Facility Standards For Accreditation-Books Pdf

Facility Standards for Accreditation
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The American Academy of Sleep Medicine AASM developed Standards for Accreditation with the. primary purpose of ensuring that the highest quality of care is delivered to patients with sleep disorders The. constant evolution of sleep medicine necessitates an update to the AASM Standards for Accreditation to reflect the. models of clinical practice that have emerged in recent years. New research policy and technology are shifting the field toward comprehensive patient management. Accreditation of entities that offer diagnostic testing and comprehensive management for sleep disorders is. increasingly important as care focuses on improving population health and engaging patients while containing costs. As such comprehensive sleep facilities must have the capability to provide patient management and testing related. to all sleep disorders, Sleep facility is used specifically to refer to sleep centers that comprise both a clinic where patient. evaluation and management occurs and a laboratory where diagnostic testing is administered through in center. sleep studies and home sleep apnea testing HSAT The clinic and laboratory may be housed in separate locations. By meeting these Standards for Accreditation sleep facilities accredited by the AASM are accredited for all types of. sleep testing including in center polysomnography PSG Multiple Sleep Latency Testing MSLT Maintenance of. Wakefulness Testing MWT and HSAT,High Quality Patient Care and Management. All qualified sleep medicine physicians and providers must be committed to providing quality patient care. Patients benefit greatly from direct personal interaction with the diagnosing treating physician and other center staff. providers It is therefore the general position of the AASM that in ideal circumstances all patients evaluated and. treated in an accredited sleep facility should be seen by a board certified sleep physician or medical staff member. prior to testing and the initiation of treatment In appropriate instances sleep facilities also may use telemedicine. tools in the provision of sleep medicine services to expand interactions between sleep physicians and sleep patients. However the AASM recognizes that patient consultations may be restricted by some health plans or. prevented by a variety of other reasonable and unavoidable circumstances Every effort should be made to manage. these conditions in the best interests of the patient and in a way that promotes high quality care It is the. recommendation of the AASM that a sleep facility should include in its policies a description of any circumstances. that prevent patient consultations,Clinical Recommendations. The AASM uses a rigorous evidence based process to establish practice guidelines on a variety of topics. that are relevant to the practice of sleep medicine Accredited sleep facilities must adopt and follow all STRONG. and STANDARD level recommendation statements in all active AASM Clinical Practice Guideline Practice. Parameter Clinical Guideline and Best Practice Guide papers In addition it is recommended that accredited entities. adopt and follow all other recommendation statements i e Good Practice WEAK GUIDELINE OPTION and. CONSENSUS level recommendations in all active AASM Clinical Practice Guideline Practice Parameter Clinical. Guideline and Best Practice Guide papers It is also recommended that accredited sleep facilities follow applicable. AASM Consensus and Position Statements,Clinical Judgement. The AASM recognizes that the practice of sleep medicine like all other medical disciplines is dynamic. and complex requiring clinical judgment AASM Clinical Practice Guidelines Practice Parameters and Clinical. Guidelines are not designed to limit physicians from using their medical judgment Therefore unique circumstances. may require deviation from AASM clinical recommendations for the appropriate evaluation and management of. select patients However in such instances the AASM accredited facility is expected to keep documentation on file. that provides justification for the deviation in standard clinical practice. Compliance, Facilities accredited by the AASM must be in compliance with all accreditation standards at the time of.
