The Paper Trail — What A Hospital Has To Keep, Post, And Report

Check your situation

Answer the questions below. The result shows the rules that turn on your answers, the statutory text behind them, and the facts you still need to confirm yourself.

What to document

A record-keeping aid built from what the law makes relevant.

If you need to escalate

The text, verbatim

Everything above is derived from the text reproduced here. Read it before relying on any summary.

What this page does not cover

• Sec. 489.20(r)(1) states five years for records of transferred individuals. (r)(2) and (r)(3) state no period at all. This page does not supply one. A hospital's own policy, a State retention rule or a CMS survey protocol may set a longer or shorter period, and none of those is in this paragraph. Last verified
• Sec. 489.20(r)(3) requires the log to be kept. It does not say who may read it, whether a patient may have a copy, or whether it is discoverable. The medical record and the central log are different documents and this paragraph does not connect them. Last verified
• Sec. 489.20(q) requires posting "conspicuously" and "in a form specified by the Secretary", and names four locations by way of example. It gives no size, no wording, no language and no test for whether a particular posting satisfies it. Last verified
• Each of these paragraphs is addressed to the hospital as a condition of participation. Sec. 489.20(m) says "to report to CMS or the State survey agency"; it does not name an individual. What a nurse is required to do internally is a matter of employer policy and, in Texas, chapter 258 and chapter 301 — not of this paragraph. Last verified

Other checks

• Screening and stabilising — the orderWhat has to happen when someone arrives at a Medicare hospital's emergency department, what may not happen first, and the one sentence in the section that protects an employee who reports it.
• The transfer itself — three routes, a list of papers, and a nameWhat has to be true before an unstabilized individual is moved: two conditions joined by "and", three routes each producing a different paper, four elements, and a list of records that runs on two clocks — ending with the name and address of a physician who did not come.
• The receiving hospital — what it may not refuse, and what it has to reportThe other end of the transfer: four limits inside one sentence, the definition of capacity that puts qualified staff inside the switch, the two paragraphs that cut against each other, and a reporting duty aimed at the hospital up the road.
• CAH on-duty coverage — 42 CFR 485.631Who has to be available, and who has to be on duty, and when each clock runs.
• Overnight gap — disposition pathwaysA nurse has said no and someone still has to be there. Every option, and what each one rests on.
• Observation status — what has to be said, by when, and who signsTwenty-four hours triggers it and thirty-six hours caps it. Two items the notice has to contain, an oral explanation with no person named, and two signature paths — one of which tells a staff member exactly what to write.
• Inpatient status — who countsTwo paragraphs turn on the word inpatient and neither defines it. The one that does defines it for payment.
• On-call and standby — six textsDefined once in Texas law, banned once as a substitute, and prescribed three times in the federal CAH rules — with a different answer each time.
• Nurse staffing plan — ch. 257The chapter before chapter 258: what a hospital must plan for, what the committee must look like, and the two numbers that must be given at the start of every shift.
• Retaliation — ch. 257 and ch. 258Two anti-retaliation sections that protect different acts, one enforcement bridge shared by both, and the single federal sentence that uses the word the other way.
• After the report — inspection, confidentiality, publicationWho may inspect a hospital and on what basis, whether anyone has to investigate, what stays confidential and from whom, and the two numbers the Texas section gives for publishing the outcome.
• Texas nurse mandatory overtimeCan a hospital require it? Ch. 258 definition, prohibition, four exceptions.
• Chapter 258 complaint — filing and what comes backWhat HHSC must put in the written decision notice, what stays confidential, and what the chapter never says.