flag of tennessee2024 Tenessee Code Unannotated

Title 63 Professions Of The Healing Arts

Chapter 2 Medical Records
§ 63-2-101. Release of medical records — Definitions.
  1. (a)
    1. (1) Notwithstanding another law to the contrary, a health care provider shall provide to a patient or a patient's authorized representative a copy of such patient's medical records within ten (10) working days of receipt of a written request by the patient or the patient's authorized representative. The health care provider may provide a summary of such patient's medical records, at the option of the health care provider, but the provision of a summary does not satisfy the patient's or representative's right to receive, or serve as a substitute for, a full medical record under this subdivision (a)(1).
    2. (2) If a provider fails to comply with subdivision (a)(1), proper notice shall be given to the provider's licensing board or boards, and the provider may be subject to disciplinary actions that include sanctions and a monetary fine.
  2. (b)
    1. (1)
      1. (A) Except as otherwise provided by law, such patient's medical records shall not constitute public records, and nothing contained in this part shall be deemed to impair any privilege of confidentiality conferred by law on patients, their personal representatives or heirs. Nothing in this subsection (b) shall impair or abridge the right of the patient or the patient's authorized representative to obtain copies of the patient's hospital records in the manner provided in § 68-11-304. Nothing in this subsection (b) shall be construed as prohibiting a patient's medical records from being subpoenaed by a court of competent jurisdiction.
      2. (B) As used in subdivision (b)(1)(A), “medical records” includes any list of patients that is compiled or maintained by or for such patient's health care provider.
    2. (2) Except for any statutorily required reporting to health or government authorities and except for access by an interested third-party payer or their designee for the purpose of utilization review, case management, peer reviews or other administrative functions, the name and address and other identifying information of a patient shall not be divulged. The name and address and other identifying information shall not be sold for any purpose. Any violation of this subdivision (b)(2) shall be an invasion of the patient's right to privacy.
    3. (3) Except as otherwise authorized in this section, title 38, chapter 7, part 1, title 68, chapter 11, part 3 and title 68, chapter 11, part 15, a health care provider shall have in place a policy to protect the dignity of a patient, even if the patient dies or becomes incapacitated, by limiting the use and disclosure of medical records, images, videos or pictures intended to be used for appropriate medical educational purposes, even if the patient's information is de-identified. The policy shall include when and to whom it is appropriate to use and disclose the patient's information, and when a written authorization from the patient or their authorized representative is required, whenever it is reasonably possible to obtain it, prior to use or disclosure. If the patient becomes incapacitated or dies, and there is no legal representative for the patient, the patient's next of kin will be considered to be an authorized representative for the patient. When required the written authorization will include the core elements required by 45 CFR Parts 160 and 164, “Standards for Privacy of Individually Identifiable Health Information.”
  3. (c) As used in this chapter:
    1. (1) “De-identified” means there is no reasonable basis to believe that the information can be used to identify an individual and there is compliance with the requirements for de-identification outlined in 45 CFR Part 164, § 164.514 “Other requirements relating to uses and disclosures of protected health information”;
    2. (2) “Health care provider” means any person required to be licensed under this title;
    3. (3) “Incapacitated” means that a patient is in a physical or mental condition such that the patient is incapable of granting or denying informed consent; and
    4. (4) “Medical records” means all medical histories, records, reports and summaries, diagnoses, prognoses, records of treatment and medication ordered and given, X-ray and radiology interpretations, physical therapy charts and notes and lab reports.
  4. (d) Nothing in this chapter shall be construed to prevent a true, correct and complete copy of the medical records from being subject to a subpoena duces tecum.
  5. (e) To further the effectiveness of the immunization program of the department of health, a physician or any third party payor or health insurance entity regulated by the department of commerce and insurance doing business in Tennessee, or any entity that has elected, organized and qualified as a self-insured entity that provides information to the department regarding a child's immunization status for any of the following purposes shall not be subject to liability or cause of action or a claim of any nature, including any licensing board disciplinary action, arising solely from the disclosure of information concerning such child's immunization status:
    1. (1) Compliance with the laws regarding child care and school attendance;
    2. (2) Ensuring that a child receives such immunization as is medically appropriate or assisting in efforts to ensure a child is appropriately immunized;
    3. (3) Providing immunization information to the immunization registry maintained by the department;
    4. (4) Insuring compliance with the Families First Act, compiled in title 71, chapter 3, part 1; or
    5. (5) Providing information that will allow the department to determine immunization levels in Tennessee.
  6. (f) All information received by the department pursuant to this part from any source shall be confidential and unavailable to the public. Contact of a parent or guardian of a child by the department regarding the child's immunization status as the result of the department's contact with the physician shall not be held to be a breach of confidentiality by the reporting physician.
  7. (g) The names of all children shall be included on the immunization registry established by title 37, chapter 10, part 4, unless such child's custodial parent or guardian objects to the inclusion of the child's name on the immunization registry to the department. The department shall notify the child's custodial parent or guardian in writing within six (6) months of the child's birth that inclusion on the immunization registry is not mandatory. Upon such written or oral request of exclusion by the child's custodial parent or guardian, the department shall either remove the child's name from the immunization registry or refrain from adding the child's name to the immunization registry and confirm in writing to the child's custodial parent or guardian that the child's name has been excluded from the immunization registry.
  8. (h) Notwithstanding this part or any other law to the contrary, it shall not be unlawful to disclose, nor shall there be any liability for disclosing, medical information in response to a subpoena, court order or request authorized by state or federal law.
  9. (i) Providers, as defined in § 71-5-2503, shall make available for inspection and copying to the office of inspector general and the medicaid fraud control unit, upon request, no later than by the close of business on the next business day, a complete set of all medical records requested in connection with an investigation being pursued by the agency or shall provide a compelling reason why the requested records cannot be produced; provided, that no such records shall be removed from the grounds of the provider's office without the provider's consent, unless the office of inspector general or the medicaid fraud control unit reasonably believes that the requested documents are about to be altered or destroyed.
  10. (j) On request of a provider, a duly authorized agent of the requesting agency shall sign a document acknowledging receipt of records produced pursuant to this section. On request of a duly authorized agent of the requesting agency, a duly authorized agent of the provider shall sign a document acknowledging the return of specific records to the provider.
