(a) The LSRH must have a professional health care staff that includes one or more physicians, and may include one or more physician assistants, or advanced practice registered nurses (APRN).(b) Any ancillary personnel are supervised by the professional staff.(c) There shall be a written delineation of functions, qualifications, and patient care responsibilities for all categories of personnel.(d) The LSRH shall maintain documentation of evidence that all personnel are trained prior to treatment of services.(e) The staff shall be sufficient to provide the services essential to the operation of the LSRH.(f) A nurse shall be on duty whenever the LSRH has one or more patients receiving emergency care or observation care.(g) If the LSRH provides outpatient services, the services shall meet the needs of the patients in accordance with acceptable standards of practice.(1) The LSRH shall assign an individual to be responsible for outpatient services.(2) The LSRH shall have appropriate physicians on staff and other professional and nonprofessional personnel available.(3) The physician must:(A) provide medical direction for the LSRH's health care activities and consultation for, and medical supervision of, the health care staff;(B) participate, in conjunction with any physician assistant or nurse practitioner members, in developing, executing, and periodically reviewing the LSRH's written policies governing the services it furnishes;(C) review periodically, in conjunction with any physician assistant or nurse practitioner members, the LSRH patient records, provide medical orders, and provide medical care services to the patients of the LSRH; and(D) review periodically and sign a sample of outpatient records of patients cared for by APRN or physician assistants only to the extent where state law requires record reviews or co-signatures, or both, by a collaborating physician.(h) A physician must be present for sufficient periods of time to provide medical direction, consultation, and supervision for the services provided in the LSRH, and is available through direct radio or telephone communication or electronic communication for consultation, assistance with medical emergencies, or patient referral.(i) The physician assistant, the nurse practitioner, or clinical nurse specialist members of the LSRH staff shall:(1) participate in the development, execution and periodic review of the written policies governing the services the LSRH furnishes; and(2) participate with a physician in a periodic review of the patients' health records.(j) The physician assistant, nurse practitioner, or clinical nurse specialist shall perform the following functions to the extent they are not being performed by a physician:(1) provides services in accordance with the LSRH's policies; and(2) arranges for, or refers patients to, needed services that cannot be furnished at the LSRH, and assures that adequate patient health records are maintained and transferred as required when patients are referred.(k) Whenever a patient is placed in observation care at the LSRH by a nurse practitioner, physician assistant, or clinical nurse specialist, a physician on the staff of the LSRH is notified of the patient's status.(l) When required by law, the quality and appropriateness of the diagnosis and treatment furnished by nurse practitioners, clinical nurse specialists, and physician assistants at the LSRH must be evaluated by a member of the LSRH staff who is a physician or by another physician under contract with the LSRH.(m) The quality and appropriateness of the diagnosis and treatment provided by a physician at the LSRH must be evaluated by one of the following:(1) One Quality Improvement Organization (QIO) or equivalent entity;(2) in the case of distant-site physicians and practitioners providing telemedicine services to the LSRH's patient under an agreement between the LSRH and a distant-site hospital, the distant-site hospital; or(3) in the case of distant-site physicians and practitioners providing telemedicine services to the LSRH's patients under a written agreement between the LSRH and a distant-site telemedicine entity, one QIO or equivalent entity.(n) The LSRH staff shall consider the findings of the evaluation and make the necessary changes as specified in Code of Federal Regulations