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

§482.62(e) Standard: Psychological Services.

The hospital must provide or have available psychological services to meet the needs of the patients.

Interpretive Guidelines §482.62(e)

Psychology services may include the following: diagnostic testing and diagnostic formulations on request from physicians; provision of individual, group and family therapies; participation in multi-disciplinary treatment conferences; and program development and evaluation.

The number of full-time, part-time and consulting psychologists must be adequate to provide necessary services to patients. Arrangements with outside resources must assure that necessary patient services will be provided.

## Survey Procedures §482.62(e)

Did the patients in the sample have a need for psychological services or testing? Were they provided in a timely manner and with sufficient intensity?

Did any of the patients in the sample indicate a need for psychological services, but none were requested?

What types of psychological services are offered? (e.g., assessments, therapy)

Do certain groups of patients receive testing routinely? Dementia?, Children?, Adolescents? Why?

Once tests are performed, are results reported in sufficient time to be integrated in the patient's active treatment and treatment plan?

How does the hospital or Psychological Service Department determine whether or not: it meets the needs of patients? Its services are underutilized or over-utilized?

Why have psychological services staff been deployed in the manner that they have?

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

§482.13(e)(1)(ii) - Seclusion is the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving. Seclusion may only be used for the management of violent or self-destructive behavior.

## Interpretive Guidelines §482.13(e)(1)(ii)

Seclusion may only be used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others.

Seclusion is not just confining a patient to an area, but involuntarily confining the patient alone in a room or area where the patient is physically prevented from leaving.  If a patient is restricted to a room alone and staff are physically intervening to prevent the patient from leaving the room or giving the perception that threatens the patient with physical intervention if the patient attempts to leave the room, the room is considered locked, whether the door is actually locked or not.  In this situation, the patient is being secluded.

A patient physically restrained alone in an unlocked room does not constitute seclusion.

Confinement on a locked unit or ward where the patient is with others does not constitute seclusion.

Timeout is not considered seclusion.  Timeout is an intervention in which the patient consents to being alone in a designated area for an agreed upon timeframe from which the patient is not physically prevented from leaving.  Therefore, the patient can leave the designated area when the patient chooses.

## Survey Procedures §482.13(e)(1)(ii)

- Determine whether the hospital's policy and procedures employ a definition or description of what constitutes seclusion that is consistent with the regulation.
- While touring hospital units look for cases where a patient is in seclusion.
- Interview hospital staff to determine whether they know the definition of seclusion.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "violent or self-destructive behavior that jeopardizes immediate physical safety of patient, staff, or others", "trigger_assertion": "seclusion is applied"}, "rule_type": "conditional_existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
A PPCI strategy is recommended over fibrinolysis if the anticipated time from diagnosis to PCI is <120 min.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"max_value": 120, "operator": "<", "target_vital": "time from diagnosis to PCI"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 141, Issued: 07-10-15, Effective: 07-10-15, Implementation: 07-10-15)

§482.26(b)(4) - Radiologic services must be provided only on the order of practitioners with clinical privileges or, consistent with State law, of other practitioners authorized by the medical staff and the governing body to order the services.

## Interpretive Guidelines §482.26(b)(4)

The medical staff and the governing body determine the necessary qualifications and clinical privileges that practitioners must have to order diagnostic radiologic studies or therapeutic procedures.

For outpatient services, the governing body and medical staff may also authorize practitioners who do not have hospital privileges to order such studies or procedures, as permitted under State law.    For example, a hospital may decide that it will routinely accept orders from physicians in the communities it services for outpatient diagnostic studies, regardless of whether those physicians have privileges to practice in the hospital.  See the guidance for §482.54(c) for more information on requirements related to outpatient orders from practitioners who do not hold privileges to practice at the hospital.

The order must include information for the radiologic technologist about the study or procedure to be performed, and the technologist is expected to review this information prior to implementing the order.