  11. (k) No person or entity shall be subject to any civil or criminal liability for releasing patient information in response to a request from the office of inspector general or the medicaid fraud control unit.
§ 63-2-102. Costs of reproduction, copying or mailing of records.
  1. (a) For records other than those involving workers' compensation cases:
    1. (1) The party requesting the patient's medical records in paper format is responsible to the provider or the provider's third-party release of information provider for the reasonable costs of copying and mailing the patient's records. Such reasonable costs must not exceed:
      1. (A) Twenty-five dollars ($25.00) for paper copies of medical records five (5) pages or less in length;
      2. (B) Fifty cents (50¢) per page for each page copied after the first five (5) pages;
      3. (C) The actual cost of mailing;
      4. (D) For producing radiology images in hard copy, no more than twenty dollars ($20.00) per printed film; and
      5. (E) A certification or notary fee, if certification or notarization is requested, must be charged as a flat fee of twenty dollars ($20.00);
    2. (2) The party requesting the patient's records in electronic format is responsible to the provider or the provider's third-party release of information provider for the following fees:
      1. (A) The reasonable fees for fulfilling a patient's request for the patient's own records are governed by the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (42 U.S.C. § 1320d et seq.), and the Health Information Technology for Economic and Clinical Health (HITECH) Act (42 U.S.C. § 201 et seq.), and those acts implementing regulations, which must not exceed the cost of the following:
        1. (i) Labor for copying the protected health information requested by the individual;
        2. (ii) Supplies for creating the paper copy, or electronic media if the individual requests that the electronic copy be provided on portable media; and
        3. (iii) Postage, when the individual has requested the copy or summary or explanation, be mailed; and
      2. (B) For all other requesters, the total fees for electronic medical records provided via portable media, electronic mail, or medical record portal, must comply with the following:
        1. (i) The total charges must be no more than twenty-five dollars ($25.00) for records ten (10) pages or less in length;
        2. (ii) The total charges must be no more than twenty-five cents (25) per page for each page after the first ten (10) pages, up to ninety dollars ($90.00);
        3. (iii) The mailing costs and applicable taxes, if any, must be the actual mailing costs and applicable taxes;
        4. (iv) The fee for producing electronic copies of radiology images must be no more than twenty-five dollars ($25.00) per request for CD, DVD, or USB, or fifteen dollars ($15.00) per request for electronic files emailed or sent via medical record portal;
        5. (v) A certification or notary fee, if certification or notarization is requested, must be charged as a flat fee of twenty dollars ($20.00);
        6. (vi) Charges for copying paper records or faxing paper records are subject to the limits set in subdivision (a)(1); and
        7. (vii) The fees charged for reproducing records of patients involved in a claim or appeal of denial for social security disability benefits must be a flat fee of twenty dollars ($20.00), only when the records are produced electronically;
    3. (3) Upon request, a person providing records pursuant to § 63-2-101 shall provide the records in electronic form unless the records are not kept in electronic form in the usual course of business;
    4. (4) A third-party release of information provider of record copying and related services is subject to the fee limits contained in this section and shall not impose a charge or fee for such service in excess of such fee limits;
    5. (5) The fees charged for reproducing records of patients involved in a workers' compensation claim are as specified in § 50-6-204; and
    6. (6) A healthcare provider shall not charge a fee for copying or notarizing a medical record when requested by the department of health pursuant to a complaint, inspection, or survey as set forth in § 63-1-117.
  2. (b) Any increase in charges for copying and certifying medical records permitted by this section that is above those charges established by this section as it existed on January 1, 2010, shall not apply to requests for medical records made by the department of human services, and charges for copying and certifying medical records requests made by the department of human services shall remain the same as existed under this section as of January 1, 2010.
  3. (c)
    1. (1) Upon request, the provider shall submit a notarized affidavit by the custodian of records certifying that the records provided in response to the request:
      1. (A) Are true and correct copies of records in the custody of the affiant;
      2. (B) Were made at or near the time of the occurrence of the matters set forth by, or from information transmitted by, a person with knowledge of and a business duty to record or transmit those matters;
      3. (C) Were kept in the course of regularly conducted activity; and
      4. (D) Were made by the regularly conducted activity as a regular practice.
    2. (2) In addition to the charge for the copies of the record, the provider may charge up to twenty dollars ($20.00) for the affidavit described in this subsection (c), and the records submitted with that affidavit, and the affidavit shall qualify for the business records exception to the hearsay rule.
  4. (d) Nothing in this chapter shall be construed as superseding any provision of law that establishes specific costs for the reproduction, copying or mailing of records.
  5. (e) Payment of such costs may be required by the provider prior to the records being furnished. Upon payment of the costs described in this section, the patient or a patient's authorized representative shall have the right to receive the medical records without delay.
  6. (f) In workers' compensation cases, a request for medical records shall include a medical or anatomical impairment rating as required by § 50-6-246 [See the Compiler’s Notes].
§ 63-2-103. Authority to promulgate regulations regarding retention of physician medical records — Limit on retention of mammography records.
  1. (a) The board of medical examiners is authorized to promulgate regulations regarding the retention of physician medical records as defined in § 63-2-101(c).
  2. (b) Notwithstanding any law or rule to the contrary, such retention of mammography records shall not exceed ten (10) years.
§ 63-2-104. Electronic medical records — Information blocking prohibited — Procedure for disclosure of test results — Exclusions.
  1. (a) A healthcare professional subject to this title who is considered a business associate, as that term is defined in 45 CFR § 160.103, shall comply with:
    1. (1) The Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) and standards for privacy of individually identifiable health information required by 45 CFR Parts 160 and 164; and
    2. (2) Federal laws regulating information blocking, as that term is defined in 45 CFR § 171.103.
  2. (b) Notwithstanding another law to the contrary, except as provided in subsection (c), a healthcare provider requesting a medical laboratory test for a patient shall not engage in information blocking as described in 42 U.S.C. § 300jj-52.
