Regulation detail

Pa. Code 5221.41

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Pa. Code 5221.41 active

Recordkeeping

Jurisdiction: PA Agency: Pennsylvania Department of Human Services (OMHSAS) and Department of Drug and Alcohol Programs (DDAP)
CMHC (60%)
Plain-English summary

This section establishes recordkeeping requirements for intensive case management (ICM) providers under Pennsylvania's community mental health system. Providers must maintain ICM records separately from other service records using Department-required forms, retain them for at least four years, and follow written procedures consistent with Chapters 1101 and 4300. All changes in a consumer's progress, including admissions and terminations, must be documented with cause and projected effect in the case record.

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Regulation text
55 Pa. Code § 5221.41 - Recordkeeping 

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(a)
 Intensive case
 management records shall be identified and maintained apart from other service
 records using forms required by the Department.

(b)
 Records shall be maintained for a minimum
 of 4 years.

(c)
 Written procedures
 and records shall be kept in accordance with Chapters 1101 and 4300 (relating
 to general provisions; and county mental health and mental retardation fiscal
 manual).

(d)
 Changes in a consumer's
 progress, including admission and termination, shall be documented detailing
 cause and projected effect in the case record. For example, a meeting with a
 teacher shall indicate why the meeting was arranged and what the case manager
 hopes to accomplish in serving the consumer.

Notes

55

 Pa. Code §
 
5221.41

This section cited in 55 Pa. Code §
 
5221.33
 (relating to intensive
 case management records-statement of
 policy).

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