## For Information Only - Not Required/Not to be Cited

Hospitals are strongly encouraged, but not required, to develop standard formats for practitioner's orders for radiologic services that clearly document the diagnostic or therapeutic purpose of the study/procedure, as well as any other pertinent information that may lead to altering the dose of radiation, including, but not limited to:

- Indication (reason) for the study/procedure
- Previous imaging studies of the body part(s) under investigation;
- Additional relevant radiation exposure; and
- Previous adverse events (e.g., over- or underexposure of dosing, allergic reaction to contrast dye) during radiologic procedures.

In addition, hospitals are encouraged to adopt policies to ensure that the radiation technologist performing the study/procedure confirms the order with the ordering practitioner if there are any concerns about its appropriateness.

## Survey Procedures §482.26(b)(4)

- Review medical records to determine that there is an order for all radiologic services, and that the order was dated/timed and authenticated by an authorized practitioner prior to the diagnostic study or therapeutic procedure being performed.

Observe whether a radiologic technologist confirms that there is an order from an authorized practitioner and reviews information included in the order before beginning a study or procedure.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "order from authorized practitioner", "trigger_assertion": "radiologic service performed"}, "rule_type": "conditional_existence", "scope_tags": ["clinical", "facility", "legal"]}
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.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "long-term glucose-lowering treatment choice based on comorbidities", "trigger_assertion": "presence of comorbidities (heart failure, CKD, obesity)"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
A PPCI strategy is recommended in patients with resuscitated cardiac arrest and an ECG with persistent ST-segment elevation (or equivalents). 368 , 387 , 388

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "PPCI strategy", "trigger_assertion": "resuscitated cardiac arrest and an ECG with persistent ST-segment elevation (or equivalents)"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Limit consultation to 6 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "consultation", "max_count": 6}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
Patient preferences should be considered in all decisions. [Ref: 340]

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)

## §482.13(a)(2)  (Continued)

[The hospital must establish a process for prompt resolution of patient grievances and must inform each patient whom to contact to file a grievance . ]  The hospital's governing body must approve and be responsible for the effective operation of the grievance process, and must review and resolve grievances, unless it delegates the responsibility in writing to a grievance committee.

## Interpretive guidelines §482.13(a)(2)

The hospital's grievance process must be approved by the governing body.  The hospital's governing body is responsible for the effective operation of the grievance process.  This includes the hospital's compliance with all of the CMS grievance process requirements. The hospital's governing body must review and resolve grievances, unless it delegates this responsibility in writing to a grievance committee.  A committee is more than one person. The committee membership should have adequate numbers of qualified members to review and resolve the grievances the hospital receives (this includes providing written responses) in a manner that complies with the CMS grievance process requirements.

## Survey Procedures §482.13(a)(2)

- Determine if the hospital's governing body approved the grievance process.
- Is the governing body responsible for the operation of the grievance process, or has the governing body delegated the responsibility in writing to a grievance committee?
- Determine how effectively the grievance process works.  Are patient's or the patient representative's concerns addressed in a timely manner?  Are patients informed of any resolution to their grievances?  Does the hospital apply what it learns from the grievance as part of its continuous quality improvement activities?
- Is the grievance process reviewed and analyzed through the hospital's QAPI process or some other mechanisms that provides oversight of the grievance process?

Structured rule (JSON):
{"intent_tags": ["quality", "compliance"], "logic_config": {"required_artifact": "Governing body approved and operated patient grievance process"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
Implementation of these guidelines varies by facility. [Ref: 525]

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)(1) The governing body must ensure all of the following:]

(ii)  All HAIs and other infectious diseases identified by the infection prevention and control program as well as antibiotic use issues identified by the antibiotic stewardship program are addressed in collaboration with hospital QAPI leadership.

