SECTION 450:17-5-181. Service plan; content

(a)   The service plan must address all services necessary to assist the client in meeting his or her physical and behavioral health goals, and include the following:

(1)   Consumer diagnoses, relative to behavioral and physical health conditions assessed by and addressed by the facility in terms of direct services provided and/or conditions for which the individual is referred elsewhere for treatment.

(2)   Treatment goals, including preventive/primary care services;

(3)   Interventions, including care coordination, physical health services, peer and family support services, targeted case management, as well as any accommodations to ensure cultural and linguistically competent services as applicable;

(4)   A detailed statement of the type, duration, and frequency of services, including primary medical and specialty care, social work, psychiatric nursing, counseling, and therapy services, necessary to meet the consumer's specific needs;

(5)   Medications, treatments, and individual and/or group therapies;

(6)   As applicable, family psychotherapy with the primary focus on treatment of the consumer's conditions; and

(7)   The interdisciplinary treatment team's documentation of the consumer's or representative's and/or primary caregiver's (if any) understanding, involvement, and agreement with the care plan.

(8)   The consumer's advance wishes related to treatment and crisis management and, if the consumer does not wish to share their preferences, that decision is documented.

(b)   Compliance with this Section will be determined by on-site review of clinical records and supported documentation.

[Source: Added at 33 Ok Reg 964, eff 9-1-16]