New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-E - Former Division of Elderly and Adult Services
Chapter He-E 500 - SOCIAL SERVICES
Part He-E 501 - THE SOCIAL SERVICES BLOCK GRANT (TITLE XX)
Section He-E 501.17 - Service Records

Universal Citation: NH Admin Rules He-E 501.17

Current through Register No. 40, October 3, 2024

(a) Providers shall maintain service records for all individuals receiving Title XX services.

(b) The service record shall contain:

(1) The individual's name, address, and telephone number;

(2) The name, address, and telephone number of the individual's primary caregiver;

(3) The name and telephone number of a person who may be contacted in an emergency;

(4) Documentation of the individual's communication access needs, including modality, and the name of the communication access provider or type of device utilized, if applicable;

(5) The name and telephone number of the individual's licensed health practitioner, if applicable;

(6) The name and contact information for the pharmacy used by the individual, if applicable;

(7) The application described in He-E 501.06;

(8) The notice of decision described in He-E 501.07;

(9) The service authorization form required by He-E 501.16;

(10) The person-centered plan as described in He-E 501.22;

(11) Copies of correspondence related to service provision; and

(12) Documentation of the following:
a. The name of the Title XX service being provided, and the type of service activities, based on the service description contained in this rule;

b. The dates of service provision and other related contacts with the individual;

c. Changes in the individual's health or other circumstances affecting service provision;

d. Any other information or correspondence deemed relevant to service provision; and

e. Documentation of any referrals made to other resources or programs.

(c) Service records shall be kept confidential in accordance with He-E 501.03 and all applicable federal and state laws, rules, or regulations.

(d) Service records shall be retained for a period of 4 years after services have ended or been terminated.

#9849-A, eff 1-12-11

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