## Interpretive Guidelines §482.42(c)(1)(ii)

Guidance is pending and will be updated in future release.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "Addressing of all identified HAIs, infectious diseases, and antibiotic use issues in collaboration with hospital QAPI leadership"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
(Rev. 137, Issued: 04-01-15, Effective: 03-27-15, Implementation: 03-27-15)

## §482.30  Condition of Participation:  Utilization Review

The hospital must have in effect a utilization review (UR) plan that provides for review of services furnished by the institution and by members of the medical staff to patients entitled to benefits under the Medicare and Medicaid programs.

## Interpretive Guidelines  §482.30

If the hospital does not satisfy one of the exception criteria at §482.30(a), it must have a UR plan in effect which provides for review of services provided to Medicare and Medicaid beneficiaries.

## Survey Procedures  §482.30

The manner and degree of noncompliance with one or more of the UR standards is considered when determining whether there is condition-level compliance or noncompliance.

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

## §482.12(e) Standard:  Contracted Services

The governing body must be responsible for services furnished in the hospital whether or not they are furnished under contracts.  The governing body must ensure that a contractor of services (including one for shared services and joint ventures) furnishes services that permit the hospital to comply with all applicable conditions of participation and standards for the contracted services.

## Interpretive Guidelines §482.12(e)

The governing body has the responsibility for assuring that hospital services are provided in compliance with the Medicare Conditions of participation and according to acceptable standards of practice, irrespective of whether the services are provided directly by hospital employees or indirectly by contract.  The governing body must take actions through the hospital's QAPI program to:  assess the services furnished directly by hospital staff and those services provided under contract, identify quality and performance problems, implement appropriate corrective or improvement activities, and to ensure the monitoring and sustainability of those corrective or improvement activities.  See §482.21 QAPI.

## Survey Procedures §482.12(e)

Ascertain that all contractor services provided in the hospital are in compliance with the Conditions of Participation for hospitals.

Structured rule (JSON):
{"intent_tags": ["quality", "compliance"], "logic_config": {"required_artifact": "services compliant with conditions of participation and standards of practice"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
Use of the ‘teach back’ technique for decision support during the securing of informed consent should be considered. 885 , 889 – 891

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "teach back technique for informed consent"}, "rule_type": "existence", "scope_tags": ["clinical", "legal"]}
Guideline text:
Fondaparinux is not recommended in patients with STEMI undergoing PPCI. 260

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"forbidden_treatment": "Fondaparinux", "trigger_condition": "STEMI undergoing PPCI"}, "rule_type": "contra", "scope_tags": ["clinical"]}
Guideline text:
Limit nebulizer treatment to 4 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "nebulizer", "max_count": 4}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
The routine use of an intra-aortic balloon pump in ACS patients with CS and without mechanical complications is not recommended.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"forbidden_treatment": "intra-aortic balloon pump", "trigger_condition": "ACS patients with CS and without mechanical complications"}, "rule_type": "contra", "scope_tags": ["clinical"]}
Guideline text:
Enoxaparin i.v. followed by s.c. is recommended as the preferred anticoagulant. 347 , 348 , 357 – 360

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "Enoxaparin i.v. followed by s.c. as preferred anticoagulant"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
Parenteral anticoagulation is recommended for all patients with ACS at the time of diagnosis. 255 , 296

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "Parenteral anticoagulation", "trigger_assertion": "patient has ACS at the time of diagnosis"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
A temporary interruption of cancer therapy is recommended in patients in whom the cancer therapy is suspected to be a contributing cause of ACS c . 713 , 714

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "temporary interruption of cancer therapy", "trigger_assertion": "cancer therapy is suspected to be a contributing cause of ACS"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
The level of evidence for this section is based on expert consensus. [Ref: 324]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
## §482.13(c) Standard:  Privacy and Safety

## Interpretive Guidelines §482.13(c)

The hospital must ensure the privacy and safety requirements are met.

