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Decision to Admit Patient YES Will treatment exceed >2 midnights? Also consider clinical presentation: Patient History; Comorbidities; the Severity of Signs and Symptoms; Current Medical Needs; Risk of an Adverse Event NO Order "Admit to" Observation Services Utilization Management Review (within 24 hours) Is Observation status appropriate? YES Discharge Patient or UM reassessment next day YES NO   1) Enter "Admit to Inpatient" Order in IMPACT Residents/Fellows; CRNPs/PAs; and RNs* * - RNs per verbal order from attending physician 2) Attending Physician add "Inpatient Admission Auto-Text" to admission H&P. Fill in required fields with pertinent clinical information. 3) Signature of Attending Physician authenticates Inpatient Order and Certification.   UM will send for level of care determination     YES Utilization Management Review (per protocol) Is Inpatient status still appropriate?   Is Inpatient Admission appropriate? NO   NO   UM will send for level of care determination UM contacts physician for change in status correction.