  3. (c) The following reports, test results, and any other related results must not be disclosed by a designated entity, as defined under § 68-29-103, to a patient as part of the patient's electronic health record until seventy-two (72) hours after the results are finalized, unless the healthcare provider directs the release of the results before the end of that seventy-two-hour period:
    1. (1) Pathology reports or radiology reports that have a reasonable likelihood of showing a finding of new or recurring malignancy;
    2. (2) Tests that could reveal genetic markers;
    3. (3) A positive HIV test, except that this section does not prevent the disclosure of HIV test results, including viral load and CD4 count test results, to a patient living with HIV by secure internet website or other electronic means if the patient has previously been informed about the results of a positive HIV test pursuant to the requirements of this section; or
    4. (4) Presence of antigens indicating a hepatitis infection.
  4. (d) This section does not apply to a person or entity that is licensed under this title or title 68.
Chapter 3 Podiatrists
Part 1 General Provisions
§ 63-3-101. “Podiatrist” defined — Performance of ankle surgery.
  1. (a) Within this chapter, “podiatrist” means one who examines, diagnoses or treats, medically mechanically or surgically, the ailments of the human foot, ankle and soft tissue structures extending no higher than the distal tibial metaphyseal flair, including the use and prescribing of drugs and medications, but excluding the direct applications of general anesthesia by a podiatrist and the amputation of the foot. A podiatrist may perform Achilles tendon repair, subject to subsection (b), but may not perform surgery on Pilon fractures or tibial fractures that do not enter the ankle joint.
  2. (b) A licensed podiatrist may perform ankle surgery only when that podiatrist meets the requirements of either subdivision (b)(1) or (b)(2):
    1. (1) Was, prior to October 2, 1995, credentialed to perform ankle surgery by a JCAHO accredited hospital in Tennessee or JCAHO accredited ambulatory surgical treatment center in Tennessee; provided, that a podiatrist who qualifies to perform ankle surgery under this subdivision (b)(1) must, if the podiatrist wishes to continue to perform ankle surgery:
      1. (A) Notify the board as to the hospital or ambulatory surgical treatment center at which the podiatrist was credentialed to perform ankle surgery prior to October 2, 1995;
      2. (B) Obtain and maintain evidence of obtaining at least ten (10) hours of approved continuing education related to ankle surgery annually; and
      3. (C) Comply with any other requirements established by the board to ensure continued proficiency in performing ankle surgery; or
    2. (2) Has completed a surgical residency program at least twenty-four (24) months in length that has been approved by the council on podiatric medical education and is currently eligible for certification to perform reconstructive rearfoot/ankle surgery by the American Board of Podiatric Surgery; provided, that a podiatrist who qualifies to perform ankle surgery under this subdivision (b)(2) must obtain certification to perform reconstructive rearfoot/ankle surgery from the American Board of Podiatric Surgery within six (6) years of May 24, 2000, or within six (6) years of first becoming eligible for certification, whichever date is later, and may not continue to perform ankle surgery if that podiatrist has not obtained certification by the end of the six-year period.
  3. (c) A licensed podiatrist may perform ankle surgery only in an accredited hospital or ambulatory surgical treatment center licensed under title 68 at which the podiatrist has surgical privileges to perform ankle surgery. For purposes of this subsection (c), an accredited hospital is one that is accredited by joint commission or the American Osteopathic Association, and an accredited ambulatory surgical treatment center is one that is accredited by joint commission, Accreditation Association for Ambulatory Health Care or American Association for Accreditation of Ambulatory Surgical Facilities. A podiatrist who performs ankle surgery in an ambulatory surgical treatment center must first have surgical privileges to perform ankle surgery at a local hospital. A licensed podiatrist who performs ankle surgery must meet the same standard of care applicable to orthopedic surgeons who perform ankle surgery.
  4. (d) Licensed podiatrists may perform nonsurgical care on the ankle without meeting the requirements of subsection (b).
  5. (e) A licensed podiatrist may collaborate with a physician assistant or an orthopedic physician assistant licensed pursuant to chapter 19 of this title. A podiatrist collaborating with a physician assistant pursuant to this subsection (e) shall comply with the requirements of and any rules adopted pursuant to §§ 63-19-106 and 63-19-107 governing collaboration with a physician assistant. A podiatrist collaborating with an orthopedic physician assistant pursuant to this subsection (e) shall comply with the requirements of and any rules adopted pursuant to §§ 63-19-203 — 63-19-205 governing collaboration with an orthopedic physician assistant.
§ 63-3-102. Chapter definitions.
  1. As used in this chapter, unless the context otherwise requires:
    1. (1) “Board” means the board of podiatric medical examiners; and
    2. (2) “Division” means the division of health related boards of the department of health.
§ 63-3-103. Board of podiatric medical examiners — Members.
  1. (a) A board of examiners is established, to be known by the name and title of “board of podiatric medical examiners.”
  2. (b) The governor shall appoint four (4) persons who have been licensed podiatrists for a period of at least two (2) years in this state as members of this board. The terms of office shall be for four (4) years. In making appointments to the board of podiatric medical examiners, the governor shall strive to ensure that at least one (1) person serving on the board is sixty (60) years of age or older and that at least one (1) person serving on the board is a member of a racial minority.
  3. (c) Upon the expiration of the term of a member, the governor shall appoint the member's successor for a term of four (4) years.
  4. (d) The governor has the power to remove from office members of the board for neglect of duties as required by this chapter, or for malfeasance in office and incompetency or for unprofessional conduct. The governor has the authority to fill any vacancy caused by the removal of any member of the board by the member's resignation or death, from a list of all licensed podiatrists who have practiced not less than two (2) years in this state.
§ 63-3-104. Organization, meetings and compensation of board.
  1. (a) The board shall elect a chair and a secretary from its own members.
  2. (b) The board shall hold one (1) regular meeting in each year and such additional meetings at such times and places as it may determine.
  3. (c) Each member of the board shall receive one hundred dollars ($100) per diem when actually engaged in the discharge of official duties and, in addition, shall be reimbursed for all travel and other necessary expenses. All expenses shall be claimed and paid in accordance with prevailing travel regulations as promulgated by the department of finance and administration and approved by the attorney general and reporter.
§ 63-3-105. Disposition of fees — Expenditures.
  1. (a) All fees and moneys from whatever source coming into the hands of the board shall be paid by the board to the state treasurer and become a part of the general fund.
