Definitions

(1) “Abuse” means willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. (2) 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: (a) How the deficiency will be corrected. (b) Who will be responsible for correcting the deficiency. (c) The date the deficiency will be corrected. (d) How the facility will prevent the same deficiency from re-occurring. (3) Accredited. The process of verifying compliance with operational standards by a federally recognized accrediting body. (4) Accredited Record Technician (ART). A person currently accredited as such by the American Medical Records Association. (5) Adult. An individual who has capacity and is at least 18 years of age. (6) Agent. An individual designated in an advance directive for health care to make a health care decision for the individual granting the power. (7) 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. (8) Cancer Treatment and Radiation Clinic. A facility in which the only procedures performed are diagnostic and therapeutic radiology, chemotherapy and related services. STANDARDS FOR OUTPATIENT DIAGNOSTIC CENTERS CHAPTER 0720-36 (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 vessels. (11) 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 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 Anesthetists. (13) Collaborative Plan. The formal written plan between the mid-level practitioners and licensed physician. (14) Collaborative 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) Commission. The Tennessee Health Facilities Commission. (16) Competent. A patient who has capacity. (17) 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 maintained. (19) Dentist. A person currently licensed as such by the Tennessee Board of Dentistry. (20) 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. (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. STANDARDS FOR OUTPATIENT DIAGNOSTIC CENTERS CHAPTER 0720-36 (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 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. (25) 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. (26) Guardian. A judicially appointed guardian or conservator having authority to make a health care decision for an individual. (27) Hazardous Waste. Materials whose handling, use, storage and disposal are governed by local, state or federal regulations. (28) 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). (29) Health Care Decision. Consent, refusal of consent or withdrawal of consent to health care. (30) 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 0720-36- .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. (31) Health Care Institution. A health care institution as defined in T.C.A. § 68-11-1602. (32) 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. (33) 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 disease. (36) Licensed Practical Nurse. A person currently licensed as such by the Tennessee Board of Nursing. STANDARDS FOR OUTPATIENT DIAGNOSTIC CENTERS CHAPTER 0720-36 (37) Licensee. The person or entity to whom the license is issued. The licensee is held responsible for compliance with all applicable rules and regulations. (38) Life Threatening or Serious Injury. Injury requiring the patient to undergo significant additional diagnostic or treatment measures. (39) 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. (40) 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 waves. (41) Mammography. A non-invasive radiological procedure used to take pictures of the breasts in order to diagnose tumors or cysts. (42) 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 part. (43) 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. (44) 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. (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 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. (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. National Fire Protection Association. STANDARDS FOR OUTPATIENT DIAGNOSTIC CENTERS CHAPTER 0720-36 (50) 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 Nurse-Midwives. (51) Outpatient 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 Commission and comply with relevant reporting requirements. (52) 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. (53) 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 the procedure. (54) Person. An individual, corporation, estate, trust, partnership, association, joint venture, government, governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. (55) Personally Informing. A communication by any effective means from the patient directly to a health care provider. (56) Physician. An individual authorized to practice medicine or osteopathy under Tennessee Code Annotated, Title 63, Chapters 6 or 9. (57) 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. (58) Physician Orders for Scope of Treatment (POST). Written orders that: (a) Are on a form approved by the Commission; (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; STANDARDS FOR OUTPATIENT DIAGNOSTIC CENTERS CHAPTER 0720-36 (i) Specify other medical interventions that are to be provided or withheld; or (ii) Specify both 1. and 2. (59) Positron Emission Tomography (PET Scan). A non-invasive radiological procedure producing a sectional view of the body constructed by positron-emission tomography. (60) 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. (61) 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. (62) Radiological Technologist. A person currently certified as such by the American Society of Radiological Technologists. (63) 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. (64) Registered Nurse (R.N.). A person currently licensed as such by the Tennessee Board of Nursing. (65) Registered Record Administrator (RRA). A person currently registered as such by the American Medical Records Association. (66) Shall or Must. Compliance is mandatory. (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) 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, e.g. tumor. (69) 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. (70) Surrogate. An individual, other than a patient’s agent or guardian, authorized to make a health care decision for the patient. (71) 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. (72) Treating Health Care Provider. A health care provider who at the time is directly or indirectly involved in providing health care to the patient. (73) 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. STANDARDS FOR OUTPATIENT DIAGNOSTIC CENTERS CHAPTER 0720-36