application and throughout the accreditation period If it is determined in the application review process that a. facility is not in compliance with the required standards the application will be returned and the facility will need to. resubmit its application once the required standards are met The AASM reserves the right to revoke accreditation. for facilities that are found to be non compliant with the Standards for Accreditation during the period of. accreditation, Denial of accreditation will be recommended by the site visitor reviewers accreditation committee or staff. when one or more of the following conditions are identified. 1 The facility fails to meet any of the accreditation standards that are indicated as MANDATORY. Facilities will not be issued provisos for accreditation standards indicated as MANDATORY If. granted accreditation with provisos the facility receives a letter that describes certain stipulations that. must be met by a specified deadline to retain accreditation. 2 The facility is determined to be non compliant with more than ten 10 non mandatory accreditation. 3 The facility fails to resolve provisos within the period of time allotted to correct the provisos. 4 The AASM has evidence that the facility submitted falsified documents or misrepresented information. in seeking to achieve or retain accreditation,Disclaimer. The AASM is one of multiple bodies that offer accreditation to entities that offer sleep medicine services. Accreditation by the AASM is a voluntary program offered to sleep facilities that meet the standards contained in. this document The AASM reserves the right to modify add or remove accreditation standards at its own discretion. and without notice In addition the AASM reserves the right to interpret the Standards for Accreditation as deemed. appropriate, Facilities accredited by the AASM must comply with all applicable local state and federal laws and. regulations If any law or government regulation conflicts with these Standards for Accreditation the law or. regulation supersedes the accreditation standard,Acknowledgments. The American Academy of Sleep Medicine acknowledges all current and past AASM Accreditation Committee. members and staff who helped develop and evaluate the accreditation standards and recommended updates that were. reviewed and approved by the AASM Board of Directors. American Academy of Sleep Medicine 2510 North Frontage Road Darien IL 60561 1511. Voice 630 737 9700 Facsimile 630 737 9790 Email accreditation aasm org. AASM American Academy of Sleep Medicine, AASM The AASM Manual for the Scoring of Sleep and Associated Events Rules.
SCORING Terminology and Technical Specifications,ABMS American Board of Medical Specialties. ABSM American Board of Sleep Medicine, ACGME Accreditation Council for Graduate Medical Education. ADA Americans with Disabilities Act,AED Automated External Defibrillator. AHI Apnea Hypopnea Index,AOA American Osteopathic Association. APRN Advanced Practice Registered Nurse, A STEP Accredited Sleep Technologist Education Program.
BRPT Board of Registered Polysomnographic Technologists. CAAHEP Commission on Accreditation of Allied Health Education Programs. CEC Continuing Education Credit,CME Continuing Medical Education. COARC Commission on Accreditation for Respiratory Care. CPR Cardiopulmonary Resuscitation,CPSGT Certified Polysomnographic Technician. CRT Certified Respiratory Therapist,DME Durable Medical Equipment. HIPAA Health Insurance Portability and Accountability Act. HITECH The Health Information Technology for Economic and Clinical Health Act. HSAT Home Sleep Apnea Test, ICSD International Classification of Sleep Disorders. ISR Inter Scorer Reliability,MSLT Multiple Sleep Latency Test.
MWT Maintenance of Wakefulness Test,NBRC National Board for Respiratory Care. OSA Obstructive Sleep Apnea, OSHA Occupational Safety and Health Administration. PA Physician Assistant,PAP Positive Airway Pressure. PHI Protected Health Information,PSG Polysomnography. QA Quality Assurance,RDI Respiratory Disturbance Index.
REI Respiratory Event Index,RLS Restless Legs Syndrome. RN Registered Nurse,RPSGT Registered Polysomnographic Technologist. RRT Registered Respiratory Therapist,RST Registered Sleep Technologist. AASM Continuing Education Appendix,CME opportunities include. AASM Courses,aasm org events,SLEEP Journal,aasm org clinical resources journals.
Journal of Clinical Sleep Medicine,jcsm aasm org,AASM Online Learning Opportunities. aasm org professional development cme,AASM MOC Modules. aasm org professional development maintenance of certification. CEC opportunities include,AASM ISR Record Review,isr aasm org. AMA PRA Category 1 Credit or equivalent type of continuing education credit accepted maintained by your profession will be. Table of Contents,General Standards,A 1 Facility Director MANDATORY p 6. A 2 Licensing MANDATORY p 6,A 3 Medical Code of Conduct MANDATORY p 6.
A 4 HIPAA Rules and Regulations MANDATORY p 6,B 1 Facility Director MANDATORY p 7. B 2 Facility Director Qualifications MANDATORY p 7. B 3 Facility Director Responsibilities p 8, B 4 Facility Director Continuing Education MANDATORY p 8. B 5 Medical Staff Member MANDATORY p 8,B 6 Medical Staff Member Continuing Education p 9. B 7 Sleep Technicians and Technologists p 9,B 8 Registered Sleep Technologist p 9. B 9 Sleep Technician and Technologist Continuing Education p 10. B 10 Non registered Sleep Technologist p 10,B 11 Scoring Personnel p 10.
