Nick-Maximillien/medgate-compiler-data huggingface dataset:
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08) §482.30(e) Standard:  Extended Stay Review

(1)  In hospitals that are not paid under the prospective payment system, the UR committee must make a periodic review, as specified in the UR plan, or each current inpatient receiving hospital services during a continuous period of extended duration.

## The scheduling of the periodic reviews may--

- (i)  Be the same for all cases; or
- (ii)  Differ for different classes of cases.

(2)  In hospitals paid under the prospective payment system, the UR committee must review all cases reasonably assumed by the hospital to be outlier cases because the extended length of stay exceeds the threshold criteria for the diagnosis, as described in §412.80(a)(1)(i).  The hospital is not required to review an extended stay that does not exceed the outlier threshold for the diagnosis.

(3)  The UR committee must make the periodic review no later than 7 days after the day required in the UR plan.

## Survey Procedures  §482.30(e)

- Review the facility's definition of extended stay in the UR plan.
- Verify that the hospital's UR plan requires a periodic review of each current Medicare/Medicaid inpatient receiving hospital services of extended duration and that the review is carried out at the specified time stated in the facility's UR plan.
- The review may be the same for all cases or be different for different classes of care.
- If the committee uses a different number of days for different diagnosis or functional categories for the period of extended stay, the surveyor must verify that there is a written list with lengths of stay designated for each diagnosis of functional category.
- Determine if the hospital is under IPPS.  Hospitals under IPPS need only review cases reasonably assumed to be outlier cases, and extended stay that exceeds the outlier threshold for the diagnosis.
- Review minutes of the UR committee.  Determine that the periodic reviews of extended stay are carried out on or before the expiration of the stated period or no later than 7 days after the day required in the hospital's plan.

Structured rule (JSON):
{"intent_tags": ["compliance", "quality", "integrity"], "logic_config": {"anchor": "day required in the UR plan", "max_delay_days": 7, "target": "periodic review"}, "rule_type": "temporal", "scope_tags": ["facility", "billing", "clinical"]}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.61(c)(1)(ii) Short-term and long range goals;

## Interpretive Guidelines §482.61(c)(1)(ii)

Based on the problems identified for treatment, short-term and long-range goals are developed. Whether the use of short-term or a combination of short-term and long-range goals is appropriate is dependent on the length of hospital stay.

Short-term and long-range goals include specific dates for expected achievement. As goals are achieved, the treatment plan should be revised. When a goal is modified, changed or discontinued without achievement, the plan should be reviewed for relevancy, and updated as needed.

In crisis intervention and short-term treatment there may be only one timeframe for treatment goals. As the length of hospital stay increases (often because of the long-term chronic nature of the patient's illness), both long-range and short-term goals are needed.

The long-range goal is achieved through the development of a series of short-term goals, i.e., smaller, logical sequential steps which will result in reaching the long-range goal. Both the short-term and long-range goals must be stated as expected behavioral outcomes for the patient. Goals must be related to the problems identified for treatment. Goals must be written as observable, measurable patient behaviors to be achieved. Discharge criteria may be included as long-range goals.

## Survey Procedures §482.61(c)(1)(ii)

How do treatment plan goals relate to the problems being treated?

Do goals indicate the outcomes to be achieved by the patient?

Are the goals written in a way that allow changes in the patient's behavior to be measured?

If not apparent, what criteria do staff use to measure success?

How relevant are the treatment plan goals to the patient's condition?

Structured rule (JSON):
{"intent_tags": ["quality", "compliance"], "logic_config": {"required_artifact": "a treatment plan that includes short-term and long-range goals. These goals must be developed based on identified problems, include specific dates for expected achievement, be stated as observable and measurable patient behavioral outcomes, and be subject to revision upon achievement or review/update upon modification/discontinuation without achievement."}, "rule_type": "existence", "scope_tags": ["clinical", "legal"]}
Guideline text:
In patients with recurrent life-threatening ventricular arrhythmias, sedation or general anaesthesia to reduce sympathetic drive may be considered.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "consideration of sedation or general anaesthesia", "trigger_assertion": "recurrent life-threatening ventricular arrhythmias"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
O2 Saturation must be above 90.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 90, "target_vital": "O2 Saturation"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

## §482.13(a) Standard:  Notice of Rights

## Interpretive Guidelines §482.13(a)

The hospital must ensure the notice of rights requirements are met.

Structured rule (JSON):
{"intent_tags": ["quality", "compliance"], "logic_config": {"required_artifact": "patient rights notification"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

## §482.57(b) Standard:  Delivery of Services

Services must be delivered in accordance with medical staff directives.

Interpretive Guidelines §482.57(b)

There should be written policies for the delivery of respiratory care services that are developed and approved by the medical staff.  Appropriate to the scope of services provided, the written policies should address at least the following:

- Equipment assembly, operation, and preventive maintenance;
- Safety practices, including infection control measures for equipment, sterile supplies, biohazardous waste, posting of signs, and gas line identification;
- Handling, storage, and dispensing of therapeutic gases to both inpatients and outpatients;
- Cardiopulmonary resuscitation;
- Procedures to follow in the advent of adverse reactions to treatments or interventions;
- Pulmonary function testing;
- Therapeutic percussion and vibration;
- Bronchopulmonary drainage;
- Mechanical ventilatory and oxygenation support;
- Aerosol, humidification, and therapeutic gas administration;
- Storage, access, control, administration of medications and medication errors; and
- Procedures for obtaining and analyzing blood samples (e.g., arterial blood gases).