  2. (b) The commissioner of finance and administration shall make allotments out of the general fund for the proper expenditures of the board, and no expenditure may be made by the board until allotment therefor has been made by the commissioner. The allotments for the operation of the board shall be disbursed under the general budgetary laws of the state.
§ 63-3-106. General powers of board.
  1. The board has the powers and duties, in addition to powers and duties granted to or imposed upon it by the other sections of this chapter, to:
    1. (1) Adopt and promulgate rules and regulations as may be necessary to govern its proceedings and carry into effect the purpose of this chapter;
    2. (2) Conduct examinations to ascertain the qualifications and fitness of applicants for a license to practice podiatry in this state;
    3. (3) Provide standards by which podiatry schools and colleges shall be approved;
    4. (4) Direct the division to issue a license for applicants who successfully pass the examination for the practice of podiatry;
    5. (5) Conduct hearings, to revoke or suspend any license or certificate under the authority of this chapter or any previous laws authorizing the holder thereof to practice podiatry for violations by a licensee of any of the provisions of this chapter or any rule or regulation of the board properly adopted and promulgated by the board; and
    6. (6) Sponsor, conduct or approve such educational programs as are necessary to carry out and make effective this chapter.
§ 63-3-107. Unlawful practice.
  1. (a) It is unlawful for any person to practice or attempt to practice podiatry in this state unless such person has been issued a valid and current license to practice podiatry by this board as provided by this chapter.
  2. (b) If any person uses any name or title that would designate that person as a podiatrist or imply that that person was or is qualified to practice podiatry under this chapter, it is deemed prima facie evidence of practicing within the meaning of this chapter.
§ 63-3-108. Exemptions.
  1. This chapter shall not apply to the commissioned physicians and surgeons of the United States army, navy, air force or marine hospital service in the actual performance of their official duties, nor to physicians and surgeons or to osteopathic physicians and surgeons regularly licensed under the laws of this state, nor to visiting podiatrists called into consultation in this state from another state where they are duly qualified under the laws of that state to practice podiatry.
§ 63-3-109. Academic license — License to practice — Requirements — Podiatrists licensed in other states.
  1. (a) Any person desiring an academic license to participate in a residency program shall:
    1. (1) Apply on a form prescribed by the board or via online application for an academic license;
    2. (2) Pay a fee as determined by the board; and
    3. (3) Have a residency program accepted by the board certify that the applicant has been accepted for its program.
  2. (b) The academic license shall terminate upon the applicant leaving the residency program.
  3. (c) Any person desiring to become licensed to practice podiatry in this state must:
    1. (1) Make application to the secretary of the board on a form prescribed by the board;
    2. (2) Pay an application fee as determined by the board;
    3. (3) Pass the examination conducted or accepted by the board; and
    4. (4) Successfully complete at least a one-year residency program approved by the Council on Podiatric Medical Education or its successor organization.
  4. (d) The board shall have the authority to issue locum tenens licenses to podiatrists licensed in another state who wish to practice podiatry in this state for a limited period of time and who meet all the requirements established by the board by rule for a locum tenens license.
§ 63-3-110. Qualifications of applicants — Educational standards.
  1. No person shall be entitled to take any examination for a license unless that person furnishes the board with satisfactory proof that the person is at least eighteen (18) years of age, is of good moral character and has graduated from a college of podiatric medicine which is accredited by the Council on Podiatric Medical Education or its successor organization.
§ 63-3-111. Contents of examination — Grade requirement — Fee.
  1. (a)
    1. (1) The board may conduct examinations at such times and places as it may designate.
    2. (2) Examinations shall be in the English language, written and clinical, and shall include subjects of histology, surgery, hygiene, dermatology, anatomy, physiology, chemistry, bacteriology, pathology, diagnosis and treatment, materia medica and therapeutics, and clinical podiatry and such additional subjects as are pertinent to podiatry; but such examinations shall be so limited in their scope as to cover only the requirements for podiatry education as provided in this chapter.
    3. (3) The board may accept the report of the National Board of Podiatric Medical Examiners on any examinee.
  2. (b) The board shall establish the minimum passing grade by regulation.
  3. (c) The board may set an examination fee.
§ 63-3-112. Reexamination.
  1. An applicant who fails to pass an examination satisfactory to the board, and is therefore refused a license, is entitled, within six (6) months after such refusal, to a reexamination upon payment of an additional fee as set annually by the board for each such reexamination.
§ 63-3-113. Issuance of licenses.
  1. (a) If an applicant successfully passes the examination provided by this chapter and meets all of the requirements of this chapter, the board shall direct the division to issue the applicable license.
  2. (b)
    1. (1) When the board receives a completed application for initial licensure from an applicant, then the board shall, within sixty (60) days from the date the board receives the completed application:
      1. (A) Render a decision on the application; or
      2. (B) Inform the applicant of the need to appear before the board.
    2. (2) As used in this subsection (b), “completed application” means an application that satisfies all statutory and board rule requirements.
§ 63-3-114. Reciprocity.
  1. (a) The board, in its discretion, may waive the examination required by § 63-3-109(c)(3) and may issue a license to any applicant who holds or possesses a valid license to practice podiatry in another state; provided, that the requirements for licensure in such state are, in the opinion of the board, at least equivalent to the requirements for licensure provided by this chapter and that such applicant pays a fee as set by the board.
  2. (b)
    1. (1) When the board receives a completed application for licensure from an applicant who is licensed in another state or territory of the United States or in the District of Columbia, then the board shall, within sixty (60) days from the date the board receives the completed application:
      1. (A) Render a decision on the application; or
      2. (B) Inform the applicant of the need to appear before the board.
    2. (2) As used in this subsection (b), “completed application” means an application that satisfies all statutory and board rule requirements.
§ 63-3-115. Renewal of license.
  1. (a) Each person licensed to practice as a podiatrist in this state shall biennially apply to the board for renewal of the person's license and shall pay a renewal fee set by the board. A podiatrist who fails to renew the license by the date of expiration of the license shall not continue to practice as a podiatrist in this state.
  2. (b) A podiatrist who fails to timely renew the license may seek reinstatement from the board. The board may reinstate the license upon good cause shown, upon payment of all past due renewal fees and a late renewal fee and upon compliance with any other reasonable conditions imposed by the board.
