US · guidance
CMS SOM App. A, Tag A-1635
§482.61(b)(5) [Each patient must receive a psychiatric evaluation that must--] Describe
attitudes and behavior;
Interpretive Guidelines §482.61(b)(5)
The medical record should describe behavior(s) that require a change in order for the
patient to function in a less restrictive setting. This may also include behavioral or
relationship difficulties with significant others which require active treatment in order to
facilitate a successful discharge.
Survey Procedures §482.61(b)(5)
• Review the Psychiatric Evaluations in the sample of medical records and verify
that they contain a description of the patient’s attitudes and behaviors.
• Interview patients and family members or others significantly involved with the
patient to determine the patient’s attitudes and behavior are accurately reflected
in the record.
History
Rev. 238; Issued: 03-20-26; Effective: 09-05-25; Implantation: 09-05-25
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
e059cc784e7ac9e0310f7474f5b22a2c7ecdffd6414b4fbf1c09a895cb81b721
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