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "written policies for respiratory care services"}, "rule_type": "existence", "scope_tags": ["clinical", "facility"]}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

## §482.43 Condition of Participation:  Discharge Planning

The hospital must have in effect a discharge planning process that focuses on the patient goals and treatment preferences and includes the patient and his or her caregivers support person(s) in the discharge planning for post-discharge care. The discharge planning process and the discharge plan must be consistent with the patient's goals for care and his or her treatment preferences, ensure an effective transition of the patient from hospital to post-discharge care, and reduce the factors leading to a preventable hospital readmissions.

## Interpretive Guidelines §482.43

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "discharge planning process and plan"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
A fibrin-specific agent (i.e. tenecteplase, alteplase, or reteplase) is recommended. 356 , 357

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "fibrin-specific agent (tenecteplase, alteplase, or reteplase)"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
Limit consultation to 5 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "consultation", "max_count": 5}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
It is recommended to assess glycaemic status at initial evaluation in all patients with ACS. 705 – 707

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "glycaemic status assessment at initial evaluation", "trigger_assertion": "patient has ACS"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
It is recommended that patients with suspected STEMI are immediately triaged for an emergency reperfusion strategy. 50 – 52

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "immediate triage for an emergency reperfusion strategy", "trigger_assertion": "suspected STEMI"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Radial access is recommended as the standard approach, unless there are overriding procedural considerations. 451 , 452

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"forbidden_treatment": "Radial access as the standard approach", "trigger_condition": "overriding procedural considerations"}, "rule_type": "contra", "scope_tags": ["clinical"]}
Guideline text:
The level of evidence for this section is based on expert consensus. [Ref: 517]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
As the default strategy for patients with atrial fibrillation and CHA 2 DS 2 -VASc score ≥1 in men and ≥2 in women, after up to 1 week of triple antithrombotic therapy following the ACS event, dual antithrombotic therapy using a NOAC at the recommended dose for stroke prevention and a single oral antiplatelet agent (preferably clopidogrel) for up to 12 months is recommended. 305 – 310

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "dual antithrombotic therapy (NOAC at recommended dose for stroke prevention + single oral antiplatelet, preferably clopidogrel) for up to 12 months", "trigger_assertion": "patient has atrial fibrillation and CHA2DS2-VASc score \u22651 (men) or \u22652 (women) AND has completed up to 1 week of triple antithrombotic therapy following an ACS event"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

## §482.55 Condition of Participation:  Emergency Services

The hospital must meet the emergency needs of patients in accordance with acceptable standards of practice.

A-1101

(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.55(a) Standard:  Organization and Direction.  If emergency services are provided at the hospital --

## Interpretive Guidelines §482.55(a):

If emergency services are provided at the hospital, the hospital must ensure that specific emergency services organization and direction requirements are met.

A-1102

(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

## §482.55(a) - [If emergency services are provided at the hospital --]

- (1) The services must be organized under the direction of a qualified member of the medical staff;

## Interpretive Guidelines §482.55(a)(1)

The hospital's emergency services must be under the direction of a qualified member of the hospital's medical staff.  The hospital's medical staff establishes criteria for the qualifications for the director of the hospital's emergency services in accordance with State law and acceptable standards of practice.  A single emergency services director must be responsible for the hospital's emergency services.

## Survey Procedures §482.55(a)(1)

Verify that emergency services are organized under the direction of a qualified member of the medical staff.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "qualified director for emergency services"}, "rule_type": "existence", "scope_tags": ["facility", "clinical", "legal"]}
Guideline text:
It is recommended that patients with suspected STEMI are immediately triaged for an emergency reperfusion strategy.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "immediate triage for emergency reperfusion strategy", "trigger_assertion": "suspected STEMI"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Systolic BP must be above 166.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 166, "target_vital": "Systolic BP"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
In all patients with an initial working diagnosis of MINOCA, it is recommended to follow a diagnostic algorithm to determine the underlying final diagnosis.

Structured rule (JSON):
{"intent_tags": ["quality", "safety"], "logic_config": {"required_artifact": "diagnostic algorithm followed", "trigger_assertion": "initial working diagnosis of MINOCA"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Systolic BP must be above 118.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 118, "target_vital": "Systolic BP"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

[The bylaws must:]

§482.22(c)(3) - Describe the organization of the medical staff.

Interpretive Guidelines §482.22(c)(3)

The medical staff bylaws must describe the organizational structure of the medical staff, and lay out the rules and regulations of the medical staff to make clear what are acceptable standards of patient care for all diagnostic, medical, surgical, and rehabilitative services.