  3. (c) The board may utilize the renewal system described in § 63-1-107.
  4. (d) Any licensed podiatrist who has retired from practice in this state shall not be required to renew the license if the person retired from practice files with the board an affidavit of retirement on a form furnished by the board. The affidavit shall state the date on which the person retired from practice and such other facts as the board deems necessary to verify retirement. If the person thereafter wishes to reenter practice in this state, the person shall apply for license reactivation, pay the reactivation fee set by the board and meet such other reasonable requirements deemed necessary by the board.
§ 63-3-116. Continuing medical education — Exemptions.
  1. (a) As a condition of the biennial renewal of a podiatrist license, every licensed podiatrist must obtain at least fifteen (15) hours of continuing medical education each calendar year in programs approved by the board. The only basis upon which a podiatrist may seek an exemption from this requirement or an extension of time for meeting this requirement is illness or disability.
  2. (b) Podiatrists who have properly retired their licenses pursuant to § 63-3-115(d) are exempt from the requirement of subsection (a).
§ 63-3-117. Application of health laws.
  1. Licensed podiatrists shall observe and be subject to all state and municipal regulations relating to the control of contagious and infectious diseases and all matters pertaining to public health, making reports to proper health officers in the same manner as other practitioners of the healing arts are required to make.
§ 63-3-118. Services provided by physician assistant or orthopedic physician assistant collaborating with podiatrist.
  1. A physician assistant collaborating with a licensed podiatrist shall not provide services that are outside of the scope of practice of a podiatrist as set forth in § 63-3-101 and may prescribe only drugs that are rational to the practice of podiatry. An orthopedic physician assistant collaborating with a licensed podiatrist shall not provide services that are outside of the scope of practice of a podiatrist as set forth in § 63-3-101.
§ 63-3-119. Suspension or revocation of license — Enforcement.
  1. (a) The board has the duty and authority to suspend for a specified time, within the discretion of the board or to revoke any license to practice podiatry or to otherwise discipline any licensee or refuse to grant any certificate of fitness whenever the licensee or applicant is found guilty of any of the following acts or offenses:
    1. (1) Fraud in procuring a license or certificate;
    2. (2) Conviction of a felony, conviction of any offense under state or federal drug laws or conviction of any offense involving moral turpitude;
    3. (3) Habitual intoxication or personal misuse of any drugs;
    4. (4) Immoral, unethical, unprofessional or dishonorable conduct;
    5. (5) Solicitation by agents or persons or profiting by the acts of those representing themselves to be agents of the licensee or the certificate holder;
    6. (6) Division of fees or agreeing to split or divide fees received for professional services with any person for bringing or referring a patient;
    7. (7) Professional connection or association with any person, firm or corporation in any manner in an effort to avoid and circumvent this chapter or lending one's name to another for the illegal practice of podiatry by such person;
    8. (8) Violation or attempted violation, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate this chapter or any lawful order of the board; issued pursuant thereto, or any criminal statute of this state;
    9. (9) Giving of testimonials, directly or indirectly, concerning the supposed virtue of secret therapeutic agents or proprietary preparations, such as remedies, vaccines or other articles or materials that are offered to the public, claiming radical cure or prevention of disease by their use;
    10. (10) Any other unprofessional or unethical conduct that may be specified by the board from time to time by means of rules and regulations duly published and promulgated by the board or the violation of any provision of this chapter;
    11. (11) Making false statements or representations or being guilty of fraud or deceit in the practice of podiatry;
    12. (12) Invasion of a field of practice in which the licensee is not licensed to practice or is not within the limits of the licensee's respective callings;
    13. (13) Dispensing, prescribing or otherwise distributing any controlled substance or any other drug not in the course of professional practice or not in good faith to relieve pain and suffering, or not to cure an ailment, physical infirmity or disease;
    14. (14) Dispensing, prescribing or otherwise distributing any controlled substance, controlled substance analogue or any other drug to any person in violation of any law of the state or of the United States;
    15. (15) Practicing podiatry under any trade name or a name designating a given location or the name of another podiatrist or any name other than that which appears on the practitioner's license or using any title other than “podiatrist”; provided, that “foot specialist” may be used as an explanatory term of the title “podiatrist” and not alone or as a substitute for the title “podiatrist”;
    16. (16) Willful violation of the rules and regulations that may be promulgated by the board of podiatric medical examiners to regulate advertising by practitioners who are under the jurisdiction of the board;
    17. (17) Making or signing in one's professional capacity any certificate that is known to be false at the time one makes or signs such certificate;
    18. (18) Engaging in the practice of podiatry when mentally or physically unable to safely do so; or
    19. (19) Gross health care liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence in the course of the practice of podiatry.
  2. (b) The board of podiatric medical examiners may adopt rules and regulations to regulate the nature, manner, content and extent of advertising by practitioners who are under the jurisdiction of the board. All methods must be allowed such as: newspaper, radio and television.
  3. (c)
    1. (1) For purposes of enforcement of this section, the board shall, upon probable cause, have authority to compel an applicant or licensee to submit to a mental and/or physical examination by a designated committee of at least three (3) practicing physicians, including a psychiatrist where a question of mental condition may be involved.
    2. (2) The applicant or licensee shall have the right to have an independent medical practitioner present during such examination and to have an independent physical or mental examination, the report of which shall be filed with the board for consideration.
    3. (3) The committee will submit a report of its findings to the board, which will then hold a hearing as provided in § 63-3-120.
  4. (d) An action taken under this section shall be subject to the applicable provisions of the Fresh Start Act that are compiled in chapter 1, part 1 of this title.
§ 63-3-120. Administrative procedure.
  1. All proceedings for disciplinary action against a licensee under this chapter shall be conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
§ 63-3-121. Enjoining violations.
  1. (a) The board, in addition to the powers and duties expressly granted by this chapter in the matter of suspension or revocation of a license and in the matter of the refusal to issue a certificate, is authorized and empowered to petition any circuit or chancery court, having jurisdiction, to enjoin any person who is practicing or attempting to practice podiatry without possessing a valid license to so practice and to enjoin any person, firm or corporation from performing any act or rendering any service that constitutes the practice of podiatry as defined by this chapter. No injunction bond shall be required of the board.
