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Baseline Care Plan Summary

(2 Pages)


On November 28, 2017, the Baseline Care Plan Summary became one of the new requirements.  This is different from the Baseline Care Plan. 


What is required on this specific form?


The Baseline Care Plan Summary provided here is a guide showing the MINIMUM required resident information based on the instructions from the SOM:   State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities Table of Contents (Rev. 11-22-17). Sample goals in quotations are directly from the SOM to kick-off this person-centered form and to remind the clinician that the layman's language should be incorporated in the care plan. Form is a 5-page DOCX file YOU CAN EDIT.


After card payment is processed, download button will appear on the Thank You page.  This is a digital download.


If unable to open file, a different format will be emailed within the next business day. Sorry, no refunds because this is a digital format.


Actual form will not have the large logo watermark.  Images are for sample viewing only.

Baseline Care Plan Summary

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