The Greenway Manor I.

“Based on record review and interview, the manager failed to ensure a standardized emergency responder patient information form as described in subsection A of this section, was completed and maintained for two of two residents sampled. The deficient practiced posed a risk as required patient information was not prepared in case of an emergency. Findings include: 1. A review of R1's and R2's medical records revealed documentation of a standardized emergency responder patient information form completed as required by Arizona Revised Statute (A.R.S.) \'a7 36-420.04(A)(1) through (9). However, the following was not included with the documentation: - A copy of R1's and R2's health insurance portability and accountability act (HIPAA) release authoring a receiving hospital to communicate with the adult foster care home. 2. In an interview, E5 reported the E5 was not aware of the need for the HIPAA form requirement. E1 and E5 acknowledged the information required in A.R.S. \'a7 36-420.04 was not prepared in a standardized emergency responder patient information form as required.”