  2. (b) Jurisdiction is conferred upon the circuit and chancery courts of the state to hear and determine such causes as chancery causes and to exercise full and complete jurisdiction in such injunctive proceedings.
§ 63-3-122. District attorneys to assist board.
  1. (a) The board at all times has the power to call upon the district attorneys general for the state in the various districts to assist the board.
  2. (b) It is hereby declared to be the duty of all district attorneys general throughout the state to assist the board, upon its request, in any suit for injunction or prosecution instituted by the board without charge or additional compensation to the district attorneys general.
§ 63-3-123. Criminal penalties.
  1. (a)
    1. (1) Any person who violates any provision of this chapter commits a Class B misdemeanor.
    2. (2) Upon being convicted of any violation of any provision of this chapter, any person who again violates any of the provisions of this chapter commits a Class E felony.
  2. (b) Any person who has been enjoined by a court of competent jurisdiction from performing any acts or rendering any services that constitute the practice of podiatry as defined by this chapter who thereafter willfully violates the terms of the injunction by again performing such acts or rendering such services commits a Class E felony.
§ 63-3-124. Retail sales of foot appliances and shoes.
  1. No part or portion of this chapter shall be deemed to prohibit the usual and customary commercial sale and adjustment of foot appliances and remedies or shoes in retail stores.
§ 63-3-125. Regulations relating to X-ray procedures.
  1. (a)
    1. (1) The board shall adopt rules and regulations that establish minimum educational standards and criteria for persons operating X-ray equipment for diagnostic purposes in podiatrist offices.
    2. (2) These regulations may include, but not be limited to, provisions for grandfathering, waiver, reciprocity, renewal, continuing education, fees, examination and hardship cases.
  2. (b) After the effective date of the rules and regulations, no person shall perform X-ray procedures in a podiatrist office who does not meet these standards and who has not received a certificate of proficiency from the board.
§ 63-3-126. Cost of prosecution — Administering oaths.
  1. (a) The board shall promulgate rules governing the assessment of costs against a licensee or other person found by the board to have violated any provision of this chapter. The costs assessed by the board may include only those costs directly related to the prosecution of the charges against the licensee or other person, including investigatory costs where appropriate. The board shall determine the appropriate amount of costs, if any, to be assessed in a contested case. These costs shall be reasonable and proportionate in light of the violation committed by the licensee or other person.
  2. (b)
    1. (1) Any elected officer of the board, or any duly appointed or elected chair has the authority to administer oaths to witnesses. Upon probable cause being established, the board, by a vote of two-thirds (⅔) of the members to which the board is entitled, may issue subpoenas for the attendance of witnesses and the production of documents and records.
    2. (2) Service of a subpoena issued by the board shall be made by the sheriff of the county of residence of the licensee or person upon whom the subpoena is served.
    3. (3)
      1. (A) A licensee or person served by subpoena shall have thirty (30) days to request in writing a hearing before the board for the sole purpose of making a special appearance to quash or modify the subpoena. The subpoena for attendance of the person or the production of books and records shall be stayed until the board votes upon the request to quash or modify the subpoena. A majority vote of the members to which the board is entitled shall be required to quash or modify a subpoena.
      2. (B) A motion to appeal from a decision by the board regarding a request to quash or modify a subpoena shall be made to the chancery court in Davidson County within fifteen (15) days of such decision.
    4. (4) If any witness fails or refuses to obey a subpoena issued by it, the board is authorized to make application to any court of record in this state within the jurisdiction of which the witness is found or resides; and the court shall have power to attach the body of the witness and compel the witness to appear before the board and give testimony or produce books, records or papers as ordered. Any failure to obey the court order may be punished by the court issuing the order as a civil contempt.
    5. (5) Each witness who appears before the board by order of the board shall receive for attendance the compensation provided by law for attendance of witnesses in a court of record, which shall be paid from the funds of the board in the same manner as all other expenses of the board are paid.
§ 63-3-127. Drug prescriptions.
  1. (a) Any handwritten prescription order for a drug prepared by a podiatrist who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription. The handwritten prescription order must contain the name of the prescribing podiatrist, the name and strength of the drug prescribed, the quantity of the drug prescribed, handwritten in letters or in numerals, instructions for the proper use of the drug and the month and day that the prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing podiatrist must sign the handwritten prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home or an assisted care living facility as defined in § 68-11-201.
  2. (b) Any typed or computer-generated prescription order for a drug issued by a podiatrist who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription order. The typed or computer-generated prescription order must contain the name of the prescribing podiatrist, the name and strength of the drug prescribed, the quantity of the drug prescribed, recorded in letters or in numerals, instructions for the proper use of the drug, and the month and day that the typed or computer-generated prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing podiatrist must sign the typed or computer-generated prescription order on the day it is issued, unless it is a standing order issued in a hospital, nursing home or an assisted care living facility as defined in § 68-11-201.
  3. (c) Nothing in this section shall be construed to prevent a podiatrist from issuing a verbal prescription order.
  4. (d)
    1. (1) All handwritten, typed or computer-generated prescription orders must be issued on either tamper-resistant prescription paper or printed utilizing a technology that results in a tamper-resistant prescription that meets the current centers for medicare and medicaid service guidance to state medicaid directors regarding § 7002(b) of the United States Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, P.L. 110-28, and meets or exceeds specific TennCare requirements for tamper-resistant prescriptions.
    2. (2) Subdivision (d)(1) shall not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the doctor or other person authorized to write prescriptions writes the order into the hospital medical record and then the order is given directly to the hospital pharmacy and the patient never has the opportunity to handle the written order, a nursing home or an assisted care living facility as defined in § 68-11-201 or inpatients or residents of a mental health hospital or residential facility licensed under title 33 or individuals incarcerated in a local, state or federal correctional facility.
Part 2 Tennessee Orthotics, Prosthetics, and Pedorthics Practice Act of 2005
§ 63-3-201. Part definitions.
