(1) Abuse. The willful infliction of injury,
unreasonable confinement, intimidation or punishment with resulting physical
harm, pain or mental anguish.
Adult. An individual who has capacity and is at least 18 years of
(3) 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.
(4) Agent. An individual designated in an
advance directive for health care to make a health care decision for the
individual granting the power.
Birthing Center. Any institution, facility, place or building devoted
exclusively or primarily to the provision of routine delivery services and
postpartum care for mothers and their newborn infants.
(6) Board. The Tennessee Board for Licensing
Health Care Facilities.
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
Resuscitation (CPR). The administering of any means or device to restore or
support cardiopulmonary functions in a patient, whether by mechanical devices,
chest compression, mouth-to-mouth resuscitation, cardiac massage, tracheal
intubation, manual or mechanical ventilators or respirations, 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 imminent.
(9) Certified Nurse Midwife (CNM). A
registered nurse currently licensed as such by the Tennessee Board of Nursing
and certified by the American College of Nurse-Midwives and qualified to
deliver midwifery services.
Certified Professional Midwife (CPM). A North American Registry of Midwives
(NARM) certified midwife, who must have midwifery skills and experience
evaluated and pass written and skills examinations.
(11) Commissioner. The Commissioner of the
Tennessee Department of Health or his or her authorized
(12) Competent. A
patient who has capacity.
Department. The Tennessee Department of Health.
(14) 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.
(15) 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.
(16) 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.
(17) 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.
(18) Guardian. A judicially appointed
guardian or conservator having authority to make a health care decision for an
(19) 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. §
(21) 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 1200-08-24-.12
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. §
(24) 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.
(25) 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, of one (1) or more nonrelated 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
(26) Incompetent. A
patient who has been adjudicated incompetent by a court of competent
jurisdiction and has not been restored to legal capacity.
(27) Individual instruction. An individual's
direction concerning a health care decision for the individual.
(28) 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
(29) Licensee. The person
or body to whom the license is issued. The licensee is held responsible for
compliance with all rules and regulations.
(30) Life Threatening Or Serious Injury.
Injury requiring the patient to undergo significant additional diagnostic or
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.
(32) 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
(33) Member of the
Professional Medical Community. A professional employed by the birthing center
and on the premises at the time of a voluntary delivery.
(34) 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
(35) 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 these rules.
The National Fire Protection Association.
(37) Person. An individual, corporation,
estate, trust, partnership, association, joint venture, government,
governmental subdivision, agency, or instrumentality, or any other legal or
Informing. A communication by any effective means from the patient directly to
a health care provider.
Physician. An individual authorized to practice medicine or osteopathy under
Tennessee Code Annotated, Title 63, Chapters 6 or 9.
(40) 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.
(42) 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
(43) 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
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.
(45) Routine Delivery Services. Services
provided by a physician or a certified professional midwife practicing when
these rules become final or a certified nurse midwife related to the normal,
uncomplicated prenatal course as determined by adequate prenatal care and
prospects for a normal uncomplicated birth as defined by reasonable and
generally accepted criteria of maternal and fetal health, promoting a
family-centered approach to care and viewing pregnancy and delivery as a normal
physiological process requiring limited technological and pharmacological
(46) Shall or Must.
Compliance is mandatory.
Stabilize. To provide such medical treatment of the emergency medical condition
as may be necessary to assure, within reasonable medical probability, that the
condition will not materially deteriorate due to the transfer as determined by
a physician or other qualified medical personnel when a physician is not
(48) 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.
A person currently enrolled in a course of study that is approved by the
appropriate licensing board or equivalent body.
(50) 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.
(51) Surrogate. An individual, other than a
patient's agent or guardian, authorized to make a health care decision for the
(52) Transfer. The
movement of a patient to a hospital 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
(53) Treating Health Care
Provider. A health care provider who at the time is directly or indirectly
involved in providing health care to the patient.
(54) Voluntary Delivery. The action of a
mother in leaving an unharmed infant aged seventy-two (72) hours or younger on
the premises of a birthing center with any birthing center employee or member
of the professional medical community without expressing any intention to
return for such infant, and failing to visit or seek contact with such infant
for a period of thirty (30) days thereafter.