(1) Abuse. The willful infliction of injury,
unreasonable confinement, intimidation or punishment with resulting physical
harm, pain or mental anguish.
Acceptable Plan of Correction. The Licensing Division approves an Ambulatory
Surgical Treatment Center's plan to correct deficiencies identified during an
on-site survey conducted by the Survey Division or its designated
representative. The plan of correction shall be a written document and shall
provide, but not limited to, the following information:
(a) How the deficiency will be
(b) Who will be
responsible for correcting the deficiency.
(c) The date the deficiency will be
(d) How the facility
will prevent the same deficiency from re-occurring.
(3) Accredited Record Technician (ART). A
person currently accredited as such by the American Medical Records
(4) Adult. An
individual who has capacity and is at least 18 years of age.
(5) Advance Directive. An individual
instruction or a written statement relating to the subsequent provision of
health care for the individual, including, but not limited to, a living will or
a durable power of attorney for health care.
(6) Agent. An individual designated in an
advance directive for health care to make a health care decision for the
individual granting the power.
Ambulatory surgical treatment center (ASTC). Any institution, place or building
devoted primarily to the maintenance and operation of a facility for the
performance of surgical procedures. Such facilities shall not provide beds or
other accommodations for the stay of a patient to exceed twelve (12) hours
duration, provided that the length of stay may be extended for an additional
twelve (12) hours in the event such stay is deemed necessary by the attending
physician, the facility medical director, or the anesthesiologist for
observation or recovery, but in no event shall the length of stay exceed
twenty-four (24) hours. Individual patients shall be discharged in an
ambulatory condition without danger to the continued well-being of the patients
or shall be transferred to a hospital. Excluded from this definition are the
private physicians' and dentists' office practices. For the purposes of this
rule, those medical and dental offices, facilities, and other settings at which
surgical procedures exclusively are performed are ASTC's and not private office
ASTC's must comply with the following for purposes of these
(a) surgical procedures
performed must be limited to those procedures which are commonly performed on
an inpatient basis in hospitals but may safely be performed in an
(b) if anesthesia is required
for a surgical procedure, it must be local, regional or general anesthesia and
routinely be four (4) hours or less in duration;
(c) surgical procedures that generally result
in extensive blood loss, require major or prolonged invasion of body cavities,
or are considered emergency or life-threatening in nature may not be
The Tennessee Board for Licensing Health Care Facilities.
(9) Cancer Treatment and Radiation Clinic. A
facility in which the only procedures performed are diagnostic and therapeutic
radiology, chemotherapy and related services.
(10) Capacity. An individual's ability to
understand the significant benefits, risks, and alternatives to proposed health
care and to make and communicate a health care decision. These regulations do
not affect the right of a patient to make health care decisions while having
the capacity to do so. A patient shall be presumed to have capacity to make a
health care decision, to give or revoke an advance directive, and to designate
or disqualify a surrogate. Any person who challenges the capacity of a patient
shall have the burden of proving lack of capacity.
(11) Cardiopulmonary Resuscitation (CPR). The
administering of any means or device to support cardiopulmonary functions in a
patient, whether by mechanical devices, chest compressions, mouth-to-mouth
resuscitation, cardiac massage, tracheal intubation, manual or mechanical
ventilators or respirators, defibrillation, the administration of drugs and/or
chemical agents intended to restore cardiac and/or respiratory functions in a
patient where cardiac or respiratory arrest has occurred or is believed to be
(12) Certified Registered
Nurse Anesthetist. A registered nurse currently licensed by the Tennessee Board
of Nursing who is currently certified as such by the American Association of
Laboratory Improvement Act (CLIA). The federal law requiring that clinical
laboratories be approved by the U.S. Department of Health and Human Services,
Health Care Financing Administration.
(14) Collaborative Plan. The formal written
plan between the mid-level practitioners and licensed physician.
(15) Collaborative Practice. The
implementation of the collaborative plan that outlines procedures for
consultation and collaboration with other health care professionals, e.g.,
licensed physicians, mid-level practitioners or nurse midwives.
(16) Commissioner. Commissioner of the
Tennessee Department of Health or his or her authorized
(17) Competent. A
patient who has capacity.
Dentist. A person currently licensed as such by the Tennessee Board of
(19) Department. The
Tennessee Department of Health.
(20) Designated Physician. A physician
designated by an individual or the individual's agent, guardian, or surrogate,
to have primary responsibility for the individual's health care or, in the
absence of a designation or if the designated physician is not reasonably
available, a physician who undertakes such responsibility.
(21) Do-Not-Resuscitate Order (DNR). A
written order, other than a POST, not to resuscitate a patient in cardiac or
respiratory arrest in accordance with accepted medical practices.
(22) Electronic Signature. The authentication
of a health record document or documentation in an electronic form achieved
through electronic entry of an exclusively assigned, unique identification code
entered by the author of the documentation.
