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RULE §306.61Crisis Stabilization Unit Medical Services

(a) A CSU physician, or physician-delegated PA or APRN, must provide an individual with the medical services documented in the individual's recovery or treatment plan developed in accordance with §306.65 of this division (relating to Crisis Stabilization Services and Recovery or Treatment Planning).

(b) A CSU must have a medical director who directs, monitors, and evaluates the psychiatric services provided.

(c) A CSU administrator, or administrator's designee, must assign a treating physician to each individual and document the assignment in the individual's medical record at the time the CSU administrator, or administrator's designee, admits the individual.

(d) A physician, PA, APRN, or RN must perform an individual's initial physical health assessment within 24 hours after the individual's presentation, as ordered. The physical assessment includes:

  (1) an evaluation and documentation of the presence or absence of cognitive signs suggesting delirium and the need for emergency intervention;

  (2) a general medical history that addresses conditions that may affect the individual's current condition, including a review of symptoms focused on conditions (such as a history of trauma) that may present with psychiatric symptoms or cause cognitive impairment;

  (3) a review of medical conditions that may cause similar psychiatric symptoms or complicate the individual's condition; and

  (4) access to phlebotomy and laboratory results.

(e) A physician must conduct an initial psychiatric evaluation of an individual, including:

  (1) a description of the individual's medical history;

  (2) a determination of the individual's mental status;

  (3) a description of the presenting problems, the onset, and the duration and severity of mental health or substance use disorder symptoms leading to CSU admission;

  (4) an estimation of the individual's intellectual functioning, memory functioning and orientation;

  (5) a description of the individual's strengths and needs; and

  (6) the diagnoses of the individual's mental illness, SED, and if applicable, any substance use disorders, ID, or DD.

(f) A physician, or physician-delegated PA or APRN, must re-evaluate the individual once every 96 hours or more often as clinically indicated after the initial examination described in subsection (e) of this section. This re-evaluation information may be included in the physician's, APRN's, or PA's discharge summary if the individual is discharged within the initial 96-hour period, as described in §306.71(b) of this subchapter (relating to Discharge Planning).

(g) A CSU medical director must ensure, as appropriate under the circumstances:

  (1) the provision of medical services to an individual in response to an emergency medical condition in accordance with the plan required by §306.89 of this subchapter (relating to Crisis Stabilization Unit Response to an Emergency Medical Condition);

  (2) the provision of other medical services, as needed by the individual;

  (3) the referral of the individual to an appropriate health care provider; or

  (4) the transfer of the individual to a health care entity that can provide the medical services.

(h) At least one physician, or physician-delegated PA or APRN, must be available 24 hours a day, 365 days a year, either in person or by telecommunication, to provide medical consultation to staff members in accordance with §306.85 of this subchapter (relating to Minimum Staffing Requirements).

Source Note: The provisions of this §306.61 adopted to be effective May 27, 2021, 46 TexReg 3257

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