  1. As used in this part, unless the context otherwise requires:
    1. (1) “Board” means the board that licenses and regulates podiatrists in Tennessee in part 1 of this chapter;
    2. (2) “Commissioner” means the commissioner of health;
    3. (3) “Custom fabricated and fitted device” means an orthosis, prosthesis or pedorthic device that is fabricated to original measurements or to a mold for use by a patient in accordance with a prescription from a health care practitioner authorized by law to write such prescriptions and that requires substantial clinical and technical judgment in its design and fitting;
    4. (4) “Custom fitted device” means a prefabricated orthosis, prosthesis or pedorthic device sized or modified for use by the patient in accordance with a prescription from a health care practitioner authorized by law to write such prescriptions that requires substantial clinical judgment and substantive alteration for appropriate use;
    5. (5) “Department” means the department of health;
    6. (6) “Director” means the director of the division of health related boards;
    7. (7) “Division” means the division of health related boards;
    8. (8) “Facility” means the business location where orthotic, prosthetic or pedorthic care is provided. In the case of an orthotic/prosthetic facility, the orthotic/prosthetic facility has the appropriate clinical and laboratory space and equipment to provide comprehensive orthotic or prosthetic care; and, in the case of a pedorthic facility, the pedorthic facility has the appropriate clinical space and equipment to provide pedorthic care. Licensed orthotists, prosthetists and pedorthists must be available to either provide care or to supervise the provision of care by nonlicensed staff;
    9. (9) “Licensed orthotist” means a person who is licensed under this part to practice orthotics and who represents the person to the public by title or description of services that includes the term “orthotic,” “orthotist,” “brace” or a similar title or description of services;
    10. (10) “Licensed pedorthist” means a person who is licensed under this part to practice pedorthics and who represents the person to the public by the title or description of services that includes the term “pedorthic,” “pedorthist” or a similar title or description of services;
    11. (11) “Licensed prosthetist” means a person who is licensed under this part to practice prosthetics and who represents the person to the public by title or description of services that includes the term “prosthetic,” “prosthetist,” “artificial limb” or a similar title or description of services;
    12. (12) “Off-the-shelf device” means a prefabricated prosthesis or orthosis sized or modified for use by the patient in accordance with a prescription from a health care practitioner authorized by law to write such prescriptions that does not require substantial clinical judgment and substantive alteration for appropriate use;
    13. (13) “Orthosis” means a custom designed, fabricated, fitted or modified device to correct, support or compensate for a neuro-musculoskeletal disorder or acquired condition. “Orthosis” does not include fabric or elastic supports, corsets, arch supports, low-temperature plastic splints, trusses, elastic hoses, canes, crutches, soft cervical collars, dental appliances or other similar devices that are carried in stock and sold without modification as over-the-counter items by a drug store, department store, corset shop or surgical supply facility;
    14. (14) “Orthotic and prosthetic education program” means a course of instruction accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), consisting of:
      1. (A) An adequate curriculum of college level training and instruction in math, physics, biology, chemistry and psychology; and
      2. (B) A specific curriculum in orthotic or prosthetic courses, including:
        1. (i) Lectures covering pertinent anatomy, biomechanics, pathomechanics, prosthetic-orthotic components and materials, training and functional capabilities, prosthetic or orthotic performance evaluation, prescription considerations, etiology of amputations and disease processes necessitating prosthetic or orthotic use and medical management;
        2. (ii) Subject matter related to pediatric and geriatric problems;
        3. (iii) Instruction in acute care techniques, such as immediate and early post-surgical prosthetics and fracture bracing techniques; and
        4. (iv) Lectures, demonstrations and laboratory experiences related to the entire process of measuring, casting, fitting, fabricating, aligning and completing prostheses or orthoses;
    15. (15) “Orthotics” means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting or servicing an orthosis, under an order from a licensed health care practitioner authorized by law to issue such an order, for the correction or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury or deformity;
    16. (16) “Orthotist” means an allied health professional who is specifically trained and educated to provide or manage the provision of a custom-designed, fabricated, modified and fitted external orthosis to an orthotic patient, based on a clinical assessment and a prescription from a health care practitioner authorized by law to write such prescriptions, to restore physiological function or cosmesis;
    17. (17) “Over-the-counter device” means a prefabricated, mass-produced device that is prepackaged and requires no professional advice or judgment in either size selection or use, including fabric or elastic supports, corsets, generic arch supports and elastic hose;
    18. (18) “Pedorthic device” means therapeutic footwear, foot orthoses for use at the ankle or below and modified footwear made for therapeutic purposes, as prescribed by a licensed health care practitioner authorized by law to issue such prescription. “Pedorthic device” does not include nontherapeutic accommodative inlays or nontherapeutic accommodative footwear, regardless of method of manufacture, shoe modifications made for nontherapeutic purposes, unmodified, over-the-counter shoes or prefabricated foot care products;
    19. (19) “Pedorthic education program” means a course of instruction accredited by the Board for Certification in Pedorthics, consisting of:
      1. (A) A basic curriculum of instruction in foot-related pathology of diseases, anatomy and biomechanics;
      2. (B) A specific curriculum in pedorthic courses, including lectures covering shoes, foot orthoses and shoe modifications, pedorthic components and materials, training and functional capabilities, pedorthic performance evaluation, prescription considerations, etiology of disease processes necessitating use of pedorthic devices, medical management and subject matter related to pediatric and geriatric problems; and
      3. (C) Lectures, demonstrations, and laboratory experiences related to the entire process of measuring and casting, fitting, fabricating, aligning and completing pedorthic devices;
    20. (20) “Pedorthics” means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting or servicing a pedorthic device, under an order from a licensed health care practitioner authorized by law to issue such order for the correction or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury or deformity;
    21. (21) “Pedorthist” means a person who measures, designs, fabricates, fits or services pedorthic devices and assists in the formulation of the order of pedorthic devices, as ordered by a licensed health care practitioner authorized by law to issue such order for the support or correction of disabilities caused by neuro-musculoskeletal diseases, injuries or deformities;
    22. (22) “Person” means a natural person;
    23. (23) “Prosthesis” means a custom designed, fabricated, fitted or modified device to replace an absent external limb, for the purpose of restoring physiological function or cosmesis. “Prosthesis” does not include artificial eyes, ears or dental appliances, cosmetic devices such as artificial breasts, eyelashes or wigs or other devices that do not have a significant impact on the musculoskeletal functions of the body;
    24. (24) “Prosthetics” means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting or servicing a prosthesis, under an order from a licensed health care practitioner authorized by law to issue such order;
    25. (25) “Prosthetist” means an allied health professional who is specifically trained and educated to provide or manage the provision of a custom designed, fabricated, modified and fitted external limb prosthesis to a prosthetic patient, based on a clinical assessment and a prescription from a health care practitioner authorized to write such prescriptions, to restore physiological function or cosmesis;
    26. (26) “Prosthetist/Orthotist” means a person who practices both disciplines of prosthetics and orthotics and who represents the person to the public by title or by description of services; and
    27. (27) “Resident” means a person who has completed an education program in either orthotics or prosthetics and is continuing such person's clinical education in a residency program approved by the board.
