Page 37

UNOFFICIAL 1737-37 indicate the client's need for a specific level of care, and shall include: (i) A physician's signature or initials clearly identified with the acronym "M.D." for medical doctor, or "D.O." for doctor of osteopathy; (ii) A physician assistant's signature or initials, clearly identified with the acronym "P.A." for physician assistant; (iii) A nurse practitioner's signature or initials, clearly identified with the acronym "R.N.C."or "R.N." whichever is appropriate; or (iv) A clinical nurse specialist's signature or initials clearly identified with the acronym "R.N.M.S." or "R.N.C.S." whichever is appropriate; and (v) The date of certification or recertification statement is signed or initialed by a physician or a physician assistant or a nurse practitioner or a clinical nurse specialist; (2) The facility shall have in effect a written utilization review plan approved by the department which shall include the following methods and procedures: (A) Use of cross reference file numbers in all UR related documentation to assure the anonymity of the medicaid client; (B) Identification of the administrative entity and sub-group of the entity responsible for the performance of UR and the medical staff of a medical institution; (C) Development and selection and adoption of forms utilized for the UR process; (D) Review of documentation necessary to verify justification for continued stay cases. The information shall be an integral part of the client's medical record and shall include the following: (i) Name of the attending physician; (ii) Date of admission to the facility; (iii) Date of application if made after admission to the facility;