Medical Records

(1) Purposes - The purposes of this rule are: (a) To recognize that medical records are an integral part of the practice of nursing as defined in T.C.A. §§ 63-7-101, et seq. (b) To give advanced practice registered nurses, their professional and non-professional staff, and the public direction about the content, transfer, retention, and destruction of those records. (c) To recognize that a distinction exists between an advanced practice registered nurse’s medical records for a patient receiving services in an office and those records created by the advanced practice registered nurse for that patient for purposes of services provided in a hospital as defined by T.C.A. § 68-11-302(4) and that the distinction exists regardless of the fact that the advanced practice registered nurse may also be an employee of the hospital or of a group practice employed or owned by the hospital. ADVANCED PRACTICE REGISTERED NURSES CHAPTER 1000-04 (2) Conflicts - As to medical records, this rule should be read in conjunction with the provisions of T.C.A. §§ 63-2-101 and 102, and is not intended to conflict with those statutes in any way. Those statutes, along with this rule, govern the subjects that they cover in the absence of other controlling state or federal statutes or rules to the contrary. (3) Applicability - This rule regarding medical records shall apply only to those records, the information for which was obtained by advanced practice registered nurses or their professionally licensed employees, or those over whom they exercise supervision, for purposes of services provided in any clinical setting other than those provided in a hospital as defined by T.C.A. § 68-11-302(4), a hospital emergency room or hospital outpatient facility. (4) Medical Records - (a) Duty to Create and Maintain Medical Records - As a component of the standard of care and of minimal competency an advanced practice registered nurse must cause to be created and cause to be maintained a medical record for every patient for whom the nurse, and/or any of the nurse’s professionally licensed supervisees, performs services or provides professional consultation. (b) Notice - Anywhere in this rule where notice is required to be given to patients of any advanced practice registered nurse that notice shall be required to be issued within thirty (30) days of the date of the event that triggers the notice requirement, and may be accomplished by email or U.S.P.S. First Class Mail to the last known address or, where overly burdensome, by public notice. (c) Distinguished from Hospital Medical Records - The medical records covered by this rule are separate and distinct from those records generated for the patient by the advanced practice registered nurse during the course of providing medical services for the patient in a hospital as defined by T.C.A. § 68-11-302(4) regardless of the fact that the advanced practice registered nurse may also be an employee of the hospital or of a medical group employed or owned by the hospital. 1. The provisions of T.C.A. Title 68, Part 11, Chapter 3 govern medical records generated in a hospital as defined by T.C.A. § 68-11-302(4). 2. The medical records covered by these rules are those: (i) That are created prior to the time of the patient’s admission to or confinement and/or receipt of services in a hospital as defined by T.C.A. § 68-11-302(4), hospital emergency room and/or hospital outpatient facility, and/or (ii) That are created after the patient’s discharge from a hospital as defined by T.C.A. § 68-11-302(4), hospital emergency room or hospital outpatient facility. (iii) That are created during the practice of advanced nursing outside of a hospital as defined by T.C.A. § 68-11-302(4), hospital emergency room or hospital outpatient facility. 3. Even though the records covered by these rules may, of necessity, reference provision of services in the hospital setting and the necessary initial work-up and/or follow-up to those services, that does not make them “hospital records” that are regulated by or obtainable pursuant to T.C.A. Title 68, Part 11, Chapter 3. ADVANCED PRACTICE REGISTERED NURSES CHAPTER 1000-04 (d) Content - All medical records, or summaries thereof, produced in the course of the practice of advanced nursing for all patients shall include all information and documentation listed in T.C.A. § 63-2-101(c)(2) and such additional information that is necessary to insure that a subsequent reviewing or treating healthcare provider can both ascertain the basis for the diagnosis, treatment plan and outcomes, and provide continuity of care for the patient. (e) Transfer - 1. Records of Advanced Practice Registered Nurses upon Death or Retirement - When an advanced practice registered nurse retires or dies while in practice, patients seen by the APRN in the nurse’s office during the immediately preceding thirty-six (36) months shall be notified by the APRN, or the nurse’s authorized representative and urged to find a new healthcare provider and be informed that upon authorization, copies of the patients’ medical records will be sent to the new healthcare provider. This notification requirement shall not apply to a patient when there have been fewer than two (2) office patient encounters within the immediately preceding eighteen (18) months. 