Section 16.03.10.583 - ICF/IID: INFORMATION REQUIRED FOR DETERMINATIONRequired information includes a medical evaluation, an initial plan of care, social evaluation, psychological evaluation, and initial plan of care by ICF/IID.
01.Medical Evaluation. A complete medical evaluation, current within ninety (90) days of admission, signed and dated by the physician, an electronic physician's signature is permissible, that includes: a. Diagnosis (primary and secondary);b. Medical findings and history;c. Mental and physical functional capacity;d. Prognosis; mobility status; ande. A statement by the physician certifying the level of care needed as ICF/IID for a specific participant.02.Initial Plan of Care by Physicians. An initial plan of care, current within ninety (90) days of admission and signed and dated by the physician that includes:a. Orders for medications and treatments;c. Professional rehabilitative and restorative services and special procedures, where appropriate.03.Social Evaluation. A social evaluation, current within ninety (90) days of admission, that includes:b. Age at onset of condition;c. Summary of functional status, such as skills level, activities of daily living; andd. Family social information.04.Psychological Evaluation. A psychological evaluation conducted by a psychologist current within ninety (90) days of admission, that includes: b. Summary of developmental findings. Instead of a psychological, infants under three (3) years of age may be evaluated by a developmental disability specialist utilizing the developmental milestones congruent with the age of the infant;c. Mental and physical functioning capacity; andd. Recommendation concerning placement and primary need for active treatment.05.Initial Plan of Care by ICF/IID. An initial plan of care developed by the admitting ICF/IID.Idaho Admin. Code r. 16.03.10.583