---
kind: "section"
citation: "42 C.F.R. § 483.30"
title: "42"
number: "483.30"
heading: "Physician services."
url: "https://uscodex.org/cfr/42/483.30"
---

# §483.30. Physician services.


A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician. A physician, physician assistant, nurse practitioner, or clinical nurse specialist must provide orders for the resident's immediate care and needs.

- (a) **Physician supervision.** The facility must ensure that—
  - (1) The medical care of each resident is supervised by a physician; and
  - (2) Another physician supervises the medical care of residents when their attending physician is unavailable.
- (b) **Physician visits.** The physician must—
  - (1) Review the resident's total program of care, including medications and treatments, at each visit required by [paragraph (c)](#c) of this section;
  - (2) Write, sign, and date progress notes at each visit; and
  - (3) Sign and date all orders with the exception of influenza and pneumococcal vaccines, which may be administered per physician-approved facility policy after an assessment for contraindications.
- (c) **Frequency of physician visits.**
  - (1) The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.
  - (2) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.
  - (3) Except as provided in paragraphs [(c)(4)](#c-4) and (f) of this section, all required physician visits must be made by the physician personally.
  - (4) At the option of the physician, required visits in SNFs after the initial visit may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with [paragraph (e)](#e) of this section.
- (d) **Availability of physicians for emergency care.** The facility must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency.
- (e) **Physician delegation of tasks in SNFs.**
  - (1) Except as specified in [paragraph (e)(4)](#e-4) of this section, a physician may delegate tasks to a physician assistant, nurse practitioner, or clinical nurse specialist who—
    - (i) Meets the applicable definition in [§ 491.2](/cfr/42/491.2.md) of this chapter or, in the case of a clinical nurse specialist, is licensed as such by the State;
    - (ii) Is acting within the scope of practice as defined by State law; and
    - (iii) **Is under the supervision of the physician.**
  - (2) A resident's attending physician may delegate the task of writing dietary orders, consistent with [§ 483.60](/cfr/42/483.60.md), to a qualified dietitian or other clinically qualified nutrition professional who—
    - (i) Is acting within the scope of practice as defined by State law; and
    - (ii) **Is under the supervision of the physician.**
  - (3) A resident's attending physician may delegate the task of writing therapy orders, consistent with [§ 483.65](/cfr/42/483.65.md), to a qualified therapist who—
    - (i) Is acting within the scope of practice as defined by State law; and
    - (ii) **Is under the supervision of the physician.**
  - (4) A physician may not delegate a task when the regulations specify that the physician must perform it personally, or when the delegation is prohibited under State law or by the facility's own policies.
- (f) **Performance of physician tasks in NFs.** At the option of the State, any required physician task in a NF (including tasks which the regulations specify must be performed personally by the physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility but who is working in collaboration with a physician.

## Notes

### Amendments

[56 FR 48875, Sept. 26, 1991, as amended at 67 FR 61814, Oct. 2, 2002. Redesignated and amended at 81 FR 68861, Oct. 4, 2016]

### Source

Source: 54 FR 5359, Feb. 2, 1989, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1320a-7, 1395i, 1395hh and 1396r.

### Amendments

[56 FR 48875, Sept. 26, 1991, as amended at 67 FR 61814, Oct. 2, 2002. Redesignated and amended at 81 FR 68861, Oct. 4, 2016]