Definitions

(1) Abuse. The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. (2) Administrator. The individual designated by the licensee or the governing body to be the person responsible for the day to day supervision and operation of the PCCC and may be either the licensee or the nursing director. (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. (6) Board. The Tennessee Board for Licensing Health Care Facilities. (7) 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 Amendments filed December 18, 2025; effective March 18, 2026.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. (8) Cardiopulmonary Resuscitation (CPR). The administering of any means or device to restore or support cardiopulmonary function in a child, whether by mechanical devices, chest compressions, 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 child where cardiac or respiratory arrest has occurred or is believed to be imminent. (9) Certified Master Social Worker. A person currently certified as such by the Tennessee Board of Social Worker Certification and Licensure. STANDARDS FOR PRESCRIBED CHILD CARE CENTERS CHAPTER 0720-15 (10) Certified Nurse Practitioner. A person who is licensed as a registered nurse and has further been issued a certificate of fitness to prescribe and/or issue drugs by the Tennessee Board of Nursing. (11) Certified Respiratory Technician. A person currently licensed as such by the Tennessee Board of Respiratory Care. (12) Child or Children. A person or persons under 18 years of age. (13) Child Care. The provision of supervision, protection, and meeting, at a minimum, the basic needs of a child for three (3) or more hours a day, but less than twenty-four (24) hours a day. (14) 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 licensure. (15) Commissioner. The Commissioner of the Tennessee Department of Health or his or her authorized representative. (16) Dentist. A person currently licensed as such by the Tennessee Board of Dentistry. (17) Department. The Tennessee Department of Health. (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) Developmentally Appropriate. As defined by the National Association for the Education of Young Children, developmentally appropriate practice is the use of child development knowledge to identify the range of appropriate behaviors, activities and materials for a specific age group. This knowledge is used in conjunction with understanding about an individual child’s growth patterns, strengths, interests, and experiences to design the most appropriate learning environment. Developmentally appropriate curriculum provides for all areas of a child’s development: physical, emotional, social, and cognitive through an integrated approach. (20) Dietitian. A person currently licensed as such by the Tennessee Board of Dietitian/Nutritionist Examiners. (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. Any situation or condition which presents an imminent danger of death or serious physical or mental harm to children. (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. STANDARDS FOR PRESCRIBED CHILD CARE CENTERS CHAPTER 0720-15 (26) Functional Assessment. An evaluation of the child’s abilities and needs related to self care, communication skills, social skills, motor skills, pre-academic areas, play with toys/objects, growth and development appropriate for age. (27) Group. A specific number of children comprising an age range, assigned to specific staff in an assigned space, which is divided from the space of other groups by a recognizable barrier to define limits and to reduce distractions. (28) Guardian. A judicially appointed guardian or conservator having authority to make a health care decision for an individual. (29) Hazardous Waste. Materials whose handling, use, storage, and disposal are governed by local, state, or federal regulations. (30) 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. § 32-11-103(5). (31) Health Care Decision. Consent, refusal of consent or withdrawal of consent to health care. (32) Health Care Decision-Maker. In the case of an individual who lacks capacity, the individual’s health care decision-maker is one of the following: the individual’s health care agent as specified in an advance directive, the individual’s court-appointed guardian or conservator with health care decision-making authority, the individual’s surrogate as determined pursuant to Rule 0720-15-.12 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. (33) Health Care Institution. A health care institution as defined in T.C.A. § 68-11-1602. (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 of practice of a profession. (35) High School Diploma. As used in the context of staff qualifications, refers to a document recognizing graduation from a legally approved institution, public or private, based on the issuing state’s required number of academic credits, including passing a GED test. As used in this Chapter, a certificate or statement of attendance or similar document, or correspondence or video courses, do not qualify as a high school diploma. (36) Holding Out to the Public. Advertising or soliciting the public through the use of personal, telephone, mail or other forms of communication to provide information about services provided by the facility. (37) Individual Instruction. An individual’s direction concerning a health care decision for the individual. (38) Infant. A child who is six (6) weeks through fifteen (15) months of age. (39) 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 