(23) Emancipated Minor. Any minor who is or
has been married or has by court order or otherwise been freed from the care,
custody and control of the minor's parents.
(24) Emergency Responder. A paid or volunteer
firefighter, law enforcement officer, or other public safety official or
volunteer acting within the scope of his or her proper function under law or
rendering emergency care at the scene of an emergency.
(25) Gastrointestinal Endoscopy Clinic. A
facility in which the only procedures performed are those related to the
gastrointestinal tract and other endoscopic procedures. This excludes
laparoscopy and limits entry to major body cavities by needle aspiration
(26) General Anesthesia. An
induced state of unconsciousness accompanied by partial or complete loss of
protective reflexes inducing the inability to continually maintain an airway
independently and respond purposefully to physical stimulation or verbal
command, and produced by a pharmacological or non-pharmacological method or a
Registered Nurse Anesthetist. A registered nurse currently licensed in
Tennessee who is a graduate of a nurse anesthesia educational program that is
accredited by the American Association of Nurse Anesthetist's Council on
Accreditation of Nurse Anesthesia Educational Programs and awaiting initial
certification examination results, provided that initial certification is
accomplished within eighteen (18) months of completion of an accredited nurse
anesthesia educational program.
(28) Guardian. A judicially appointed
guardian or conservator having authority to make a health care decision for an
(29) Hazardous Waste.
Materials whose handling, use, storage and disposal are governed by local,
state or federal regulations.
Health Care. Any care, treatment, service or procedure to maintain, diagnose,
treat, or otherwise affect an individual's physical or mental condition, and
includes medical care as defined in T.C.A. §
(31) Health Care Decision. Consent, refusal
of consent or withdrawal of consent to health care.
Health Care Decision-maker. In the case
of a patient who lacks capacity, the patient's health care decision-maker is
one of the following: the patient's health care agent as specified in an
advance directive, the patient's court-appointed guardian or conservator with
health care decision-making authority, the patient's surrogate as determined
pursuant to Rule 1200-08-10-.13
or T.C.A. §
, the designated physician
pursuant to these Rules or in the case of a minor child, the person having
custody or legal guardianship.
Health Care Institution. A health care institution as defined in T.C.A. §
(34) Health Care Provider. A person who is
licensed, certified or otherwise authorized or permitted by the laws of this
state to administer health care in the ordinary course of business or practice
of a profession.
(35) Hospital. Any
institution, place, building or agency represented and held out to the general
public as ready, willing and able to furnish care, accommodations, facilities
and equipment for the use, in connection with services of a physician or
dentist, to one (1) or more non-related persons who may be suffering from
deformity, injury or disease or from any other condition for which nursing,
medical or surgical services would be appropriate for care, diagnosis or
(36) Incompetent. A
patient who has been adjudicated incompetent by a court of competent
jurisdiction and has not been restored to legal capacity.
(37) Individual instruction. An individual's
direction concerning a health care decision for the individual.
(38) Infectious Waste. Solid or liquid wastes
which contain pathogens with sufficient virulence and quantity such that
exposure to the waste by a susceptible host could result in an infectious
(39) Licensed Practical
Nurse. A person currently licensed as such by the Tennessee Board of
(40) Licensee. The person
or entity to whom the license is issued. The licensee is held responsible for
compliance with all applicable rules and regulations.
(41) Life Threatening or Serious Injury.
Injury requiring the patient to undergo significant additional diagnostic or
emergency. A medical condition manifesting itself by acute symptoms of
sufficient severity (including severe pain) such that the absence of immediate
medical attention could reasonably be expected to result in placing the
patient's health in serious jeopardy, serious impairment to bodily functions or
serious dysfunction of any bodily organ or part.
(43) Medical Record. Medical histories,
records, reports, summaries, diagnoses, prognoses, records of treatment and
medication ordered and given, entries, x-rays, radiology interpretations and
other written electronics, or graphic data prepared, kept, made or maintained
in a facility that pertains to confinement or services rendered to patients
admitted or receiving care.
Medical Staff. An organized body composed of individuals appointed by the
ambulatory surgical treatment center governing board. All members of the
medical staff shall be licensed to practice in Tennessee, with the exception of
interns and residents.
Medically Inappropriate Treatment. Resuscitation efforts that cannot be
expected either to restore cardiac or respiratory function to the patient or
other medical or surgical treatments to achieve the expressed goals of the
informed patient. In the case of the incompetent patient, the patient's
representative expresses the goals of the patient.
(46) Mid-Level Practitioner. A registered
nurse licensed in Tennessee who holds a master's degree in a clinical nursing
specialty, national certification through the ANCC or American Academy of Nurse
Practitioners and holds a certificate of fitness to prescribe from the
Tennessee Board of Nursing.
Misappropriation of Patient/Resident Property. The deliberate misplacement,
exploitation or wrongful, temporary or permanent use of an individual's
belongings or money without the individual's consent.
