Section 0940-05-06-.05 - INDIVIDUAL CLIENT RECORD REQUIREMENTS FOR ALL SERVICES AND FACILITIESThe governing body must ensure that an individual record is maintained, in electronic or hard copy format, for each client being served and which minimally includes the following information:
(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: (a) Name and title of the person or organization to or from who disclosure is to be made;(b) The signature of the client or the client's legal representative;(c) The purpose of the disclosure;(d) The extent and nature of information to be disclosed;(e) A statement that the content is subject to revocation at any time except to the extent that action has already been taken in reliance thereon and a specified date, event or condition upon which the consent will expire without express revocation; and,(f) The date on which the consent is signed;(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).Tenn. Comp. R. & Regs. 0940-05-06-.05
Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Developmental Disabilities on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010 Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Developmental Disabilities on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Department of Mental Health and Developmental Disabilities on February 25, 2011. Repeal and new rules filed November 30, 2016; effective 2/28/2017.Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-304, 33-2-404, 33-2-405, 33-2-407, and 33-2-504.