2. Records of Advanced Practice Registered Nurses upon Departure from a Group - The responsibility for notifying patients of an advanced practice registered nurse who leaves a group practice whether by death, retirement or departure shall be governed by the APRN’s employment contract or the partnership agreement, whichever is applicable. (i) Whomever is responsible for that notification must notify patients seen by the APRN in the nurse’s office during the immediately preceding thirty-six (36) months of his/her departure, except that this notification requirement shall not apply to a patient when there have been fewer than two (2) office patient encounters within the immediately preceding eighteen (18) months. (ii) Except where otherwise governed by provisions of the Advanced Practice Registered Nurse’s employment contract or the partnership agreement, those patients shall also be notified of the APRN’s new address and offered the opportunity to have copies of their medical records forwarded to the departing APRN at his or her new practice. Provided however, a group shall not withhold the medical records of any patient who has authorized their transfer to the departing advanced practice registered nurse or any other healthcare provider. (iii) The choice of healthcare provider in every case should be left to the patient, and the patient should be informed that upon authorization patient’s records will be sent to the healthcare provider of the patient’s choice. 3. Sale of a Practice - An APRN or the estate of a deceased advanced practice registered nurse may sell the elements that comprise the nurse’s practice, one of which is its goodwill, i.e., the opportunity to take over the patients of the seller by purchasing the advanced practice registered nurse’s medical records. Therefore, the transfer of records of patients is subject to the following: (i) The APRN (or the estate) must ensure that all medical records are transferred to another healthcare provider or entity that is held to the same standards of confidentiality as provided in these rules. ADVANCED PRACTICE REGISTERED NURSES CHAPTER 1000-04 (ii) Patients seen by the advanced practice registered nurse in the nurse’s office during the immediately preceding thirty-six (36) months shall be notified that the advanced practice registered nurse (or the estate) is transferring the practice to another healthcare provider who will retain custody of their records and that at their written request the copies of their records will be sent to another healthcare provider of their choice. This notification requirement shall not apply to a patient when there have been fewer than two (2) office patient encounters within the immediately preceding eighteen (18) months. 4. Abandonment of Records - For purposes of this section of the rules death of an advanced practice registered nurse shall not be considered as abandonment. (i) It shall be a prima facie violation of T.C.A. § 63-7-115(a)(1)(F) for an advanced practice registered nurse to abandon the nurse’s practice without making provision for the security, or transfer, or otherwise establish a secure method of patient access to their records. (ii) Upon notification that an advanced practice registered nurse in a practice has abandoned the nurse’s practice and not made provision for the security, or transfer, or otherwise established a secure method of patient access to their records patients should take all reasonable steps to obtain their medical records by whatever lawful means available and should immediately seek the services of another healthcare provider. (f) Retention of Medical Records - Medical records shall be retained for a period of not less than ten (10) years from the advanced practice registered nurse’s or the nurse’s supervisees’ last professional contact with the patient except for the following: 1. Immunization records shall be retained indefinitely. 2. Medical records for incompetent patients shall be retained indefinitely. 3. Mammography records shall be retained for at least twenty (20) years. 4. X-rays, radiographs and other imaging products shall be retained for at least four (4) years after which if there exist separate interpretive records thereof they may be destroyed. 5. Medical records of minors shall be retained for a period of not less than one (1) year after the minor reaches the age of majority or ten (10) years from the date of the advanced practice registered nurse’s or his supervisees’ last professional contact with the patient, whichever is longer. 6. Notwithstanding the foregoing, no medical record involving services which are currently under dispute shall be destroyed until the dispute is resolved. (g) Destruction of Medical Records - 1. No medical record shall be singled out for destruction other than in accordance with established office operating procedures. 2. Records shall be destroyed only in the ordinary course of business according to established office operating procedures that are consistent with these rules. ADVANCED PRACTICE REGISTERED NURSES CHAPTER 1000-04 3. Records may be destroyed by burning, shredding, or other effective methods in keeping with the confidential nature of the records. 4. When records are destroyed, the time, date and circumstances of the destruction shall be recorded and maintained for future reference. The record of destruction need not list the individual patient medical records that were destroyed but shall be sufficient to identify which group of destroyed records contained a particular patient’s medical records. (5) Violations - Violation of any provision of this rule is grounds for disciplinary action pursuant to T.C.A. § 63-7-115(a)(1)(F).