(1) Purposes - The
purposes of these rules are:
(a) To recognize
that chiropractic records are an integral part of the practice of chiropractic
as defined in T.C.A. §§
63-4-101.
(b) To give chiropractic physicians, 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 a chiropractic physician's records created by the patient's
chiropractic physician and the records of chiropractic services provided to a
hospitalized patient created by or at the request of and that are under the
control of a hospital as defined by T.C.A. §§
68-11-302(4).
(2) Conflicts - As to chiropractic
records, these rules should be read in conjunction with the provisions of
T.C.A. §§
63-2-101 and 102, and are not
intended to conflict with those statutes in any way. Those statutes, along with
these rules, govern the subjects that they cover in the absence of other
controlling state or federal statutes or rules to the contrary.
(3) Applicability - These rules regarding
chiropractic records shall apply only to those records, the information for
which was obtained by chiropractic physicians or their professionally licensed
employees, or those over whom they exercise supervision, for purposes of
services provided in any clinical setting and not to those records for a
hospitalized patient created by or at the request of and that are under the
control of a hospital as defined by T.C.A. §§ 6811-302 (4), or any
health care facility or entity owned or operated by the hospital.
(4) Chiropractic Records
(a) Duty to Create and Maintain Chiropractic
Records - As a component of the standard of care and of minimal competency a
chiropractic physician must cause to be created and cause to be maintained a
chiropractic record for every patient for whom he or she, and/or any of his or
her professionally licensed supervisees, performs services or provides
professional consultation.
(b)
Notice - Anywhere in these rules where notice is required to be given to
patients of any chiropractic physician 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 public notice.
(c) Distinguished from Hospital Records - The
chiropractic records covered by these rules are separate and distinct from
those records of chiropractic services provided to hospitalized patients
created by or at the request of and that are under the control of a hospital as
defined by T.C.A. §§
68-11-302(4), or
any health care facility or entity owned or operated by the hospital.
1. The provisions of T.C.A. Title 68, Part
11, Chapter 3 govern records created by or at the request of and that are under
the control of a hospital as defined by T.C.A. §§
68-11-302(4).
2. The chiropractic records covered by these
rules are those that are created prior to, during or after the hospitalization
of a patient that are not created by or at the request of a hospital as defined
by T.C.A. §§
68-11-302(4), or
any health care facility or entity owned or operated by the hospital and that
are not under the control of that hospital.
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.
(d) Content - All chiropractic records, or
summaries thereof, produced in the course of the practice of chiropractic 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 chiropractic physician 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 Chiropractic Physicians upon
Death or Retirement - When a chiropractic physician retires or dies while in
practice, patients seen by the chiropractic physician in his/her office during
the immediately preceding thirty-six (36) months shall be notified by the
chiropractic physician, or his/her authorized representative and urged to find
a new chiropractic physician and be informed that upon authorization, copies of
the records will be sent to the new chiropractic physician. 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 Chiropractic
Physicians upon Departure from a Group - The responsibility for notifying
patients of a chiropractic physician who leaves a group practice whether by
death, retirement or departure shall be governed by the chiropractic
physician's employment contract.
(i) Whomever
is responsible for that notification must notify patients seen by the
chiropractic physician in his/her 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 chiropractic physician's contract, those patients
shall also be notified of the chiropractic physician's new address and offered
the opportunity to have copies of their chiropractic records forwarded to the
departing chiropractic physician at his or her new practice. Provided however,
a group shall not withhold the chiropractic records of any patient who has
authorized their transfer to the departing chiropractic physician or any other
chiropractic physician.
(iii) The
choice of chiropractic physicians in every case should be left to the patient,
and the patient should be informed that upon authorization his/her records will
be sent to the chiropractic physician of the patient's choice.
3. Sale of a Chiropractic Practice
- A chiropractic physician or the estate of a deceased chiropractic physician
may sell the elements that comprise his/her practice, one of which is its
goodwill, i.e., the opportunity to take over the patients of the seller by
purchasing the chiropractic physician's records. Therefore, the transfer of
records of patients is subject to the following:
(i) The chiropractic physician (or the
estate) must ensure that all chiropractic records are transferred to another
chiropractic physician or entity that is held to the same standards of
confidentiality as provided in these rules.
(ii) Patients seen by the chiropractic
physician in his/her office during the immediately preceding thirty-six (36)
months shall be notified that the chiropractic physician (or the estate) is
transferring the practice to another chiropractic physician or entity who will
retain custody of their records and that at their written request the copies of
their records will be sent to another chiropractic physician or entity 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 a chiropractic physician shall not be
considered as abandonment.
(i) It shall be a
prima facie violation of T.C.A. §§
63-4-114 for a chiropractic
physician to abandon his 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 a chiropractic physician in a practice has abandoned his 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 chiropractic records by whatever lawful means available
and should immediately seek the services of another chiropractic
physician.
(f) Retention of Chiropractic Records -
Chiropractic records, including x-rays, radiographs, and other imaging products
shall be retained for a period of not less than ten (10) years from the date of
the chiropractic physician's or his supervisees' last professional contact with
the patient except for the following:
1.
Chiropractic records for incompetent patients shall be retained
indefinitely.
2. Chiropractic
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 chiropractic physician's or his supervisees' last professional contact with
the patient, whichever is longer.
3. X-rays, radiographs and other imaging
products may be destroyed if there exists separate interpretive
records.
4. Notwithstanding the
foregoing, no chiropractic record involving services which are currently under
dispute shall be destroyed until the dispute is resolved.
(g) Destruction of Chiropractic Records
1. No chiropractic 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.
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 chiropractic records that were destroyed but
shall be sufficient to identify which group of destroyed records contained a
particular patient's chiropractic records.
(5) Violations - Violation of any provision
of these rules is grounds for disciplinary action pursuant to T.C.A.
§§
63-4-114(4)
and/or (12).