DHS 75.20(1)(b)2.2. The patient’s date of birth, self-identified gender, and self-identified race or ethnic origin. DHS 75.20(1)(b)3.3. Consent for treatment forms signed by the patient or the patient’s legal guardian, if applicable, that are maintained in accordance with s. DHS 94.03. DHS 75.20(1)(b)4.4. An acknowledgment by the patient or the patient’s legal guardian, if applicable, that the service policies and procedures were explained to the patient or the patient’s legal guardian. DHS 75.20(1)(b)5.5. A copy of the signed and dated patient notification that was reviewed with and provided to the patient or the patient’s legal guardian, if applicable, which identifies patient rights, and explains provisions for confidentiality and the patient’s recourse in the event that the patient’s rights have been abused. DHS 75.20(1)(b)6.6. Results of all screening, examinations, tests, and other assessment information. DHS 75.20(1)(b)7.7. A completed copy of the standardized placement criteria and level of care assessment at admission, and subsequent reviews of level of care placement criteria. DHS 75.20(1)(b)8.8. Treatment plans, including all reviews and updates to the treatment plan. DHS 75.20(1)(b)9.9. Records for any medications prescribed or administered by the service, including any medication consent records required by s. DHS 94.09. DHS 75.20(1)(b)10.10. Copies of any incident reports or documentation of medication errors applicable to the patient. DHS 75.20(1)(b)13.13. Records of any referrals by the service, including documentation that referral follow-up activities occurred. DHS 75.20(1)(b)14.14. Correspondence relevant to the patient’s care and treatment, including dated summaries of relevant telephone or electronic contacts and letters. DHS 75.20(1)(b)15.15. Consents authorizing disclosure of specific information about the patient. DHS 75.20(1)(b)19.19. Documentation of each transfer from one level of care to another. Documentation shall identify the applicable criteria from ASAM or other department-approved placement criteria, and shall include the dates the transfer was recommended and initiated. DHS 75.20(1)(c)(c) For patients that discharge from a service and are subsequently re-admitted, a new case record shall be established for each episode of care. DHS 75.20(1)(e)(e) If the service discontinues operations or is taken over by another service, records containing patient identifying information shall be turned over to the replacement service, as permitted by applicable state and federal confidentiality requirements. DHS 75.20(2)(2) Case records for persons receiving only screening and referral. A treatment service shall have a written policy and procedure regarding case records for individuals that receive only screening, consultation, or referral services. The policy and procedure shall include: DHS 75.20(2)(a)(a) Information to be obtained for phone and in-person screening, consultation, or referral. DHS 75.20(2)(b)(b) Assurance that screening includes an individual’s pregnancy status. DHS 75.20(2)(c)(c) Assurance that screening, consultation, and referral procedures address individual risks and needs. DHS 75.20 HistoryHistory: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22; correction in (1) (a) 3., (b) 3., 9. made under s. 35.17, Stats., Register October 2021 No. 790. DHS 75.21DHS 75.21 Confidentiality. A service shall have written policies, procedures and staff training to ensure compliance with applicable confidentiality provisions of 42 CFR part 2, 45 CFR parts 164 and 170, ss. 51.30, 146.816 and 146.82, Stats., and ch. DHS 92. Each staff member shall sign a statement acknowledging responsibility to maintain confidentiality of personal information about persons served. DHS 75.21 HistoryHistory: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22; correction made under s. 35.17, Stats., Register October 2021 No. 790.