disease. (40) Licensee. The person or entity to whom the license is issued. The licensee is held responsible for compliance with all rules and regulations. STANDARDS FOR PRESCRIBED CHILD CARE CENTERS CHAPTER 0720-15 (41) Licensed Clinical Social Worker. A person currently licensed as such by the Tennessee Board of Social Workers. (42) Licensed Practical Nurse. A person currently licensed as such by Tennessee Board of Nursing. (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 child’s health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part, which includes labor when delivery is imminent, when there is inadequate time to effect safe transfer to a hospital prior to delivery, or when a transfer may pose a threat to the health and safety of the child or the unborn child. (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) 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 certified nurse practitioner or a licensed physician assistant. (47) 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 these rules. (49) N.F.P.A. The National Fire Protection Association. (50) Nursing Director. A licensed registered nurse providing continuous supervision of PCCC services and managing the operations of the facility. (51) Occupational Therapist. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (52) Occupational Therapy Assistant. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (53) Optometrist. A person currently licensed as such by the Tennessee Board of Optometry. (54) Parent. A biological, legal or adoptive parent, guardian, or a legal or physical custodian who has primary responsibility for a child. STANDARDS FOR PRESCRIBED CHILD CARE CENTERS CHAPTER 0720-15 (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 provider. (57) Pharmacist. A person currently licensed as such by the Tennessee Board of Pharmacy. (58) Physical Therapist. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (59) Physical Therapy Assistant. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (60) Physician. An individual authorized to practice medicine or osteopathy under Tennessee Code Annotated, Title 63, Chapters 6 or 9. (61) 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, Chapter 19. (62) Physician Orders 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 (c) 1. Specify whether, in the event the patient suffers cardiac or respiratory arrest, cardiopulmonary resuscitation should or should not be attempted; 2. Specify other medical interventions that are to be provided or withheld; or 3. Specify both 1. and 2. (63) Plan of Care. The comprehensive plan for implementation of medical, nursing, psychosocial, developmental, and educational therapies to be provided upon admission and shall include necessary equipment to meet the child’s need, and the plan will be revised to include recommended changes in the therapeutic plans. The disposition to be followed in the event of emergency situations will be specified in the Plan of Care. (64) Podiatrist. A person currently licensed as such by the Tennessee Board of Registration in Podiatry. (65) 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. (66) Prescribed Child Care Center (PCCC). A nonresidential child care, health care/child care center providing physician prescribed services and appropriate developmental services for six (6) or more children who are medically and/or technology dependent and require continuous nursing intervention. Child care for purposes of this section means the provision of supervision, protection, and meeting the basic needs of children, who are not related to the primary caregivers, for three (3) or more hours a day, but less than twenty-four (24) hours a STANDARDS FOR PRESCRIBED CHILD CARE CENTERS CHAPTER 0720-15 day. As part of the continuum of care for medically dependent children, the center provides a triad of medically necessary services: skilled nursing care, developmental programming, and parental training. Prescribed child care (PCCC) provides a less restrictive alternative to hospitalization and reduces the isolation often experienced by the homebound, medically dependent child and family. The purpose of prescribed childcare is health care, but does not exclude other services. (67) Psychologist. A person currently licensed as such by the Tennessee Board of Examiners in Psychology. (68) 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 emergency responders. (69) 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 child’s health care needs. Such availability shall include, but not be limited to, availability by telephone. (70) Registered Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (71) Registered Respiratory Therapist. A person currently licensed as such by the Tennessee Board of Respiratory Care. (72) Shall or Must. Compliance is mandatory. (73) Social Worker. A person who has at least a bachelor’s degree in Social Work or related field, and preferably, two (2) years medical social work or other community based work experience. (74) 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 Sciences. (75) 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. (76) 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. (77) Surrogate. An individual, other than a patient’s agent or guardian, authorized to make a health care decision for the patient. (78) Toddler. A child who is sixteen (16) months through thirty (30) months of age. (79) Treating Health Care Provider. A health care provider who at the time is directly or indirectly involved in providing health care to the child.