Observation documentation requires a medical record that contains nursing notes, physician progress notes and discharge summary outlining the outcome of the observation care services, including patient discharge information, transition to admission, or in the condition code 44 circumstance, when the reason for downgrading a patient from admission to observation. Accurately managing observation length of stay time assists determination for advancing a patient’s care to admission or discharging to the community. Calculating length of stay, determining whether a patient has crossed two-midnights are important considerations for determining a patient’s medically necessary condition for hospital admission. Additionally, documentation of the patient’s severity of illness, potential adverse outcomes if the patient is discharge precipitously, and the intensity of services are important characteristics of observation care documentation.