(1) Abuse. The willful infliction of injury,
unreasonable confinement, intimidation or punishment with resulting physical
harm, pain or mental anguish.
Administrator. A person who establishes policies and procedures and is
responsible for the activities of the agency and its staff. This person may be
a physician, registered nurse, therapist, or a person with at least one (1)
year experience in a health or disability related field. The administrator of a
home care organization may serve as both a home health agency and professional
support service agency administrator if both agencies are owned by the same
corporation or legal entity.
Adult. An individual who has capacity and is at least 18 years of
(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) Agency. A home care organization
providing professional support services.
(6) Agent. An individual designated in an
advance directive for health care to make a health care decision for the
individual granting the power.
Board. The Tennessee Board for Licensing Health Care Facilities.
(8) 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 consumer to make health care decisions while having
the capacity to do so. A consumer 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 consumer
shall have the burden of proving lack of capacity.
(9) 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
(10) Clinical Note. A
written and dated notation containing a consumer assessment, responses to
medications, treatments, services, any changes in condition and signed by a
health team member who made contact with the consumer.
(11) Commissioner. The Commissioner of the
Tennessee Department of Health or his or her authorized
(12) Competent. A
consumer who has capacity.
Comprehensive Nursing assessment. An assessment conducted by a registered nurse
which consists of four parts: completion of a Physical Status Review (PSR);
consumer and family history; identification of health concerns, functional
abilities, activities of daily living; and, completion of a head to toe
Any person with a primary diagnosis of mental retardation or developmental
disability served through the Division of Mental Retardation Services or the
Department of Mental Health and Developmental Disabilities in need of nursing,
occupational, physical or speech therapy through a professional support service
(15) Department. The
Tennessee Department of Health.
(16) 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.
(17) 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.
(18) 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.
(19) 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.
(20) Guardian. A judicially appointed
guardian or conservator having authority to make a health care decision for an
(21) 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. §
(23) Health Care Decision. Consent, refusal
of consent or withdrawal of consent to health care.
(24) Health Care Decision-maker. In the case
of a consumer who lacks capacity, the consumer's health care decision-maker is
one of the following: the consumer's health care agent as specified in an
advance directive, the consumer's court-appointed guardian or conservator with
health care decision-making authority, the consumer's surrogate as determined
pursuant to Rule 1200-08-34-.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. §
(26) 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.
instruction. An individual's direction concerning a health care decision for
Support Plan (ISP). The document resulting from a process of person-centered
planning. The ISP describes in detail the person, including his/her vision for
his/her future, preferences, non-negotiables, and other information required to
support the person in daily life. The ISP contains outcomes to be achieved with
the assistance of the person's Circle of Support that relate to the person's
vision for the future. The ISP is written upon a person's enrollment in
Department of Mental Retardation Services and updated thereafter as changes
occur in the individual's life, or at least annually.
(29) 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
(30) Licensed Practical
Nurse. A person currently licensed as such by the Tennessee Board of
(31) Licensee. The person
or entity to whom the license is issued. The licensee is held responsible for
compliance with all rules and regulations.
(32) Life Threatening or Serious Injury.
Injury requiring the consumer 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
consumers. The medical record shall meet the standards established in the
contractual agreement between the state agency financially responsible for
services to individuals with mental retardation or developmental
Inappropriate Treatment. Resuscitation efforts that cannot be expected either
to restore cardiac or respiratory function to the consumer or other medical or
surgical treatments to achieve the expressed goals of the informed consumer. In
the case of the incompetent consumer, the consumer's representative expresses
the goals of the consumer.
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.
(36) 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.
(38) Occupational Therapy Assistant. A person
currently licensed as such by the Tennessee Board of Occupational and Physical
(39) Person. An
individual, corporation, estate, trust, partnership, association, joint
venture, government, governmental subdivision, agency, or instrumentality, or
any other legal or commercial entity.
(40) Personally Informing. A communication by
any effective means from the consumer directly to a health care
(41) Physical Status
Report (PSR). An instrument used by a registered nurse or other designated
professional staff to determine level of risk and define the required health
services and supports.
Physical Therapist. A person currently licensed as such by the Tennessee Board
of Occupational and Physical Therapy Examiners.
(43) 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.
(45) 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.
(47) Plan of Care. Health care
plan resulting from the comprehensive nursing assessment and/or therapy plan
identifying the need for nursing, physical, occupational, or speech therapy for
consumers of professional support services. The plan shall meet the standards
established in the contractual agreement between the state agency financially
responsible for services to individuals with mental retardation or
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 2.
Professional Support Services. Nursing, occupational, physical or speech
therapy services provided to individuals with mental retardation or
developmental disabilities pursuant to a contract with the state agency
financially responsible for such services.
(50) 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
consumer's health care needs. Such availability shall include, but not be
limited to, availability by telephone.
(52) Registered Nurse. A person currently
licensed as such by the Tennessee Board of Nursing.
(53) Shall or Must. Compliance is
(54) Site Code. An
approved location from which the professional support services may be provided
as deemed by the Department of Mental Retardation Services with written notice
provided to the Department of Health by the professional support service agency
for each site code approved for such agency.
(55) Speech 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
(56) 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
(57) 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
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.
(59) Surrogate. An individual, other than a
consumer's agent or guardian, authorized to make a health care decision for the
(60) Treating Health Care
Provider. A health care provider who at the time is directly or indirectly
involved in providing health care to the consumer.