Family Interview Form Page 8
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8DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
FAMILY INTERVIEW
Are you notified when [resident’s name]'s treatment is changed?
4)
No
Yes
Participation in Care Plan QP242
Q
Are you invited to participate in [resident’s name]'s care planning
No
1)
conferences?
Yes
N/A, newly admitted resident who has not
yet had a care plan meeting
N/A, interviewee is not designated for
decision making
FORM CMS-20049 (7/2012)
8
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