Rules & Regulations of the State of Tennessee
Title 0940 - Mental Health and Substance Abuse Services
Subtitle 0940-05 - Licensure
Chapter 0940-05-06 - Minimum Program Requirements for All Services and Facilities
Section 0940-05-06-.05 - INDIVIDUAL CLIENT RECORD REQUIREMENTS FOR ALL SERVICES AND FACILITIES

(1) The name and social security number of the client;

(2) The address of the client or, for residential treatment programs, a permanent or previous address;

(3) The telephone number of the client;

(4) The sex of the client;

(5) The date of the client's birth;

(6) The date of the client's admission to the facility;

(7) The source of the client's referral to the facility;

(8) If applicable, legal documents affirming that the client has a court-appointed legal representative and the name, address and telephone number of the legal representative;

(9) The name, address, and telephone number of a family representative and/or an emergency contact person;

(10) If the facility charges fees for its services, a fee schedule, as described in Rule 0940-05-06-.02(1)(d), shall be dated, completed and signed by the client (or the client's legal representative) prior to provision of any services other than emergency services. The licensee should complete a new fee schedule when there is a change in the amount of fees, the services provided, or additional charges for which the client is responsible are incurred;

(11) When appropriate, informed, signed and dated consent and authorization forms for the release or obtaining of information from the client. These forms shall be in compliance with state and federal confidentiality laws and include at least the following information:

(12) Documentation that the client or someone legally acting on behalf of the client has been informed of the client's rights and responsibilities and of the facility's general rules affecting the client; and,

(13) A written account of all monies received or disbursed on behalf of the client and a copy of the annual report on the use and disbursement of client funds as required by 0940-05-06-.03(6).