Survey on the Use of Interdisciplinary Teams (IDT) for Unrepresented Residents

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AFL 21-06 From the California Department of Public Health

January 20, 2021

TO: Skilled Nursing Facilities (SNF)

Intermediate Care Facilities (ICF)

SUBJECT: Survey on the Use of Interdisciplinary Teams (IDT) for Unrepresented Residents

AUTHORITY:     Health and Safety Code section 1418.8

​All Facilities Letter (AFL) Summary

This AFL requests SNFs participate in a survey about IDTs and the need for independent patient representatives.

​The California Department of Public Health (CDPH) has developed an eight question survey that will be used to determine the scope of need for independent patient representatives serving as part of IDTs when informed consent is necessary for a medical intervention on behalf of a resident with diminished cognitive capacity who lacks a legally recognized healthcare decision maker.


Health and Safety Code 1418.8 authorizes an IDT at a SNF or ICF to make treatment decisions for unrepresented residents. “Unrepresented residents” are those residents who are unable to provide informed consent, due to diminished cognitive capacity, and lack a surrogate decision maker to provide informed consent.

The IDT must oversee the care of the resident using a team approach for assessment and care planning, and must include the resident’s attending physician, a registered professional nurse with responsibility for the resident, other appropriate staff in disciplines as determined by the resident’s needs, and, where practicable, a patient representative, in accordance with applicable federal and state requirements. A “patient representative” is independent of the facility and represents the resident who is unable to provide informed consent and who lacks designated friends and family to receive information and make determinations about necessary medical procedures.


Please take a few minutes to complete the survey as accurately as possible and submit before January 28, 2021. If you have any questions about the survey, please email  


Original signed by Heidi W. Steinecker

Heidi W. Steinecker
Deputy Director