Nick-Maximillien/medgate-compiler-data huggingface dataset:
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.13(d)(2) - The patient has the right to access their medical records, including current medical records, upon an oral or written request, in the form or format requested by the individual. If it is readily producible in such form and format (including in an electronic form or format when such medical records are maintained electronically); or if not, in a readable hard copy form or such other form or format as agreed by the facility and the individual, and within a reasonable timeframe. The hospital must not frustrate the legitimate efforts of individuals to gain access to their own medical records and must actively seek to meet these requests as quickly as its record keeping system permits.

## Interpretive Guidelines  §482.13(d)(2)

Guidance is pending and will be updated in future release.

## Survey Procedures  §482.13(d)(2)

- Does the hospital promote and protect the patient's right to access information contained in his/her clinical record?
- Does the hospital have a procedure for providing records to patients within a reasonable time frame?
- Does the hospital's system frustrate the legitimate efforts of individuals to gain access to their own medical record?
- Does the procedure include the method to identify what documents were not provided and the reason?

Structured rule (JSON):
{"intent_tags": ["quality"], "logic_config": {"required_artifact": "unknown_requirement"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
Limit massage therapy to 6 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "massage", "max_count": 6}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
Limit massage therapy to 2 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "massage", "max_count": 2}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.55(b)(2) - There must be adequate medical and nursing personnel qualified in emergency care to meet the written emergency procedures and needs anticipated by the facility.

## Interpretive Guidelines §482.55(b)(2)

The hospital must staff the emergency department with the appropriate numbers and types of professionals and other staff who possess the skills, education, certifications, specialized training and experience in emergency care to meet the written emergency procedures and needs anticipated by the facility.

The hospital must determine the categories and numbers of MD/DOs, specialists, RNs, EMTs, and emergency department support staff the hospital needs to met its anticipated emergency needs.

The medical staff must establish criteria, in accordance with State law and regulations and acceptable standards of practice delineating the qualifications required for each category of emergency services staff (e.g., emergency physicians, specialist MD/DO, RNs, EMTs, mid-level practitioners, etc.).

As a suggested prudent practice the hospital should conduct periodic assessments of its emergency needs in order to anticipate the policies, procedures, staffing, training, and other resources that may be needed to address likely demands.

Additionally, the hospital should work cooperatively with Federal, State and local emergency preparedness agencies and officials in order to identify likely risks to the community (e.g., natural disasters, mass casualties, terrorist acts, etc.), to anticipate demands and resources needed by the hospital emergency services, and to develop plans, methods and coordinating networks to address those anticipated needs.

## Survey Procedures §482.55(b)(2)

- Verify that there are sufficient medical and nursing personnel qualified in the needs anticipated by the facility and that there are specific assigned duties for emergency care personnel and a clear chain of command.
- Interview staff to determine that they are knowledgeable, within their own level of participation in emergency care including:
- o Parenteral administration of electrolytes, fluids, blood and blood components;
- o Care and management of injuries to extremities and central nervous system;
- o Prevention of contamination and cross infection.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "adequate and qualified emergency medical and nursing personnel"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
Limit physical therapy unit to 3 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "physical", "max_count": 3}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
If the LDL-C goal is not achieved despite maximally tolerated statin therapy after 4–6 weeks, the addition of ezetimibe is recommended. 788

Structured rule (JSON):
{"intent_tags": ["quality"], "logic_config": {"required_artifact": "ezetimibe addition", "trigger_assertion": "LDL-C goal not achieved despite maximally tolerated statin therapy after 4-6 weeks"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Pre-treatment with a P2Y 12 receptor inhibitor may be considered in NSTE-ACS patients who are not expected to undergo an early invasive strategy (<24 h) and do not have HBR c . 263

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "consideration of P2Y 12 receptor inhibitor pre-treatment", "trigger_assertion": "NSTE-ACS patient not expected to undergo early invasive strategy within 24 hours and without high bleeding risk (HBR c)"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Fondaparinux is not recommended in patients with STEMI undergoing PPCI.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"forbidden_treatment": "Fondaparinux", "trigger_condition": "patients with STEMI undergoing PPCI"}, "rule_type": "contra", "scope_tags": ["clinical"]}
Guideline text:
For patients with NSTE-ACS in whom early invasive angiography (i.e. within 24 h) is not anticipated, fondaparinux is recommended. 262 , 304

Structured rule (JSON):
{"intent_tags": ["quality", "safety"], "logic_config": {"required_artifact": "fondaparinux administration", "trigger_assertion": "patient has NSTE-ACS and early invasive angiography (within 24 h) is not anticipated"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
This document replaces the 2019 standards of care. [Ref: 381]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.12(d)(5)  ( Continued)

A capital expenditure is not subject to section 1122 review if 75 percent of the health care facility's patients who are expected to use the service for which the capital expenditure is made are individuals enrolled in a health maintenance organization (HMO) or competitive medical plan (CMP) that meets the requirements of section 1876(b) of the Act, and if the Department determines that the capital expenditure is for services and facilities that are needed by the HMO or CMP in order to operate efficiently and economically and that are not otherwise readily accessible to the HMO or CMP because--

- (i)  The facilities do not provide common services at the same site;
- (ii)  The facilities are not available under a contract of reasonable duration;
- (iii)  Full and equal medical staff privileges in the facilities are not available;
- (iv)  Arrangements with these facilities are not administratively feasible; or
- (v)  The purchase of these services is more costly than if the HMO or CMP provided the services directly.

