CMS SOM App. B, Tag G584

by applicable state laws and regulations and by the HHA's internal policies.

§484.60(b)(4) When services are provided on the basis of a physician or allowed

practitioner’s verbal orders, a nurse acting in accordance with state licensure

requirements, or other qualified practitioner responsible for furnishing or

supervising the ordered services, in accordance with state law and the HHA’s

policies, must document the orders in the patient’s clinical record, and sign, date,

and time the orders. Verbal orders must be authenticated and dated by the

physician or allowed practitioner in accordance with applicable state laws and

regulations, as well as the HHA’s internal policies.

Interpretive Guidelines §484.60(b)(4)

When services are furnished based on a physician or allowed practitioner's verbal order,

the order must be put into writing by personnel authorized to do so by applicable state

laws as well as by the HHA's internal policies. The orders must be signed and dated with

the date of receipt by the nurse or qualified therapist (i.e., physical therapist, speech-language pathologist, occupational therapist, or medical social worker) responsible for

furnishing or supervising the ordered services.

In the absence of a state requirement, the HHA should establish a timeframe for

physician or allowed practitioner authentication, i.e. for obtaining a physician or allowed

practitioner signature for verbal/telephone orders received. The signature may be written

or in electronic form following the requirements of the particular system. A method must

be established to identify the signer.

When verbal orders are added to the plan of care, it is not necessary for the physician or

allowed practitioner to sign an updated plan of care until the patient is recertified.

However, all verbal orders must be authenticated and dated by the physician or allowed

practitioner in accordance with applicable state laws and regulations, as well as the

HHA’s internal policies.