1. A hospital shall adopt and maintain a written discharge planning process, including policies and procedures, which applies to all patients. 2. At an early stage of hospitalization, a hospital shall identify patients who are likely to suffer adverse health consequences if discharged without adequate discharge planning. A hospital shall involve a patient throughout the discharge planning process. As appropriate, a hospital shall involve the patient's informal caregiver or legal representative in the discharge planning process. A hospital shall: a. Document the patient's discharge plan in the patient's medical record. b. As appropriate, communicate the plan to the patient, the patient's informal caregiver, or the patient's representative. c. Document the arrangements made for initial implementation of the patient's discharge plan in the patient's medical record, including any training or materials provided to the patient, the patient's informal caregiver, or the patient's representative.
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