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Subpart 1.

General provisions.

The operator shall ensure that an individual record is maintained in the adult foster home on each resident.

Subp. 2.

Demographic information.

The record must include the resident's name, birthdate, sex, race, marital status, next of kin, Social Security number, medical assistance number, name, address, and phone number of an emergency contact or the resident's legal representative, admission date, place or address from which the resident was admitted, date of leaving the residence, and place or address to which the resident has moved.

Subp. 3.

Medical information.

The record must contain the following medical information:


the name, address, and phone number of the resident's physician, dentist, clinic, and other sources of medical care;


a health history and information on any health risks, allergies, currently prescribed medication, and documentation of the physical examination or transfer record required in part 9555.6225, subpart 3;


any emergency treatment needed or provided while the resident resides in the adult foster home; and


the medication record required under part 9555.6225, subpart 8.

Subp. 4.

Cash resource information.

The record must include an accounting of any personal funds and charges against those funds if the operator or a caregiver gives cash resource assistance to a resident.

Subp. 5.

Incident reports.

The record must contain all incident reports. Incident reports must be written when a resident requires emergency care, when a police report of an incident involving a resident has been made, or when a complaint has been filed under the Vulnerable Adults Act. Incident reports must be entered into the resident's personal record by the operator within eight hours after knowledge of the occurrence.

Subp. 6.

Individual abuse prevention plan.

The record must contain an individual abuse prevention plan for a resident developed in compliance with part 9555.8300.

Subp. 7.

Individual service plan.

The record must contain the service agency's initial and current individual service plan for a resident.

Subp. 8.

Individual resident placement agreement.

The record must contain the initial individual resident placement agreement for a resident and the annual update of the agreement.

Subp. 9.

Individual mobility check list.

The record must contain an individual mobility check list for a resident as specified in part 9555.5605, subpart 2.

Subp. 10.

Transfer or discharge.

When a resident is transferred or discharged for any reason a note must be made in the resident's record showing the date of discharge, forwarding address, and reason for discharge or transfer.

Subp. 11.

Record storage.

The personal record on a resident must be stored by the operator for four years after the resident has been discharged from the residence.

Statutory Authority:

MS s 245A.09


12 SR 148

Published Electronically:

October 8, 2007

Official Publication of the State of Minnesota
Revisor of Statutes