333-536-0065 Service Plan (1) For clients receiving any service(s) described in OAR 333-536-0045, the service(s) provided shall be in accordance with a written service plan developed in collaboration with a client or the client's representative based on the client's or the client's representative's request and an agency evaluation of the client. The service plan must be consistent with the agency's capabilities. (2) The agency administrator, administrator's designee or administrator's delegate shall conduct and document an initial evaluation of the client including but not limited to the client's physical, mental and emotional needs. The evaluation must be dated, and signed by the individual who conducted the evaluation, and maintained in the client's agency record. (3) The agency administrator, administrator's designee, or administrator's delegate, in collaboration with the client or the client's representative, shall complete a written service plan within seven days after the initiation of services. The service plan: (a) May be developed and maintained in electronic form; (b) Shall include a list of individuals participating in the development of the plan; and (c) Shall be signed and dated when it is complete and acceptable to all individuals participating in the development of the plan. (4) The completed service plan shall be client-directed or client representative-directed and include at least the following: (a) A comprehensive list of client information including but not limited to: (A) Client’s name, address, and telephone number; (B) The client’s medical condition(s); (C) The types of services being received, including but not limited to: (i) Medication services - include the tasks to be performed and who will perform the tasks; and (ii) Nursing services - include current identification of the delegated specific nursing procedures to be provided and specify the caregivers to whom the nursing procedure(s) have been delegated. (D) The name of the client's primary care provider; (E) Any special instructions or notations pertinent to providing services including, but not limited to, allergies; (b) The schedule for the provision of services specifying a range of hours for services per month; (c) The services to be provided, specifying the tasks to be conducted; and (d) Pertinent information about the client's needs in relation to the services to be provided to ensure the provision of safe and appropriate care. (5) The administrator, the administrator designee or administrator's delegate must review the client's service plan with each caregiver before the initial delivery of client care. (a) Each caregiver providing in-home care services to the client must confirm that the service plan was reviewed prior to providing client care. (b) The date of the review(s), the signature or a unique electronic identifier such as an individual’s log-in and password into a computer program or an electronic stamp of the agency administrator, administrator's designee, or administrator's delegate and each caregiver must be documented in the client’s record. (c) A list of assigned caregivers must be documented in the client's record. (6) A client or a client's representative may request changes in the service plan. All changes must be reviewed and approved by the agency and must be communicated to the caregiver(s) and documented in the client's record. (7) An agency shall maintain the original service plan and all updated service plans in each client's agency record. Complete and legible copies of the service plan(s) shall be given to the client or client's representative upon request. Statutory/Other Authority: ORS 443.340 Statutes/Other Implemented: ORS 443.340 History: PH 50-2023, amend filed 10/23/2023, effective 10/23/2023 PH 26-2021, amend filed 06/29/2021, effective 07/01/2021 PH 10-2012, f. 6-26-12, cert. ef. 7-1-12 PH 22-2004, f. & cert. ef. 6-25-04 PH 3-2004(Temp), f. & cert. ef. 2-6-04 thru 7-30-04 OHD 19-2002, f. 12-4-02, cert. ef. 2-1-03