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Library: Policy

317:30-5-42.7. Emergency department (ED) care/services

Issued 12-1-06

     Emergency department care must:

  • (1) Be provided in a hospital with a designated emergency department; and

  • (2) Provide direct patient care, including patient assessment, monitoring, and treatment by hospital medical personnel such as physicians, nurses, or lab and x-ray technicians.

    • (A) Medical records must document the emergency diagnosis and the extent of direct patient care.

    • (B) Emergency department care does not include unattended waiting time.

    • (C) Emergency services are covered for a medical emergency. This means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

      • (i) Placing the physical or mental health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; or continuation of severe pain;

      • (ii) serious impairment to bodily functions; serious dysfunction of any bodily organ or part; or death.

    • (D) Labor and delivery is a medical emergency, if it meets this definition.

  • (3) Prescheduled services are not considered an emergency.

  • (4) Services provided as follow-up to initial emergency care are not considered emergency services.

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