; (iv) fall risk rating, if appropriate; (v) assessment of psychological, behavioral, and emotional functioning, if appropriate; and (vi) other sources;
2. A written description of what services will be provided to address identified needs, and if applicable, other services, and who will provide them;
3. When and where the services will be provided;
4. The expected outcome and time frame for expected outcome;
5. Date outcome achieved; and
6. For a facility licensed for residential living care only, if a resident lives in a building housing 19 or fewer residents, a statement that specifies whether the resident does or does not need to have a staff member awake and on duty at night.

1. Methods to ensure an understanding of the responsibilities associated with medication management;
2. Standard operating procedures, including the facility’s standard dosing schedule and any general restrictions specific to the facility;
3. Methods to prevent the use of outdated, damaged, or contaminated medications;
4. Methods to ensure that each resident’s prescription medications and any over-the-counter drugs and supplements ordered for the resident are filled and refilled in a timely manner to avoid missed dosages;
5. Methods for verifying that medication orders have been accurately transcribed to medication administration records (MARs) within 24 hours of receipt of a new order or change in an order;
6. Methods for monitoring medication administration and the effective use of the MARs for documentation;
7. Methods to ensure that MARs are maintained as part of the resident’s record;
8. Methods to ensure accurate counts of all controlled substances whenever assigned medication administration staff changes;
9. Methods to ensure that staff who are responsible for administering medications meet the qualification requirements of 22 VAC 40-73-670;
10. Methods to ensure that staff who are responsible for administering medications are adequately supervised, including periodic direct observation of medication administration;
11. A plan for proper disposal of medication;
12. Methods to ensure that residents do not receive medications or dietary supplements to which they have known allergies;
13. Identification of the medication aide or the person licensed to administer drugs responsible for routinely communicating issues or observations related to medication administration to the prescribing physician or other prescriber;
14. Methods to ensure that staff who are responsible for administering medications are trained on the facility’s medication management plan; and
15. Procedures for internal monitoring of the facility’s conformance to the medication management plan.
    

1. The person’s name, address, and telephone number;
2. The date of the physical examination;
3. Height, weight, and blood pressure;
4. Significant medical history;
5. General physical condition, including a systems review as is medically indicated;
6. Any diagnosis or significant problems;
7. Any known allergies and description of the person’s reactions;
8. Any recommendations for care including medication, diet, and therapy;
9. Results of a risk assessment documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it;
10. A statement that the individual does not have any of the conditions or care needs prohibited by 22 VAC 40-73-310 H;
11. A statement that specifies whether the individual is considered to be ambulatory or nonambulatory as defined in this chapter;
12. A statement that specifies whether the individual is or is not capable of self-administering medication; and
13. The signature of the examining physician or his designee.

1. At least annually;
2. When the condition of the resident changes; and
3. After a fall.

A. Initial tuberculosis examination and report.

1. Each staff person on or within seven days prior to the first day of work at the facility and each household member prior to coming in contact with residents shall submit the results of a risk assessment, documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it.
2. The risk assessment shall be no older than 30 days.

B. Subsequent tuberculosis evaluations and reports.

1. Any staff person or household member required to be evaluated who comes in contact with a known case of infectious tuberculosis shall be screened as determined appropriate based on consultation with the local health department.
2. Any staff person or household member required to be evaluated who develops chronic respiratory symptoms of three weeks duration shall be evaluated immediately for the presence of infectious tuberculosis.
3. Each staff person or household member required to be evaluated shall annually submit the results of a risk assessment, documenting that the individual is free of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it.

C. Any individual suspected to have infectious tuberculosis shall not be allowed to return to work or have any contact with the residents and personnel of the facility until a physician has determined that the individual is free of infectious tuberculosis.

D. The facility shall report any active case of tuberculosis developed by a staff person or household member required to be evaluated to the local health department.