CMS SOM App. A, Tag A-0170

physician did not order the restraint or seclusion.

Interpretive Guidelines §482.13(e)(7)

The attending physician is the MD/DO who is responsible for the management and care of the patient.

Hospital medical staff policies determine who is considered the attending physician. The intent of this

requirement is to ensure that the physician who has overall responsibility and authority for the

management and care of the patient is aware of the patient’s condition and is aware of the restraint or

seclusion intervention. It is important to consult with the attending physician to promote continuity of

care, to ensure patient safety, and to elicit information that might be relevant in choosing the most

appropriate intervention for the patient. The attending physician may have information regarding the

patient’s history that may have a significant impact on the selection of a restraint or seclusion

intervention or an alternative intervention, and the subsequent course of treatment. Therefore,

consultation should occur as soon as possible. Hospital policies and procedures should address the

definition of “as soon as possible” based on the needs of their particular patient population(s). However,

any established time frames must be consistent with “as soon as possible.”

The hospital CoPs do permit the patient to be under the care of a treating LIP other than a physician.

Section 482.12(c)(1) requires every Medicare patient to be under the care of

a doctor of medicine or osteopathy; or, within the scope of their respective licenses, a doctor of dental

surgery or dental medicine, a doctor of podiatry, chiropractor, or clinical psychologist. The individual

overseeing the patient’s care may be the attending physician or a health professional practicing with the

delegated authority or supervision of a doctor of medicine or osteopathy as permitted by State law and

hospital policy.

When the attending physician of record is unavailable, responsibility for the patient must be delegated to

another physician, who would then be considered the attending physician.

This provision does not specify that consultation with the attending physician be face-to-face. The

consultation can occur via telephone.

Survey Procedures §482.13(e)(7)

• Review the patient’s medical record for documentation that the attending physician was notified

immediately if the attending physician did not order the restraint or seclusion. Was the attending

physician notified “as soon as possible?”

• Review the hospital’s policies and procedures regarding consultation with the attending physician if

the attending physician did not order the restraint or seclusion.

• Interview staff to determine if actual practice is consistent with written hospital policies and

procedures.