Structured rule (JSON):
{"intent_tags": ["quality"], "logic_config": {"required_artifact": "unknown_requirement"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
Glucose-lowering therapy should be considered in ACS patients with blood glucose >10 mmol/L (>180 mg/dL), with the target adapted to comorbidities, while episodes of hypoglycaemia should be avoided.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"min_value": 180, "operator": ">", "target_vital": "Blood Glucose", "unit": "mg/dL"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
Limit nebulizer treatment to 5 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "nebulizer", "max_count": 5}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.61(c)(1)(i) The written plan must include-A substantiated diagnosis;

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

The substantiated diagnosis serves as the basis for treatment interventions. A substantiated diagnosis is the diagnosis identified by the treatment team to be the primary focus upon which treatment planning will be based. It evolves from the synthesis of data from various disciplines.

At the time of admission, the patient may have been given an initial diagnosis or a ruleout diagnosis. At the time of treatment planning, a substantiated diagnosis must be recorded. It may be the same as the initial diagnosis, or, based on new information and assessment, it may differ.

Rule-out diagnoses, by themselves are not acceptable as a substantiated diagnosis.

Data to substantiate the diagnosis may be found in, but is not limited to, the psychiatric evaluation, the medical history and physical examination, laboratory tests, medical and other psychological consults, assessments done by disciplines involved in patient evaluations and information supplied from other sources such as community agencies and significant others.

## Survey Procedures §482.61(c)(1)(i)

What specific problems will be treated during the patient's hospitalization?

Does the treatment plan identify and precisely describe problem behaviors rather than generalized statements i.e., 'paranoid,' 'aggressive,' 'depressed?' or generic terminology i.e., 'alteration in thought process,' 'ineffective coping,' 'alteration in mood?'

Are physical problems identified and included in the treatment plan if they require treatment, or interfere with treatment, during the patient's hospitalization?

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance", "integrity"], "logic_config": {"required_artifact": "substantiated diagnosis"}, "rule_type": "existence", "scope_tags": ["clinical", "legal"]}
Guideline text:
Routine immediate angiography after resuscitated cardiac arrest is not recommended in haemodynamically stable patients without persistent ST-segment elevation (or equivalents).

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"forbidden_treatment": "Routine immediate angiography", "trigger_condition": "patient is haemodynamically stable and without persistent ST-segment elevation (or equivalents) after resuscitated cardiac arrest"}, "rule_type": "contra", "scope_tags": ["clinical"]}
Guideline text:
Implementation of these guidelines varies by facility. [Ref: 179]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
Implementation of these guidelines varies by facility. [Ref: 727]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
Limit physical therapy unit to 6 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "physical", "max_count": 6}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

[The bylaws must:]

§482.22(c)(1) - Be approved by the governing body.

## Interpretive Guidelines §482.22(c)(1)

Medical staff bylaws and any revisions of those bylaws must be submitted to the governing body for approval.  The governing body has the authority to approve or disapprove bylaws suggested by the medical staff.  The bylaws and any revisions must be approved by the governing body before they are considered effective.

## Survey Procedures §482.22(c)(1)

Verify that the medical staff bylaws have been approved by the medical staff and the governing body.

Structured rule (JSON):
{"intent_tags": ["quality", "compliance", "integrity"], "logic_config": {"required_artifact": "Governing body approval of medical staff bylaws"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
It is recommended that ACS patients adopt a healthy lifestyle, including: • stopping all smoking of tobacco • healthy diet (Mediterranean style) • alcohol restriction • regular aerobic physical activity and resistance exercise • reduced sedentary time 724 , 761 , 763 , 772 , 773 , 776 , 777 , 855 –

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "healthy lifestyle for ACS patients, including smoking cessation, healthy diet, alcohol restriction, regular exercise, and reduced sedentary time"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
Routine oxygen is not recommended in patients with oxygen saturation >90%.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"min_value": 90, "operator": ">", "target_vital": "Oxygen Saturation"}, "rule_type": "threshold", "scope_tags": ["clinical"]}