B 12 Addressing Problems during HSAT p 11,B 13 Employee Background Checks p 11. Patient Policies,C 1 Patient Acceptance for In center Testing p 11. C 2 Patient Acceptance for Home Sleep Apnea Testing p 11. C 3 Record Review of Direct Referrals p 12,Facility and Equipment. D 1 Permanent Address p 12,D 2 Phone Line p 12,D 3 Signage p 12. D 4 Stationery p 12,D 5 Use of Space p 13, D 6 Testing Bedrooms Physical Characteristics p 13.
D 7 Testing Bedrooms Emergency Care p 13,D 8 Bathrooms p 13. D 9 Handicap Testing Bedroom and Bathroom p 13,D 10 Control Room p 13. D 11 Communication p 13,D 12 Video Recording p 14,D 13 Polysomnographic Equipment p 14. D 14 Home Sleep Apnea Testing HSAT Equipment p 14,D 15 PAP Therapy p 14. Policies and Procedures,E 1 Policy and Procedures Manual p 14.
E 2 Protocols PSG HSAT MSLT MWT and PAP Titration p 15. E 3 Other Protocols p 15,E 4 Pediatric Protocols p 15. E 5 Equipment Maintenance Procedures p 15,Data Acquisition Scoring and Reporting. F 1 Signal Acquisition p 16,F 2 PSG Reports p 16,F 3 HSAT Reports and Interpretation p 16. F 4 Conducting MSLT and MWT p 16,F 5 PSG Scoring p 16. F 6 Computer assisted Scoring p 16,F 7 Inter scorer Reliability p 16.
F 8 Diagnosis of Sleep Disorders p 17,F 9 Subcontracting HSAT p 17. F 10 Subcontracting Scoring p 17,Patient Evaluation and Care. G 1 Patient Management MANDATORY p 18,Patient Records. H 1 Medical Records p 18,H 2 PAP Assessment p 18,H 3 Storage p 19. Emergency Procedures,I 1 Emergency Plan p 19,I 2 HSAT Emergency Procedure p 19.
I 3 Emergency Drills p 19,I 4 Emergency Equipment p 20. Quality Assurance,J 1 Quality Assurance Program p 20. J 2 Quality Improvement p 20,K 1 Facility Safety p 20. K 2 Occupational Safety p 21,K 3 Hazardous Materials p 21. K 4 Patient Safety Risk Analysis p 21, K 5 Patient Safety Related Significant Adverse Events p 21.
K 6 Analysis of Significant Adverse Events p 22, K 7 Safety Risks Unique to In center Sleep Testing p 22. Patients Rights,L 1 Patients Rights p 22,A General Standards. Facilities accredited by the AASM are considered qualified to perform all testing related to all sleep disorders. listed in the current version of the International Classification of Sleep Disorders This includes but is not. limited to in center polysomnography MSLT MWT and HSAT. A 1 Facility Director MANDATORY, Facilities must appoint a facility director who is board certified in sleep medicine as defined in Standard B 2 by. the ABSM a member board of the ABMS or a member board of the AOA and who may be a MD DO or PhD See. Standards B 1 through B 4 for additional requirements. A 2 Licensing MANDATORY,1 Facility License, Facilities must maintain a valid state license to provide health care services If a valid state license is not. required by applicable law the facility may submit a certificate of occupancy and or permit to provide. health care services If no license certificate or permit is required by applicable law the facility director. must submit a written attestation that the above is not required. 2 Individual Licensure, All professional staff including MDs DOs PhDs APRNs PAs and RNs and technical staff including.
RRTs RSTs RPSGTs and non registered technologists must maintain valid unrestricted licenses. commensurate with the services they perform in the state s where patients are seen when required by state. law Each staff member must practice within the limits of his or her license The AASM neither sanctions. nor defends individuals practicing outside the scope of their license Privileges and restrictions of licenses. are contained in the practice act related to each license. A 3 Medical Code of Conduct MANDATORY, Facilities and their physician staffs are required to follow the current opinions in the Code of Medical Ethics of the. American Medical Association Council on Ethical and Judicial Affairs The facility must have the ability to easily. access the Code of Medical Ethics,A 4 HIPAA Rules and Regulations MANDATORY. 1 Facilities are required to abide by all current applicable Health Insurance Portability and Accountability. Act HIPAA and the Health Information Technology for Economic and Clinical Health HITECH. rules and regulations, 2 Facilities must operate under written policies that govern the practice of maintaining the confidentiality of. Protected Health Information PHI It is the responsibility of the facility director that these policies are. in place Written policies must address the importance of protecting PHI Protecting PHI must be the. responsibility of all personnel employed by the facility and all employees must attest to their awareness. that federal and state privacy laws along with any additional privacy rules protect PHI Except as. permitted by law personnel shall not share any PHI with any party including but not limited to other. health care providers health care institutions DME companies employers or payers. 3 Facility policies shall reflect that patients have a right to. Review a privacy notice to inform them how PHI will be used and disclosed. Request that uses and disclosures of PHI be restricted facilities are not required to agree to. the restrictions,Inspect copy and amend their medical records and. Get an accounting of the disclosure of their PHI, 4 The facility director is responsible for ensuring that all appropriate personnel are trained regarding HIPAA.
