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. Author manuscript; available in PMC: 2019 May 1.
Published in final edited form as: J Am Med Dir Assoc. 2018 Mar 10;19(5):415–421. doi: 10.1016/j.jamda.2018.01.004

Figure 1. Assessment and Care Planning Process in Nursing Homes (Adapted from Resident Assessment Instrument Minimum Data Set Version 3.0).

Figure 1

*Assessment—Taking stock of all observations, information, and knowledge about a resident from all available sources (e.g., medical records, the resident, resident’s family, and/or guardian or other legally authorized representative).

†Decision-making — Determining with the resident (resident’s family and/or guardian or other legally authorized representative), the resident’s physician and the interdisciplinary team, the severity, functional impact, and scope of a resident’s clinical issues and needs.

‡Care Planning—Establishing a course of action with input from the resident (resident’s family and/or guardian or other legally authorized representative), resident’s physician and interdisciplinary team that moves a resident toward resident-specific goals utilizing individual resident strengths and interdisciplinary expertise; crafting the “how” of resident care