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F0849
D

Missing Hospice Election Forms in Resident Records

Minot, North Dakota Survey Completed on 06-10-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that the medical records of two residents receiving hospice services contained the required hospice election forms. Review of the hospice contract and facility policy confirmed that providing and obtaining the hospice election form is a responsibility of both the hospice agency and designated facility staff. For one resident, a nurse's note documented enrollment in hospice for end-of-life care, but the corresponding hospice election of benefits form was missing from the medical record. For the second resident, both a physician's order for hospice admission and a nurse's note confirming hospice admission were present, yet the hospice election form was also absent from the record. An administrative nurse verified that both records lacked the necessary documentation.

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