Or. Admin. R. 411-328-0690 - Individual Summary Sheets

The provider must maintain a current one to two page summary sheet for each individual receiving services from the provider. The record must include:

(1) The name of the individual and his or her current address, home phone number, date of entry, date of birth, gender, marital status, social security number, social security beneficiary account number, religious preference, preferred hospital, and where applicable, the number of the Disability Services Office (DSO) or the Multi-Service Office (MSO) of the Department and guardianship status; and

(2) The name, address, and telephone number of:

(a) The legal or designated representative, family, and other significant person of the individual (as applicable);

(b) The primary care provider and clinic preferred by the individual;

(c) The dentist preferred by the individual;

(d) The identified pharmacy preferred by the individual;

(e) The day program or employer of the individual (if any);

(f) The services coordinator of the individual; and

(g) Other agencies and representatives providing services and supports to the individual.

Notes

Or. Admin. R. 411-328-0690

MHD 5-1992, f. 8-21-92, cert. ef. 8-24-92; MHD 3-1997, f. & cert. ef. 2-7-97; Renumbered from 309-041-0690by SPD 17-2009, f. & cert. ef. 12-9-09; SPD 59-2013, f. 12-27-13, cert. ef. 12-28-13; APD 42-2014, f. 12-26-14, cert. ef. 12/28/2014

Stat. Auth.: ORS 409.050 &430.662

Stats. Implemented: ORS 430.610, 430.630 & 430.670