USE OF ASSESSMENTS FROM REFERRAL FACILITIES
If a client has been referred for treatment from another facility, the results of a physical exam and laboratory tests from the other facility may be documented and used to assess current physical status provided that:
Such physical exam was done within 6 months of admission
There has been no significant change in the physical status of the patient
Further assessments or laboratory tests may be required depending on a medical evaluation of treatment needed, or the client’s changing condition.