This letter informs nursing homes and healthcare facilities of the requirements for physicians to review the resident's total program of care, including medications and treatments, write, sign, and date progress notes at each visit, and sign and date all orders with the exception of influenza and pneumococcal vaccines. The intent of this regulation is to have the physician take an active role in supervising the care of the residents, and progress notes must be written, signed and dated during each physician visit. Facilities must also provide adequate safeguards for rubber stamp signatures, if used. This letter outlines probes, potential tags for additional investigation, and deficiency categorization for violations of this regulation. Nursing homes and healthcare facilities must adhere to these requirements to ensure the highest quality of care for residents.

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