INPATIENT ADMISSION CERTIFICATION NOTE

1. Order

 Inpatient Services is the appropriate status for this patient based on information available at the time  The medical record provides a properly signed inpatient order that is in accordance with Medicare Regulations.

2. Rationale for Inpatient Services & Expectation of Two-Midnights LOS

 Inpatient hospital services are reasonable and necessary for a time period that will at a minimum span two midnights (excludes Medicare services specified as inpatient-only).  Expectation and need for Inpatient Services is based upon complex medical judgment in evaluating the patient, as documented in the medical record (see attending physician's History & Physical or first Progress Note for documentation of presenting signs & symptoms, medical history, comorbidities, risk, and potential adverse outcomes).

3. Estimated Hospital Length of Stay  When necessary, estimated stay beyond the two midnights will be reflected in the physician orders and the patient plan of care.  The patient may reasonably be expected to be discharged or transferred to a PPS hospital within 96 hours after admission to the CAH.  In the event that an unforeseen circumstance occurs, and the patient cannot be transferred or would not be appropriate, the physician’s documentation will reflect the extent of the unforeseen circumstance in the progress note and in the discharge summary

CMS requires that all plans for post-discharge care (i.e., F/U visits, medication instructions, home care, and post-acute care) be documented in the record prior to the signing, dating, and timing of the discharge order.

As the practitioner familiar with the case, I certify all of the above items are/have been addressed with supporting documentation in the medical record:

Physician Signature Date Time