regulations and that patients are informed of their rights under HIPAA including the unauthorized. solicitation of PHI by any person or company through distribution of privacy practices notices Proof of. training shall be maintained by the facility, 5 The facility director must promptly notify all appropriate parties including but not limited to a hospital. compliance officer attorney or other appropriate office within a hospital of any HIPAA violations. Facilities must have or operate under written privacy breach notification policies and procedures which. outline the processes to determine whether there has been the acquisition access use or disclosure of PHI. in a manner not permitted under the HIPAA regulations which compromise the security or privacy of the. PHI Breach If it is determined there is more than a low probability that PHI is compromised. notification shall be made in accordance with applicable law. B Personnel,B 1 Facility Director MANDATORY, Facilities must designate a single facility director who is board certified as defined in Standard B 2 in sleep. medicine by the ABSM a member board of the ABMS or a member board of the AOA The facility director must be. an unrestricted licensed physician or a PhD See Standard A 1. B 2 Facility Director Qualifications MANDATORY, The designated facility director must be a sleep specialist who meets one of the following requirements. 1 A physician or PhD who is board certified in sleep medicine by the ABSM or a physician certified in sleep. medicine by either a member board of the ABMS or a member board of the AOA. 2 A physician who has completed a 12 month ACGME accredited or AOA accredited fellowship in sleep. medicine is eligible to sit for the sleep medicine board examination and is awaiting the first available. opportunity to apply to an ABMS member board or AOA member board to sit for the sleep medicine. examination To retain accreditation the ABMS or AOA examination in sleep medicine must be passed. within two consecutive examination cycles,B 3 Facility Director Responsibilities. The facility director, 1 Is responsible for serving as primary contact or designating a primary contact for the AASM and.
apprising the AASM of any changes to the facility, 2 Is responsible for ensuring there is a process for determining that only licensed health care. professionals with prescriptive authority in the state where the patient would be tested can request a. 3 Is responsible for the qualifications of all medical and technical personnel. 4 Is responsible for the supervision and oversight of facility professional and technical staff. 5 Is responsible for assuring staff complies with the Code of Medical Ethics as well as any institutional. ethics requirements, 6 Must provide direct and ongoing oversight of the testing protocols and the quality of testing including. the proper operation and calibration of the equipment. 7 Must review report and manage the facility s quality assurance program on a quarterly basis as. mandated in Section J, 8 It is recommended that the facility director spend a minimum of 8 hours per month fulfilling the above. responsibilities The facility director may fulfill this requirement by either physical presence in the. center and or regular conference calls virtual meetings and webinars with the professional and. technical staff, B 4 Facility Director Continuing Education MANDATORY. The facility director must earn at least 30 credits averaged 10 credits per year over the past 36 months of AMA. PRA Category 1 CME credit in sleep medicine Compliance with CME requirements must be documented See. appendix for CME opportunities, Physicians recently completing a sleep medicine fellowship or initial board certification in sleep medicine will have.
