§ 483.30 Physician services. A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician. A physician, physician assistant, nurse practitioner, or clinical nurse specialist must provide orders for the resident's immediate care and needs. ( a ) *Physician supervision.* The facility must ensure that— ( 1 ) The medical care of each resident is supervised by a physician; and
( 2 ) Another physician supervises the medical care of residents when their attending physician is unavailable.
( b ) *Physician visits.* The physician must— ( 1 ) Review the resident's total program of care, including medications and treatments, at each visit required by paragraph (c) of this section;
( 2 ) Write, sign, and date progress notes at each visit; and
( 3 ) Sign and date all orders with the exception of influenza and pneumococcal vaccines, which may be administered per physician-approved facility policy after an assessment for contraindications.
( c ) *Frequency of physician visits.* ( 1 ) The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.
( 2 ) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.
( 3 ) Except as provided in paragraphs (c)(4) and (f) of this section, all required physician visits must be made by the physician personally.
( 4 ) At the option of the physician, required visits in SNFs after the initial visit may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section.
( d ) *Availability of physicians for emergency care.* The facility must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency.
( e ) *Physician delegation of tasks in SNFs.* ( 1 ) Except as specified in paragraph (e)(4) of this section, a physician may delegate tasks to a physician assistant, nurse practitioner, or clinical nurse specialist who— ( i ) Meets the applicable definition in § 491.2 of this chapter or, in the case of a clinical nurse specialist, is licensed as such by the State;
( ii ) Is acting within the scope of practice as defined by State law; and
( iii ) Is under the supervision of the physician.
( 2 ) A resident's attending physician may delegate the task of writing dietary orders, consistent with § 483.60, to a qualified dietitian or other clinically qualified nutrition professional who— ( i ) Is acting within the scope of practice as defined by State law; and
( ii ) Is under the supervision of the physician.
( 3 ) A resident's attending physician may delegate the task of writing therapy orders, consistent with § 483.65, to a qualified therapist who— ( i ) Is acting within the scope of practice as defined by State law; and
( ii ) Is under the supervision of the physician.
( 4 ) A physician may not delegate a task when the regulations specify that the physician must perform it personally, or when the delegation is prohibited under State law or by the facility's own policies.
( f ) *Performance of physician tasks in NFs.* At the option of the State, any required physician task in a NF (including tasks which the regulations specify must be performed personally by the physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility but who is working in collaboration with a physician.
[56 FR 48875, Sept. 26, 1991, as amended at 67 FR 61814, Oct. 2, 2002. Redesignated and amended at 81 FR 68861, Oct. 4, 2016]