(48) Neglect. The failure to provide goods
and services necessary to avoid physical harm, mental anguish or mental
illness; however, the withholding of authorization for or provision of medical
care to any terminally ill person who has executed an irrevocable living will
in accordance with the Tennessee Right to Natural Death Law, or other
applicable state law, if the provision of such medical care would conflict with
the terms of the living will, shall not be deemed "neglect" for purposes of
(49) N.F.P.A. National
Fire Protection Association.
Nurse Midwife. A person currently licensed by the Tennessee Board of Nursing as
a registered nurse (R.N.) and qualified to deliver midwifery services or
certified by the American College of Nurse-Midwives.
(51) Patient. Includes but is not limited to
any person who is suffering from an acute or chronic illness or injury or who
is crippled, convalescent or infirm, or who is in need of obstetrical,
surgical, medical, nursing or supervisory care.
(52) PALS. Pediatric Advance Life
(53) Person. An
individual, corporation, estate, trust, partnership, association, joint
venture, government, governmental subdivision, agency, or instrumentality, or
any other legal or commercial entity.
(54) Personally Informing. A communication by
any effective means from the patient directly to a health care
(55) Physician. An
individual authorized to practice medicine or osteopathy under Tennessee Code
Annotated, Title 63, Chapters 6 or 9.
(56) Physician Assistant. A person who has
graduated from a physician assistant educational program accredited by the
Accreditation Review Commission on Education for the Physician Assistant, has
passed the Physician Assistant National Certifying Examination, and is
currently licensed in Tennessee as a physician assistant under title 63,
for Scope of Treatment or POST. Written orders that:
(a) Are on a form approved by the Board for
Licensing Health Care Facilities;
(b) Apply regardless of the treatment setting
and that are signed as required herein by the patient's physician, physician
assistant, nurse practitioner, or clinical nurse specialist; and
Specify whether, in the event the patient suffers cardiac or respiratory
arrest, cardiopulmonary resuscitation should or should not be
2. Specify other medical
interventions that are to be provided or withheld; or
3. Specify both 1 and 2.
(58) Podiatrist. A person
currently licensed as such by the Tennessee Board of Registration in
(59) Power of Attorney
for Health Care. The designation of an agent to make health care decisions for
the individual granting the power under T.C.A. Title 34, Chapter 6, Part
(60) Qualified Emergency Medical
Service Personnel. Includes, but shall not be limited to, emergency medical
technicians, paramedics, or other emergency services personnel, providers, or
entities acting within the usual course of their professions, and other
Radiological Technologist. A person currently certified as such by the American
Society of Radiological Technologists.
(62) Reasonably Available. Readily able to be
contacted without undue effort and willing and able to act in a timely manner
considering the urgency of the patient's health care needs. Such availability
shall include, but not be limited to, availability by telephone.
(63) Registered Nurse (R.N.). A person
currently licensed as such by the Tennessee Board of Nursing.
(64) Registered Record Administrator (RRA). A
person currently registered as such by the American Medical Records
(65) Shall or Must.
Compliance is mandatory.
State. A state of the United States, the District of Columbia, the Commonwealth
of Puerto Rico, or a territory or insular possession subject to the
jurisdiction of the United States.
(67) Supervising Health Care Provider. The
designated physician or, if there is no designated physician or the designated
physician is not reasonably available, the health care provider who has
undertaken primary responsibility for an individual's health care.
(68) Surgical Procedure. A manual or
operative method performed by a licensed medical practitioner to treat
diseases, injuries, conditions and/or deformities. (As related to pregnancy
termination, surgical procedure excludes, but is not limited to, PAP smear or
vaginal examinations, ultrasounds, amniocentesis, intramuscular
Technologist. A person who works under supervision to facilitate the safe and
effective conduct of invasive surgical procedures. This individual is usually
employed by a hospital, medical office, or surgical center and supervised
during the surgical procedure according to institutional policy and procedure
to assist in providing a safe operating room environment that maximizes patient
safety by performing certain tasks including, but not limited to:
(a) Preparation of the operating room and the
sterile field for surgical procedures by preparing sterile supplies,
instruments, and equipment using sterile technique;
(b) Preparation of the operating room for
surgical procedures by ensuring that surgical equipment is functioning properly
and safely; and
instruments, equipment or supplies to a surgeon, sponging or suctioning an
operative site, preparing and cutting suture material, holding retractors,
transferring but not administering fluids or drugs, assisting in counting
sponges, needles, supplies, and instruments, and performing other similar tasks
as directed during a surgical procedure.
(70) Surrogate. An individual, other than a
patient's agent or guardian, authorized to make a health care decision for the
(71) Transfer. The
movement of a patient at the direction of a physician or other qualified
medical personnel when a physician is not readily available but does not
include such movement of a patient who leaves the facility against medical
(72) Treating Health Care
Provider. A health care provider who at the time is directly or indirectly
involved in providing health care to the patient.