Which of the following is a form or view that is typically seen in the health record of a long-term care patient, but is rarely seen in records of a…

Federal regulations for long-term care (LTC) facilities mandate a monthly medication regimen review for each resident by a licensed pharmacist. This review, documented as a pharmacy consultation, is crucial for managing polypharmacy and preventing adverse drug events common in the geriatric population. This makes the pharmacy consultation a standard and recurring form in the LTC health record. While pharmacy consultations can occur in acute care, they are typically initiated for specific, complex cases and are not a routine, periodic requirement for every patient as they are in the LTC setting.

B. Medical consultations with specialists are a common and essential component of patient care records in both acute and long-term care settings.

C. A physical examination is a fundamental requirement for admission and ongoing assessment in both acute care and long-term care facilities.

D. An emergency record is documentation created in an acute care setting (the emergency department) and is not a standard form originating within an LTC record.

1. U.S. Centers for Medicare & Medicaid Services (CMS). (2017). State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities. Section 42 CFR §483.45(c) Drug Regimen Review. This regulation explicitly states

"The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist." This establishes the pharmacy consultation as a required

routine document in LTC records.

2. LaTour

K. M.

& Eichenwald-Maki

S. (Eds.). (2021). Health information management: Concepts

principles

and practice (6th ed.). AHIMA Press. In the chapter on "Long-Term and Other Post-Acute Care Settings

" the text describes the unique documentation requirements for LTC

including the consultant pharmacist's drug regimen review as a key component of the clinical record

distinguishing it from typical acute care documentation.

3. Brandt

N. J. (2017). The new long-term care survey process: A primer for pharmacists. Journal of the American Pharmacists Association

57(5)

640–643. https://doi.org/10.1016/j.japh.2017.06.008. This article details the integral role of the pharmacist's monthly review in LTC facilities

reinforcing that this practice and its associated documentation are standard for this care setting but not for acute care.