Section 380. Resident personal and social information

A. Prior to or at the time of admission to an assisted living facility, the following personal and social information on a person shall be obtained and placed in the individual's record:

1. Name;

2. Last home address, and address from which resident was received, if different;

3. Date of admission;

4. Social security number;

5. Birthdate (if unknown, estimated age);

6. Birthplace, if known;

7. Marital status, if known;

8. Name, address and telephone number of all legal representatives, if any;

9. Copies of current legal documents that show proof of each legal representative's authority to act on behalf of the resident and that specify the scope of the representative's authority to make decisions and to perform other functions;

10. Name, address and telephone number of next of kin, if known (two preferred);

11. Name, address and telephone number of designated contact person authorized by the resident or legal representative, if appropriate, for notification purposes, including emergency notification and notification of the need for mental health, mental retardation, substance abuse, or behavioral disorder services (if resident or legal representative willing to designate an authorized contact person). There may be more than one designated contact person. The designated contact person may also be listed under another category, such as next of kin or legal representative;

12. Name, address and telephone number of the responsible individual stipulated in 22VAC40-72-550 G, if needed;

13. Name, address and telephone number of personal physician, if known;

14. Name, address and telephone number of personal dentist, if known;

15. Name, address and telephone number of clergyman and place of worship, if applicable;

16. Name, address and telephone number of local department of social services or any other agency, if applicable, and the name of the assigned case manager or caseworker;

17. Service in the armed forces, if applicable;

18. Lifetime vocation, career, or primary role;

19. Special interests and hobbies;

20. Information concerning advance directives, Do Not Resuscitate (DNR) orders, or organ donation, if applicable; and

21. For residents who meet the criteria for assisted living care, additional information to be included:

a. Previous mental health/mental retardation services history, if any, and if applicable for care or services;

b. Current behavioral and social functioning including strengths and problems; and

c. Any substance abuse history if applicable for care or services.

Historical Notes

Derived from Volume 23, Issue 06, eff. December 28, 2006.

Statutory Authority

§§ 63.2-217 and 63.2-1732 of the Code of Virginia.