Structured rule (JSON):
{"intent_tags": ["compliance", "integrity"], "logic_config": {"condition_for_non_applicability": {"conditions": [{"description": "75% of expected patients using the service are HMO/CMP enrollees", "min_percentage": 75, "patient_group": "HMO/CMP"}, {"description": "Department determines capital expenditure is for services/facilities needed by HMO/CMP for efficient and economic operation"}, {"conditions": ["facilities do not provide common services at the same site", "facilities are not available under a contract of reasonable duration", "full and equal medical staff privileges in the facilities are not available", "arrangements with these facilities are not administratively feasible", "purchase of these services is more costly than if the HMO or CMP provided the services directly"], "context": "services/facilities are not otherwise readily accessible because", "type": "OR"}], "type": "AND"}, "protocol_name": "section 1122 review"}, "rule_type": "protocol_validity", "scope_tags": ["facility", "legal"]}
Guideline text:
Implantation of a permanent pacemaker is recommended when high-degree AV block does not resolve within a waiting period of at least 5 days after MI.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "implantation of a permanent pacemaker", "trigger_assertion": "high-degree AV block does not resolve within 5 days after MI"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.11(c)  The hospital must assure that personnel are licensed or meet other applicable standards that are required by State or local laws.

## Interpretive Guidelines §482.11(c)

All staff that are required by the State to be licensed must possess a current license.  The hospital must assure that these personnel are in compliance with the State's licensure laws. The laws requiring licensure vary from state to state.  Examples of healthcare professionals that a state may require to be licensed could include:  nurses, MD/DOs, physician assistants, dieticians, x-ray technologists, dentists, physical therapists, occupational therapists, respiratory therapists and hospital administrators.

All staff must meet all applicable standards required by State or local law for hospital personnel.  This would include at a minimum:

- Certification requirements;
- Minimum qualifications;
- Training/education requirements; and
- Permits (such as food handlers permits).

When telemedicine is used and the practitioner and patient are located in different states, the practitioner providing the patient care service must be licensed and/or meet the other applicable standards that are required by State or local laws in both the state where the practitioner is located and the state where the patient is located.

## Survey Procedures §482.11(c)

- Verify for those personnel required to be licensed, certified, and/or permitted by the State, that the hospital has established, and follows procedures for determining that personnel are properly licensed, certified, and/or permitted.
- Verify that staff and personnel are licensed, certified, and/or permitted in accordance with State and local requirements.
- Verify that staff and personnel meet all standards (such as continuing education, basic qualifications, etc.) required by State and local laws or regulations.  Verify that the hospital has a mechanism established and enforced to ensure compliance.
- Review a sample of personnel files to verify that licensure and/or other required credentials information is up to date.  Verify State licensure compliance of the direct

care personnel as well as administrators and supervisory personnel.

Structured rule (JSON):
{"intent_tags": ["compliance"], "logic_config": {"details": "Personnel must possess current licenses, certifications, and meet all applicable state and local standards, including for telemedicine.", "required_artifact": "licensed and qualified personnel"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
In patients with no recurrence of chest pain, normal ECG findings, and normal levels of cardiac troponin (preferably high sensitivity), but still with suspected ACS, a non-invasive stress test (preferably with imaging) for inducible ischaemia or CCTA is recommended before deciding on an invasive approach.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "a non-invasive stress test (preferably with imaging) for inducible ischaemia or CCTA, performed before deciding on an invasive approach", "trigger_assertion": "patients with no recurrence of chest pain, normal ECG findings, normal levels of cardiac troponin (preferably high sensitivity), and suspected ACS"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Patient discharge information should be provided in both written and verbal formats prior to discharge. Adequate preparation and education for patient discharge using the teach back technique and/or motivational interviewing, giving information in chunks, and checking for understanding, should be considered.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "discharge information in written and verbal formats"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
Implementation of these guidelines varies by facility. [Ref: 783]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
Heart Rate must be above 99.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 99, "target_vital": "Heart Rate"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
Angiography and PCI of the IRA, if indicated, is recommended between 2 and 24 h after successful fibrinolysis.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"anchor": "successful fibrinolysis", "condition": "if indicated", "max_delay_hours": 24, "min_delay_hours": 2, "target": "Angiography and PCI of the IRA"}, "rule_type": "temporal", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

## §482.41(b)

- (1) Except as otherwise provided in this section-
2. (i)  The hospital must meet the applicable provisions and must proceed in accordance with the Life Safety Code (NFPA 101 and Tentative Interim Amendments TIA 12-1, TIA 12-2, TIA 12-3, and TIA 12-4.) Outpatient surgical departments must meet the provisions applicable to Ambulatory Health Care Occupancies, regardless of the number of patients served.
3. (ii)  Notwithstanding paragraph (b)(1)(i) of this section, corridor doors and doors to rooms containing flammable or combustible materials must be provided with positive latching hardware. Roller latches are prohibited on such

doors.

