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individual program plan as part of the interdisciplinary team process either in person or

through written report to the interdisciplinary team.

Guidance §483.460(b)(2)

The need for physician participation on an individual client’s IPP team is determined by the

medical needs of the client. How the physician participates (whether through written report,

telephone consultation, attendance at the meeting, etc.) is to be left to the discretion of the

facility. In instances where a client has no overriding medical issues, the nurse of the facility can

represent the medical component on the IDT process or consult with the appropriate physician

and share the information with the team. However, in situations where a client’s medical

condition is unstable/fragile to the extent that it impacts the training/work that may be planned,

the physician must participate in providing guidance on the types and extent of programs that

would be appropriate considering the client’s physical/medical limitations.

If a client is noted to be having difficulty participating in the objectives set forth in his/her IPP

due to serious medical concerns, review the input that was provided by the physician into the

development of the plan and whether the IPP team requested such input.

(c) Standard: Nursing services