N.H. Admin. Code § He-E 501.17

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Current through Register No. 45, November 7, 2024

Section He-E 501.17 - Service Records

(a) Providers shall maintain service records for all individuals receiving Title XX services.

(b) The service record shall contain:

(1) The individual's name, address, and telephone number;

(2) The name, address, and telephone number of the individual's primary caregiver;

(3) The name and telephone number of a person who may be contacted in an emergency;

(4) Documentation of the individual's communication access needs, including modality, and the name of the communication access provider or type of device utilized, if applicable;

(5) The name and telephone number of the individual's licensed health practitioner, if applicable;

(6) The name and contact information for the pharmacy used by the individual, if applicable;

(7) The application described in He-E 501.06;

(8) The notice of decision described in He-E 501.07;

(9) The service authorization form required by He-E 501.16;

(10) The person-centered plan as described in He-E 501.22;

(11) Copies of correspondence related to service provision; and

(12) Documentation of the following:

a. The name of the Title XX service being provided, and the type of service activities, based on the service description contained in this rule;

b. The dates of service provision and other related contacts with the individual;

c. Changes in the individual's health or other circumstances affecting service provision;

d. Any other information or correspondence deemed relevant to service provision; and

e. Documentation of any referrals made to other resources or programs.

(c) Service records shall be kept confidential in accordance with He-E 501.03 and all applicable federal and state laws, rules, or regulations.

(d) Service records shall be retained for a period of 4 years after services have ended or been terminated.

N.H. Admin. Code § He-E 501.17

#9849-A, eff 1-12-11

Amended by Volume XXXIX Number 06, Filed February 7, 2019, Proposed by #12720, Effective 1/29/2019, Expires 7/29/2019.

Amended by Volume XL Number 2, Filed January 9, 2020, Proposed by # 12936, Effective 12/7/2019, Expires 12/7/2029.