Quarterly Resident Care Plan Review

Structured interdisciplinary review form to update a resident's comprehensive care plan every 90 days, capturing goal status, intervention changes, and resident or representative participation.

Review Period and Administrative Details

• Resident Identifier
  Use the facility's resident ID or chart number. Do not enter SSN.
• Review Date
  Date the quarterly review is completed.
• Review Period Start
  Start date of the 90-day review period.
• Review Period End
  End date of the 90-day review period.
• Disciplines Present
  Select all disciplines that participated in the review.
• Care Plan Type
  Identify the primary care plan area being reviewed.
• Did the resident participate in the review?
• Did a resident representative participate?

Goal Progress Review

• Overall Progress Status
• Goals Reviewed
  Add one entry for each goal reviewed during this quarterly update.
• Goal Status Summary
  Summarize the resident's progress, including objective observations and any measurable changes.

Intervention Changes and Barriers

• Were any intervention changes made?
• Changed Interventions
  Complete this section if interventions were added, removed, or modified.
• Barriers to Progress
• Barrier Details
  Describe any barriers selected above and the plan to address them.
• New Supports Needed
  Document any additional services, referrals, equipment, or monitoring needed.

Resident or Representative Participation

• Resident Preferences or Requests
  Capture any resident or representative preferences that should be reflected in the care plan.
• Concerns Raised
  Summarize concerns discussed during the review and any follow-up needed.
• Education or Updates Provided
  Document any education, explanations, or care plan updates shared with the resident or representative.
• Consent to Care Plan Updates
  Record consent when the resident or representative agrees to the updated plan. If consent is not applicable, document the reason in the notes.

Plan Update, Attestation, and Follow-Up

• Updated Plan Summary
  Summarize the final care plan updates, including any revised goals, interventions, or monitoring.
• Follow-Up Actions
  Add any action items assigned after the review.
• Next Review Due
  Enter the next quarterly review due date.
• Review Completed By
  Name and role of the person completing the review.
• Attestation
  Signature confirming the review was completed and the care plan was updated as documented.