the CME requirement waived for 36 months from the end date of the program. B 5 Medical Staff Member MANDATORY, Sleep facilities whose facility director is not an appropriately licensed physician must have at minimum. one physician MD or DO medical staff member with a valid unrestricted license in the state where the. center is located Sleep facility medical staff members include physicians licensed psychologists APRN. all of whom may or may not be board certified in sleep medicine and physician assistants who hold a. valid unrestricted state license in states where patients are evaluated diagnosed or treated The AASM. recommends medical staff members be board certified in sleep medicine. B 6 Medical Staff Member Continuing Education, Medical staff members must earn at least 30 credits averaged 10 credits per year over the past 36 months of AMA. PRA Category 1 CME credit in sleep medicine Compliance with CME requirements must be documented. Medical staff members who have completed a formal training program within the previous 12 months will have their. credit requirements waived Upon completion of a training program the applicable continuing education. requirement in sleep medicine will be prorated based on the end date of the program Education sessions conducted. at the facility are acceptable for fulfilling this standard provided the session has defined educational objective s and. attendance is documented by a roster signed by the facility director See appendix for additional CME opportunities. The AASM has adopted job descriptions that delineate the education training and responsibilities. of sleep technologists sleep technicians and sleep technician trainees All sleep. technologists technicians must be able to perform the duties listed in the AASM approved job. descriptions Standards B 7 through B 11 address requirements for sleep technologists technicians. and trainees These standards do not differentiate between the various job descriptions or titles that. facilities may use for the employment of sleep technicians and technologists For example. a sleep technologist or technician whose primary responsibility is to score a sleep study is subject to. the same accreditation standards as a sleep technologist or technician whose primary responsibility. is sleep test monitoring Specifically CPR certification is required for all facility technical staff. members regardless of their duties,B 7 Sleep Technicians and Technologists. 1 Facilities must maintain appropriately trained supervised and where required by state law licensed. sleep technologists Technologist staffing at facilities must be adequate to address the workload of the. facility and assure the safety of patients The AASM recommends a patient to technologist ratio of 2 1. under usual circumstances for attended PSG at facilities. 2 Facilities must maintain appropriately trained supervised and where required by law licensed. personnel It is the responsibility of the facility director to ensure that training is provided and. documented for technical personnel, 3 Technical staff must be trained on the proper use of HSAT devices including. Device operations application of sensors use maintenance warnings and safety. Instruction of patients in the use of HSAT devices. Troubleshooting of HSAT problems and,Infection control.
B 8 Registered Sleep Technologist, Facilities must employ at least one sleep technologist that is registered in sleep technology or accepted to sit for the. registry examination through one of the following organizations. 1 American Board of Sleep Medicine ABSM,a Registered Sleep Technologist RST. 2 National Board for Respiratory Care NBRC, a Registered Respiratory Therapist Sleep Disorder Specialist RRT SDS. 3 Board of Registered Polysomnographic Technologists BRPT. a Registered Polysomnographic Technologist RPSGT, 4 Another organization that offers an equivalent examination accepted by the AASM. The registry exam must be passed within one year from acceptance to sit for the examination The individual s. fulfilling this standard must be present at the facility at least 30 hours per week If the facility is open fewer than 40. hours per week then the registered technologist s must be present at the facility for 75 of operating hours. A facility that loses its sole registered technologist will have 120 days to fulfill this standard. B 9 Sleep Technician and Technologists Continuing Education. All technical staff must participate in at least 30 credits averaged 10 credits per year over the past 36 months of. sleep related continuing education credits This must be documented for each technical staff member Education. sessions conducted at the facility are acceptable for fulfilling this standard provided the session has defined. educational objective s and attendance is documented by a roster signed by the facility s facility director. Each sleep technician and technologist must have valid CPR certification that includes skills training. B 10 Non Registered Sleep Technologist, All technologists and technicians conducting sleep testing who are not registered by the ABSM BRPT or NBRC.
as defined in Standard B 8, 1 Must be enrolled in or have completed the A STEP Online Self Study Modules Non registered. technologists and technicians must complete A STEP Online Self Study Modules within two years of. enrollment, 2 Must be enrolled in or have completed training in polysomnography in a program accredited by the. Commission on Accreditation of Allied Health Education Programs CAAHEP or a Commission on. Accreditation for Respiratory Care CoARC program with the polysomnography option. B 11 Scoring Personnel, Scoring personnel must be one of the following RST RPSGT CPSGT respiratory therapists with the sleep. disorders specialist certification either CRT SDS or RRT SDS or medical staff members PhDs board certified in. sleep medicine as defined in Standard B 2 Non registered sleep technologists as defined in Standard B 10 may. score only under the supervision of one of the above while adhering to Standard B 10. 10 P a g e,B 12 Addressing Problems during HSAT, 1 The facility must have and comply with a written protocol that provides on call coverage to address. problems encountered during HSAT, 2 All patient and technical problems encountered during testing hours must be documented in a secure log.
