Comment:

Regulation reads that "a participant shall be assumed capable of understanding and exercising these rights and responsibilities unless a physician determines otherwise and documentation is contained in the participant's record."

The physician assesses for general orientation, not for understanding and exercising these rights and responsibilities. The center staff interact with the participant significantly more than the physician and would have a more accurate assessment of capabilities. Orientation and ability to understand and exercise rights can change drastically in between physician visits. 

Recommendation:

Remove this regulation.