Every finding on record at Arizona Physicians Hospice Care LLC

Upon patient record review, 1 of 5 (Patient #5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient Record #5: Patient admitted 10/4/21 and was discharged 10/16/21. The SN frequency order was for 1 x wk. There was no evidence of a SN visit after 10/4/21.

Upon patient record review, 1 of 5 (Patient #2) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #2: The Hospice Election and Informed Consent contained no effective date, the designated space was blank.

Upon patient record review, 5 of 5 (Patient #1,2, 3, 4, 5) did not have evidence that each patient record contains complete/ accurate Advance Directives. Patient #1, 2, 3, 4, 5: Patient Records include Arizona State DNR forms. Section #4 has witness requirement and signature line that specifically states: "NOTE: At least one adult witness OR a Notary Public must witness the signing of this document. The witness or Notary Public CANNOT be anyone who is: (a) under the age of 18; (b) related to you by blood, adoption, or marriage; (c) entitled to any part of your estate; (d) appointed as your representative; or (e) involved in providing your health care at the time this form is signed." None of the DNR forms on file have a required witness signature.

Upon patient record review, 2 of 2 applicable (Patient #4, #5) did not have evidence that the discharge summary includes all required information. Patient Record #4: According to the discharge summary, patient experienced worsening respiratory symptoms and family chose hospitalization with non-contracted facility. There was no documented evidence that the 10/17/21 Discharge Summary and other information was shared with hospital at that time to assist in post-discharge continuity of care. The discharge summary was electronically signed by the physician. Patient Record #5: The patient discharge summary was incomplete and only included patient's diagnosis and indication that patient had moved "out of the area". The discharge date was 10/16/21.