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Ohio Administrative Code (Last Updated: January 12, 2021) |
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5122 Department of Mental Health - Administration and Director |
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Chapter5122-27. Minimum Requirements for Integrated Clinical Records |
5122-27-05. Discharge summary
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(A) Each provider shall have policies and procedures addressing the completion of discharge summaries.
(B) The discharge summary shall include, but not be limited to, the following information:
(1) Date of admission of the client;
(2) Date of the last service provided to the client;
(3) Outcome of the service provided, i.e. amount of progress or the level of care;
(4) ASAM level of care at discharge, if applicable;
(5) Recommendations made to the client, as appropriate to the ITP, including referrals made to other community resources unless the client discontinued services without notice to the provider;
(6) Medications prescribed by the agency upon the client's termination from service;
(7) Upon involuntary termination from service, documentation that the client was informed of their right to file an appeal; and
(8) Dated signature and credentials of the staff member completing the summary.