- (2) In consideration of a recommendation by the State survey agency or Accrediting Organization or at the discretion of the Secretary, may waive, for periods deemed appropriate, specific provisions of the Life Safety Code, which would result in unreasonable hardship upon a hospital, but only if the waiver will not adversely affect the health and safety of the patients.

(3) The provisions of the Life Safety Code do not apply in a State where CMS finds that a fire and safety code imposed by State law adequately protects patients in hospitals.

## Interpretive Guidelines §482.41(b)(1)-(3)

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "compliance"], "logic_config": {"required_artifact": "hospital compliance with Life Safety Code (NFPA 101)"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

[…the governing body must ensure that the following requirements are met:] §482.12(c)(3)  A doctor of medicine or osteopathy is on duty or on call at all times.

## Survey Procedures §482.12(c)(3)

- Verify the governing body has established and monitors the enforcement of policies that ensure a doctor of medicine or osteopathy is on duty or on call at all times to provide medical care and onsite supervision when necessary.
- Review the 'call' register and documents that assure that a doctor of medicine or osteopathy is on duty or on call at all times.
- Interview nursing staff.  How do they know who is on call?  Are they able to call the on-call MD/DO and speak with him/her at all times?  When appropriate, do on-call MD/DOs come to the hospital to provide needed care.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "Doctor of Medicine or Osteopathy on duty or on call"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
It is recommended to assess symptoms using methods that help patients to describe their experience. 910

Structured rule (JSON):
{"intent_tags": ["quality", "safety"], "logic_config": {"required_artifact": "symptom assessment using patient-centered methods"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.42(d)(4)   A qualified individual (or individuals) with expertise in infection prevention and control has been designated at the hospital as responsible for communicating with the unified infection prevention and control and antibiotic stewardship programs, for implementing and maintaining the policies and procedures governing infection prevention and control and antibiotic stewardship as directed by the unified infection prevention and control and antibiotic stewardship programs, and for providing education and training on the practical applications of infection prevention and control and antibiotic stewardship to hospital staff.

## Interpretive Guidelines §482.42(d)(4)

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "designated qualified individual for infection prevention and control and antibiotic stewardship"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
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 non-vitamin K antagonist oral anticoagulant at the recommended dose for stroke prevention and a single oral antiplatelet agent (preferably clopidogrel) for up to 12 months is recommended.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "dual antithrombotic therapy using a non-vitamin K antagonist oral anticoagulant at the recommended dose for stroke prevention and a single oral antiplatelet agent (preferably clopidogrel) for up to 12 months", "trigger_assertion": "patients with atrial fibrillation and CHA2DS2-VASc score \u22651 in men and \u22652 in women, after up to 1 week of triple antithrombotic therapy following the ACS event"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Limit consultation to 1 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "consultation", "max_count": 1}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
Clinicians should use their best judgment when applying these rules. [Ref: 923]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
In smokers, offering follow-up support, nicotine replacement therapy, varenicline or bupropion, individually or in combination, should be considered. 859 – 864

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"interventions_to_consider": ["follow-up support", "nicotine replacement therapy", "varenicline", "bupropion"], "required_artifact": "documentation of smoking cessation intervention consideration", "trigger_assertion": "patient is a smoker"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Pre-treatment with a P2Y 12 receptor inhibitor may be considered in patients undergoing a primary PCI strategy. 244 , 245

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "P2Y 12 receptor inhibitor pre-treatment consideration", "trigger_assertion": "patient undergoing primary PCI strategy"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

## §482.11(a) The hospital must be in compliance with applicable Federal laws related to the health and safety of patients.

## Survey Procedures §482.11(a)

Interview the CEO, or appropriate individual designated by the hospital, to determine whether the hospital is in compliance with Federal laws related to patient health and safety. (For example, ask  if the hospital was cited since its last survey for any violation of Section 504 of the Rehabilitation Act of 1973 related to denying people with disabilities access to care.  If so, verify that satisfactory corrections have been made to bring the hospital into compliance with that law.)  Refer or report noted noncompliance with Federal laws and regulations to the appropriate agency having jurisdiction (e.g., accessibility issues, bloodborne pathogens, standard precautions, and TB control to OSHA; hazardous chemical/waste issues to EPA; etc.)

Structured rule (JSON):
{"intent_tags": ["compliance"], "logic_config": {"required_artifact": "compliance with applicable Federal laws related to patient health and safety"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
This document replaces the 2019 standards of care. [Ref: 968]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}