(1) Abuse. The willful infliction of injury,
unreasonable confinement, intimidation or punishment with resulting physical
harm, pain or mental anguish.
Administrator. A person who:
(a) Is a
licensed physician with at least one (1) year supervisory or administrative
experience in home health care, hospice care or related health programs;
(b) Is a registered nurse with
at least one (1) year supervisory or administrative experience in home health
care, hospice care or related health programs; or
(c) Has training and experience in health
service administration and at least one (1) year of supervisory or
administrative experience in home health care, hospice care or related health
(3) Adult. An
individual who has capacity and is at least 18 years of age.
(4) 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.
(5) Agent. An individual designated in an
advance directive for health care to make a health care decision for the
individual granting the power.
Agency. A Home Care Organization providing hospice services.
(7) Bereavement Counselor. An individual who
has at least a bachelor's degree in social work, counseling, psychology,
pastoral care or specialized training or experience in bereavement theory and
(8) Board. The
Tennessee Board for Licensing Health Care Facilities.
(9) 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.
(10) 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
ventilations 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
(11) Certified Master
Social Worker. A person currently certified as such by the Tennessee Board of
Social Worker Certification and Licensure.
(12) Clinical Fellow. A Speech Language
Pathologist who is in the process of obtaining his or her paid professional
experience, as defined by a Communications Disorders and Sciences
Board-approved accreditation agency, before being qualified for
(13) Clinical Note. A
written and dated notation containing a patient assessment, responses to
medications, treatments, services, any changes in condition and signed by a
health team member who made contact with the patient.
(14) Commissioner. The Commissioner of the
Tennessee Department of Health or his or her authorized
(15) Competent. A
patient who has capacity.
Services. Services consisting of nursing, medical social services, physician
services and counseling services.
(17) Department. The Tennessee Department of
(18) 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.
(19) 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.
(20) 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.
(21) 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.
(22) Guardian. A judicially appointed
guardian or conservator having authority to make a health care decision for an
(23) 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. §
(25) Health Care Decision. Consent, refusal
of consent or withdrawal of consent to health care.
(26) 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 1200-08-27-.13 or T.C.A. §
33-3-220, 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. §
(28) 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.
(29) Home Care
Organization. As defined by T.C.A. §
68-11-201, a "home care
organization" provides home health services, home medical equipment services or
hospice services to patients on an outpatient basis in either their regular or
temporary place of residence.
Home Health Aide/Hospice Aide. A person who has completed a total of
seventy-five (75) hours of training which included sixteen (16) hours of
clinical training prior to or during the first three (3) months of employment
and who is qualified to provide basic services, including simple procedures as
an extension of therapy services, personal care regarding nutritional needs,
ambulation and exercise, and household services essential to health care at
(31) Homemaker Service. A
non-skilled service in the home to maintain independent living which does not
require a physician's order. An agency does not have to be licensed as a home
care organization to provide such services.
(32) Hospice Services. As defined by T.C.A.
68-11-201, hospice services means
a coordinated program of care, under the direction of an identifiable hospice
administrator, providing palliative and supportive medical and other services
to hospice patients and their families in the patient's regular or temporary
place of residence. Hospice services shall be available twenty-four (24) hours
a day, seven (7) days a week pursuant to the patient's Hospice plan of care. A
licensed hospice services program may provide services to a non-hospice
patient; provided, that services to a non-hospice patient shall be limited to
palliative care only.
Incompetent. A patient who has been adjudicated incompetent by a court of
competent jurisdiction and has not been restored to legal capacity.
(34) Individual instruction. An individual's
direction concerning a health care decision for the individual.
(35) 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
(36) Licensed Clinical
Social Worker. A person currently licensed as such by the Tennessee Board of
Practical Nurse. A person currently licensed as such by the Tennessee Board of
(38) Licensee. The person
or entity to whom the license is issued. The licensee is held responsible for
compliance with all rules and regulations.
(39) Life Threatening or Serious Injury.
Injury requiring the patient to undergo significant additional diagnostic or
Record. Medical histories, records, reports, clinical notes, summaries,
diagnoses, prognoses, records of treatment and medication ordered and given,
entries and other written electronic or graphic data prepared, kept, made or
maintained in an agency that pertains to confinement or services rendered to
(41) Medical Social
Services. Medical social services must be provided by a qualified social worker
under the direction of a physician, in accordance with the plan of
(42) 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
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.
(44) 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
Therapist. A person currently licensed as such by the Tennessee Board of
Occupational and Physical Therapy Examiners.
(46) Occupational Therapy Assistant. A person
currently licensed as such by the Tennessee Board of Occupational and Physical
The reduction or abatement of pain or troubling symptoms, by appropriate
coordination of all elements of the hospice care team, to achieve needed relief
(48) Patient. Hospice
patient means only a person who has been diagnosed as terminally ill; been
certified by a physician in writing to have an anticipated life expectancy of
six (6) months or less; has voluntarily though self or a surrogate requested
admission to a hospice; and been accepted by a licensed hospice. Patient will
also include a non-hospice patient receiving only palliative care.
(49) 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.
Physical Therapist. A person currently licensed as such by the Tennessee Board
of Occupational and Physical Therapy Examiners.
(52) Physical Therapy Assistant. A person
currently licensed as such by the Tennessee Board of Occupational and Physical
An individual authorized to practice medicine or osteopathy under Tennessee
Code Annotated, Title 63, Chapters 6 or 9.
(54) 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.
(56) 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
(57) 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.
(59) Registered Nurse. A person currently
licensed as such by the Tennessee Board of Nursing.
(60) Respiratory Technician. A person
currently licensed as such by the Tennessee Board of Respiratory
(61) Respiratory Therapist. A
person currently licensed as such by the Tennessee Board of Respiratory
(62) Respite Care. A
short-term period of inpatient care provided to the patient only when necessary
to relieve the family members or other persons caring for the
(63) Shall or Must.
Compliance is mandatory.
Social Work Assistant. A person who has a baccalaureate degree in social work,
psychology, sociology or other field related to social work, and has at least
one (1) year of social work experience in a health care setting. Social work
related fields include bachelor/masters degrees in psychology, sociology, human
services (behavioral sciences, not human resources), masters degree in
counseling fields (psychological guidance and guidance counseling) and degrees
Language Pathologist. As defined in T.C.A. §
63-17-103, a person currently
licensed as such by the Tennessee Board of Communications Disorders and
(66) Spiritual Counselor.
A person who has met the requirements of a religious organization to serve the
constituency of that religious organization.
(67) 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.
(68) Student. A person currently enrolled in
a course of study that is approved by the appropriate licensing board or
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
Authoritative procedural guidance by a qualified person for the accomplishment
of a function or activity with initial direction and periodic inspection of the
actual act of accomplishing the function or activity. Periodic supervision must
be provided if the person is not a licensed or certified assistant, unless
otherwise provided in accordance with these rules.
(71) Surrogate. An individual, other than a
patient's agent or guardian, authorized to make a health care decision for the
(72) Terminally ill. An
individual with a medical prognosis that his or her life expectancy is six (6)
months or less if the illness runs its normal course.
(73) Treating Health Care Provider. A health
care provider who at the time is directly or indirectly involved in providing
health care to the patient.
Volunteer. An individual who agrees to provide services to a hospice care
patient and/or family member(s), without monetary compensation, in either
direct patient care or an administrative role and supervised by an appropriate
hospice care employee.