## Survey Procedures §482.22(c)(3)

- Verify that the bylaws specify the organization and structure of the medical staff, and a mechanism that delineates accountability to the governing body.
- Verify that the bylaws describe who is responsible for regularly scheduled review and evaluation of the clinical work of the members of the medical staff and describe the formation of medical staff leadership.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance", "integrity"], "logic_config": {"required_artifact": "medical staff bylaws"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
Low-dose colchicine (0.5 mg once a day) may be considered, particularly if other risk factors are insufficiently controlled or if recurrent cardiovascular disease events occur under optimal therapy.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "consideration of low-dose colchicine (0.5 mg once a day)", "trigger_assertion": "other risk factors are insufficiently controlled OR recurrent cardiovascular disease events occur under optimal therapy"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

## §482.43(a) Standard: Discharge Planning Process

- (a) The hospital's discharge planning process must identify at an early stage of hospitalization those patients who are likely to suffer adverse health consequences upon discharge in the absence of adequate discharge planning and must provide a discharge planning evaluation for those patients so identified as well as for other patients upon the request of the patient, patient's representative, or patient's physician.

## Interpretive Guidelines §482.43(a)

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "discharge planning evaluation", "trigger_assertion": "patient identified as likely to suffer adverse health consequences upon discharge OR patient/representative/physician requests evaluation"}, "rule_type": "conditional_existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
The level of evidence for this section is based on expert consensus. [Ref: 606]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

[§482.42(c)(2)  The infection preventionist(s)/infection control professional(s) is responsible for:]

(vi)  Communication and collaboration with the antibiotic stewardship program.

## Interpretive Guidelines §482.42(c)(2)(vi)

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "communication and collaboration with the antibiotic stewardship program by infection preventionist(s)/infection control professional(s)"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
Clinicians should use their best judgment when applying these rules. [Ref: 771]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

## §482.43(a)(3) Standard:  Discharge Planning Evaluation

(3) The discharge planning evaluation must be included in the patient's medical record for use in establishing an appropriate discharge plan and the results of the evaluation must be discussed with the patient (or the patient's representative).

## Interpretive Guidelines §482.43(a)(3)

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "discharge planning evaluation in medical record and documented discussion of its results with patient or representative"}, "rule_type": "existence", "scope_tags": ["clinical", "legal"]}
Guideline text:
It is recommended to assess kidney function using eGFR in all patients with ACS.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "eGFR assessment of kidney function", "trigger_assertion": "diagnosis of ACS"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Systolic BP must be above 176.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 176, "target_vital": "Systolic BP"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
• urgent angiography with a view to revascularization is recommended if the patient

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "urgent angiography with a view to revascularization", "trigger_assertion": "patient meets criteria for urgent angiography"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Limit nebulizer treatment to 6 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "nebulizer", "max_count": 6}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
O2 Saturation must be above 99.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 99, "target_vital": "O2 Saturation"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

[§482.42(c)(2)  The infection preventionist(s)/infection control professional(s) is responsible for:]

(iv)  Competency-based  training and education of hospital personnel and staff, including medical staff, and, as applicable, personnel providing contracted services in the hospital, on the practical applications of infection prevention and control guidelines, policies, and procedures.

## Interpretive Guidelines §482.42(c)(2)(iv)

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "competency-based training and education on infection prevention and control for hospital personnel and staff"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
It is recommended to include ACS patients in decision-making (as much as their condition allows) and to inform them about the risk of adverse events, radiation exposure, and alternative options. Decision aids should be used to facilitate the discussion.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "patient involvement in decision-making and informed consent process, including discussion of risks, alternatives, and use of decision aids"}, "rule_type": "existence", "scope_tags": ["clinical", "legal"]}
Guideline text:
Limit nebulizer treatment to 3 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "nebulizer", "max_count": 3}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
It is recommended to base the choice of long-term glucose-lowering treatment on the presence of comorbidities, including heart failure, CKD, and obesity. 698 – 704

Structured rule (JSON):
{"intent_tags": ["quality"], "logic_config": {"required_artifact": "documentation of glucose-lowering treatment choice rationale considering comorbidities", "trigger_assertion": "presence of heart failure, CKD, or obesity"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

## [§482.42(c)(3)  The leader(s) of the antibiotic stewardship program is responsible for:]

(iii)  Communication and collaboration with medical staff, nursing, and pharmacy leadership, as well as with the hospital's infection prevention and control and QAPI programs, on antibiotic use issues.

## Interpretive Guidelines §482.42(c)(3)(iii)

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "Communication and collaboration by the antibiotic stewardship program leader(s) with medical staff, nursing, pharmacy leadership, infection prevention and control, and QAPI programs on antibiotic use issues."}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
When fibrinolysis is the reperfusion strategy, it is recommended to initiate this treatment as soon as possible after diagnosis in the pre-hospital setting (aim for target of <10 min to lytic bolus). 206 , 353 – 355

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"anchor": "diagnosis", "max_delay_minutes": 10, "target": "lytic bolus"}, "rule_type": "temporal", "scope_tags": ["clinical"]}
Guideline text:
Limit EKG interpretation to 3 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "ekg", "max_count": 3}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}