.27 Discharge Planning Requirements.

A. Discharge Options. A hospital may discharge a patient:

(1) Entirely;

(2) To another level of care, treatment, or services;

(3) To different health care professionals; or

(4) To settings for continued services.

B. A hospital's process for transfer or discharge shall be based on a patient's assessed needs at the time of discharge.

C. To facilitate discharge or transfer, the hospital shall:

(1) Assess the patient's needs beginning at an early stage of the patient's hospitalization and as the patient's needs change throughout the hospitalization;

(2) Develop plans for the patient's discharge or transfer with input, if appropriate, from the patient, the family, or other interested party;

(3) Identify appropriately qualified staff, such as registered nurses or licensed social workers, who have the knowledge and experience necessary to determine what services or type of providers can best meet the patient's discharge needs;

(4) Arrange or help to arrange for services needed to meet the patient's needs after discharge; and

(5) Provide the patient, or the provider who is responsible for providing continuing care to the patient, with written discharge instructions and other necessary medical information in a form the patient or provider can understand.