Baseline Care Summary
Updated 2021
Baseline Care Plan Summary to comply with F655: The facility must provide the resident and their representative with a summary of the Baseline Care Plan that includes but is not limited to:
- the initial goals for the resident
- a summary of the resident's medications and dietary instructions
- any services and treatments to be administered by the facility and personnel acting on behalf of the facility
- any updated information based on the details of the comprehensive care plan, as necessary
The Briggs Baseline Care Plan Summary is designed to be a companion to the Baseline Care Plan. The Summary is a 2-part form to comply with the requirement that the resident’s medical record reflect evidence that the summary was given to the resident and/or resident representative.
• Size: 8 ½” x 11”
• 2-part with canary copy
• Swiss Punched; 5-holes top and side
• 100 per pack
• 2-part with canary copy
• Swiss Punched; 5-holes top and side
• 100 per pack