(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 Outpatient
Diagnostic 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:
How the deficiency will be corrected.
(b) Who will be responsible for correcting
(c) The date the
deficiency will be corrected.
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) Agent. An individual designated in an
advance directive for health care to make a health care decision for the
individual granting the power.
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
(7) Board. The Tennessee
Board for Licensing Health Care Facilities.
(8) Cancer Treatment and Radiation Clinic. A
facility in which the only procedures performed are diagnostic and therapeutic
radiology, chemotherapy and related services.
(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) Cardiac Catheterization. An invasive
procedure in which a transluminal catheter is inserted into the femoral,
internal jugular or antecubital vein and guided through the venous system into
the heart chambers and/or coronary arteries while the patient is under
conscious sedation in order to provide anatomic information on the heart
chambers, coronary arteries, valves, myocardium, and the great
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 imminent.
(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 Nurse
Plan. The formal written plan between the mid-level practitioners and licensed
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.
(15) Commissioner. Commissioner of the
Tennessee Department of Health or his or her authorized
(16) Competent. A
patient who has capacity.
Computerized Tomography. A non-invasive radiological diagnostic procedure that
may or may not include nuclear medical dye.
(18) Conscious Sedation. A drug induced
depression of consciousness during which patients respond purposefully to
verbal commands, either alone or accompanied by light tactile stimulation. No
interventions are usually required to maintain a patient airway, and
spontaneous ventilation is usually adequate. Cardiovascular function is usually
(19) Dentist. A person
currently licensed as such by the Tennessee Board of Dentistry.
(20) Department. The Tennessee Department of
(21) 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.
(22) 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.
(23) 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.
(24) 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.
(25) 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.
(26) Graduate 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.
(27) Guardian. A judicially appointed
guardian or conservator having authority to make a health care decision for an
(28) 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. §
(30) 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 1200-08-35-.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. §
(33) 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.
A patient who has been adjudicated incompetent by a court of competent
jurisdiction and has not been restored to legal capacity.
(35) Individual instruction. An individual's
direction concerning a health care decision for the individual.
(36) 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
(37) Licensed 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 applicable rules and regulations.
(39) Life Threatening or Serious Injury.
Injury requiring the patient to undergo significant additional diagnostic or
Lithotripsy. A technique using extracorporeal shock waves to break up stones
that form in the kidney, bladder, ureters, or gallbladder while monitoring
through x-ray or ultrasound.
Magnetic Resonance Imaging (MRI). A non-invasive diagnostic technique that
produces computerized images of internal body tissues and is based on nuclear
magnetic resonance of atoms within the body induced by the application of radio
(42) Mammography. A
non-invasive radiological procedure used to take pictures of the breasts in
order to diagnose tumors or cysts.
(43) Medical 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
(44) 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.
(45) Medical Staff. An organized body
composed of individuals appointed by the Outpatient Diagnostic Center governing
board. All members of the medical staff shall be licensed to practice in
Tennessee, with the exception of interns and residents.
(46) 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
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.
(48) 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
(49) 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.
N.F.P.A. National Fire Protection Association.
(51) 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
Diagnostic Center. Any facility providing outpatient diagnostic services
(computerized tomography, magnetic resonance imaging, positron emission
tomography, or other imaging technology developed after June 9, 2005 which
provides substantially the same functionality), unless the outpatient
diagnostic services are provided as the services of another licensed healthcare
institution that reports such outpatient diagnostic services on its joint
annual report, or the facility is otherwise excluded from this definition.
Outpatient diagnostic center does not include a physician or dental practice
that is conducted at a location occupied and controlled by one or more
physicians or dentists licensed under Title 63, if the outpatient diagnostic
services are ancillary to the specialties of the physicians' practice or are
provided primarily for persons who are patients of the physicians or dentists
in the practice for purposes other than outpatient diagnostic services.
Outpatient diagnostic centers in existence prior to the effective date of this
rule will be required to obtain licensure by the department of health and
comply with relevant reporting requirements.
(53) 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.
(54) Percutaneous Transluminal Coronary
Angioplasty. An invasive diagnostic procedure in which a transluminal catheter
is guided through the femoral, subclavian, internal jugular or antecubital vein
allowing the passage of a balloon-tipped catheter distally into the coronary
artery while viewing through radiological pictures. The balloon is aligned
within the stenosis and inflated to dilate the vessel with or without the use
of anticoagulants to reduce the incidence of thrombosis at the site of balloon
dilation and calcium blockers or nitrates to reduce coronary spasm. Conscious
sedation and local anesthesia at catheter insertion site are utilized during
(55) Person. An
individual, corporation, estate, trust, partnership, association, joint
venture, government, governmental subdivision, agency, or instrumentality, or
any other legal or commercial entity.
(56) Personally Informing. A communication by
any effective means from the patient directly to a health care
(57) Physician. An
individual authorized to practice medicine or osteopathy under Tennessee Code
Annotated, Title 63, Chapters 6 or 9.
(58) 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.
(60) Positron Emission Tomography
(PET Scan). A non-invasive radiological procedure producing a sectional view of
the body constructed by positron-emission tomography.
(61) 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.
(62) 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.
(64) 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.
(65) Registered Nurse (R.N.). A person
currently licensed as such by the Tennessee Board of Nursing.
(66) Registered Record Administrator (RRA). A
person currently registered as such by the American Medical Records
(67) 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.
(69) Stereotactic Procedure. An invasive
technique utilized for precisely directing the tip of a delicate needle or beam
of radiation in three planes using coordinates provided by medical imaging such
as x-ray or CT scan in order to reach a specific location in the body, eg.
(70) 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
(71) Surrogate. An
individual, other than a patient's agent or guardian, authorized to make a
health care decision for the patient.
(72) 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 advice.
(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.
Vascular Embolization. Therapeutic introduction of various substances into the
circulation to occlude vessels, either to arrest or prevent hemorrhaging, to
devitalize a structure, tumor or organ by occluding its blood supply or to
reduce blood flow to an arteriovenous malformation.