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Private Health Facilities Regulation 2024
96Clinical records
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96 Clinical records
96 Clinical records
The clinical record of a patient in a facility must include the following—
(a) a clear statement by the treating medical practitioner—
(i) explaining why the patient is receiving rehabilitation, and
(ii) that is consistent with the policies, procedures and plans referred to in this schedule, section 94,
(b) a rehabilitation plan based on the assessment of the patient,
(c) a record of each evaluation of the patient’s progress,
(d) a discharge plan.