Quarterly audits must be conducted of these logs to identify trends related to device sensor or service. B 13 Employee Background Checks, The facility shall comply with all background check requirements which may be required by federal state or local. law In the absence of such requirements the facility shall conduct criminal background checks of all new. employees The facility shall utilize information obtained in this process only to the extent such information is. relevant to the job duties of a particular person,C Patient Policies. C 1 Patient Acceptance for In center Testing, Facilities must maintain a Policy and Procedures Manual that addresses patient acceptance policies for in center. testing Written policies for patient acceptance must include. Adherence to all applicable current AASM guidelines. Age limitations,A mechanism for acceptance,Evidence based criteria for exclusion and. Information required from a referring health care provider prior to all sleep testing. Facilities must demonstrate their acceptance and testing of patients with the full spectrum of sleep diagnoses as. delineated by the current edition of the International Classification of Sleep Disorders The testing portion of this. standard can be met by providing a list of diagnoses or tests performed over a period of at least six months. C 2 Patient Acceptance for HSAT, Facilities must maintain a Policy and Procedures Manual that addresses evidence based patient acceptance policies.
for HSAT Written policies for patient acceptance must include. Adherence to all applicable current AASM guidelines If the AASM guidelines are not used as in the case. of insurance mandate or medical exception then a written protocol explaining acceptance criteria. 11 P a g e, rationale and follow up procedure on negative tests and positive tests must be in place. Age limitations,A mechanism for acceptance,Evidence based criteria for exclusion and. Information required from a referring health care provider prior to all sleep testing. C 3 Record Review of Direct Referrals, For patients directly referred the facility director or appropriately licensed medical staff member must review the. information provided for each patient and determine if the requested test is indicated according to Standard C 1 C 2. Evidence of communication with the referring clinician should be recorded in the patient record for every PSG or. HSAT This should include a history and physical received from the referring clinician and a sleep study report sent. back to the referring clinician,D Facility and Equipment. D 1 Permanent Address,Facilities must have a permanent physical address.
D 2 Phone Line, Facilities including both the clinical and laboratory settings if they are separate must have a phone to receive. incoming or make outgoing calls Facilities must have immediate communications access to emergency services. medical fire and security,D 3 Signage, Facilities must have signage on the outside of the facility or in a directory identifying the facility. D 4 Stationery, Facilities must have paper or electronic professional stationery that includes the name and or address and phone. number of the facility For hospital based facilities this standard will be met provided the facility is located on the. site carrying the primary address listed on the hospital s stationery. 12 P a g e,D 5 Use of Space, Accreditation is granted to a single facility generally defined by a physical space used primarily for conducting. sleep testing All of the elements required to conduct sleep tests must be available within the defined testing space. The administrative office s and or staff clinician office s of the facility may be separate from the laboratory testing. D 6 Testing Bedrooms Physical Characteristics, All testing bedrooms must be single occupancy private comfortable and quiet have hard floor to ceiling walls and.
a privacy door that opens directly to a corridor or common use area such that the patient can access the testing. bedroom without having to pass through another testing bedroom Caregivers staying overnight at the facility must. have a space to sleep e g recliner cot,D 7 Testing Bedrooms Emergency Care. Patient testing bedrooms must not have any impediments to the delivery of emergency care The patient testing. 1 Must be of sufficient size to accommodate emergency personnel access with a minimum of 24 inches. of available clear space on three sides of the bed. 2 Must include a testing bed with a mattress not smaller than a standard hospital bed. D 8 Bathrooms, The facility must have clean bathrooms with a minimum ratio of one bathroom for every three testing rooms these. bathrooms must each contain a toilet and a sink Each bathroom must have a working privacy door Sole access to a. shared bathroom shall not be through a testing bedroom. D 9 Handicap Testing Bedroom and Bathroom, At least one testing bedroom and bathroom at each facility must be handicap accessible as defined by local building. regulations and the Americans with Disabilities Act ADA. D 10 Control Room, The dimensions of the control room must not be less than 40 square feet total or 20 square feet per testing bedroom. whichever is larger,D 11 Communication, The facility must maintain a two way communication system between the patient bedroom and the control room.


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