§ 63-3-202. Rules and regulations — Authority of the board.
  1. (a) The board shall adopt rules and regulations, promulgated in compliance with all requirements of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to:
    1. (1) Establish licensure categories and issue licenses for prosthetists, orthotists and pedorthists;
    2. (2) Establish the qualifications, educational courses, curriculum, hours and standards that are prerequisite to issuance of all levels and types of licensure established pursuant to subdivision (a)(1); provided, however, that such qualifications shall include the following:
      1. (A) To qualify for a license to practice orthotics or prosthetics, a person shall:
        1. (i) Possess a baccalaureate degree or semester hours equivalent to four (4) years of study at a four-year college or university;
        2. (ii) Complete the amount of formal training, including, but not limited to, any necessary hours of classroom education and clinical practice required by the board;
        3. (iii) Complete a clinical residency in the professional area for which a license is sought, in accordance with standards, guidelines, or procedures for residencies inside or outside this state established and approved by the board. The majority of training shall be devoted to services performed under the supervision of a licensed practitioner of orthotics or prosthetics or a person who has obtained certification from the American Board for Certification in Orthotics and Prosthetics, Inc. or the Board for Orthotist/Prosthetist Certification;
        4. (iv) Pass all written, practical and oral examinations that are required and approved by the board; and
        5. (v) Be qualified to practice in accordance with commonly accepted standards of orthotic and prosthetic care acceptable to the board;
      2. (B) To qualify for a license to practice pedorthics, a person shall:
        1. (i) Possess a high school diploma or comparable credential approved by the board;
        2. (ii) Complete the amount of formal training, including, but not limited to, any necessary hours of classroom education and clinical practice required by the board;
        3. (iii) Pass all examinations that are required and approved by the board;
        4. (iv) Complete a qualified work experience program or internship in pedorthics, in accordance with standards and procedures established by the board; and
        5. (v) Be qualified to practice in accordance with commonly accepted standards of pedorthic care acceptable to the board; and
      3. (C) A person may be licensed in more than one (1) discipline;
    3. (3) Establish the circumstances or conditions, if any, under which persons shall be entitled to exemption from licensure during training, while waiting to take or receive the results of any required examination or upon meeting specified minimum educational and clinical qualifications;
    4. (4) Select the examination or examinations to be utilized as the board's licensure examination or examinations and the prerequisites, if any, for admission to the examination or examinations. The board is authorized to enter into a contract or agreement with the chosen examination service or services or select an intermediary between the board and the examination service or services to process applicants for the examination or examinations;
    5. (5) Establish any other criteria for issuance of licensure that are reasonably related to the safe and competent performance of prosthetics, orthotics and pedorthics;
    6. (6) Accredit continuing education courses;
    7. (7)
      1. (A) Establish the fees to be paid for each of the following:
        1. (i) Application for licensure;
        2. (ii) Renewal or reinstatement of licensure;
        3. (iii) Late renewal of licensure;
        4. (iv) Application for continuing education course accreditation; and
        5. (v) Duplicate or replacement license;
      2. (B) The fees shall be set at a level that is adequate to pay all of the expenses of implementing and administering this part. All deposits and disbursements shall be handled in accordance with § 63-1-137;
    8. (8) Establish the continuing education requirements for license holders, which shall include the frequency of reporting, number of hours, types of courses, approval of courses, methods of proving compliance, penalties for violation and all fees necessary for implementation of the continuing education process;
    9. (9) Regulate the nature, manner, content and extent of advertising by persons licensed under this part;
    10. (10) Delineate the actions relative to therapeutic footwear and medical devices for the foot and ankle that must be performed by licensed health care practitioners; and
    11. (11) Establish a registration process for residents as prescribed in § 63-3-209(2)(B).
  2. (b) The board shall have the authority to:
    1. (1) Conduct disciplinary hearings, in accordance with the Uniform Administrative Procedures Act; and
    2. (2) [Deleted by 2024 amendment.]
§ 63-3-203. Licensing.
  1. (a) Licenses shall be issued and renewed by the board pursuant to the division's biennial issuance and renewal system.
  2. (b) Any person who has been issued a license to practice under this part and who wishes to retire that license shall file with the board an affidavit, on a form to be furnished by the board, stating the date on which the person retired from such practice and such other facts that tend to verify such retirement, as the board deems necessary. Any person who wishes to reenter practice after retiring such person's license must request reinstatement of licensure.
  3. (c) Any license issued by the board shall contain the name of the person to whom it is issued, the address of the person, the date and number of the license and such other information as the board deems necessary. The address contained on the license shall be the address where all correspondence and renewal forms from the board shall be sent. Any person whose address changes shall, within thirty (30) days after the address change, notify the board of the address change. The most recent address contained in the board's records for each license holder shall be the address deemed sufficient for purposes of service of process.
  4. (d) Every person issued a license pursuant to this part shall either keep such license prominently displayed in the office or place in which such person practices or have it stored in a place from which it can be immediately produced upon request of a patient or a representative of the department.
  5. (e) Any person whose license has been lost or destroyed may make application to the board for a replacement. Such application shall be accompanied by an affidavit setting out the facts concerning the loss or destruction of the original license.
  6. (f) Any person whose name is changed by marriage or court order may surrender the person's license and apply to the board for a replacement license.
§ 63-3-204. Powers of the board.
  1. (a) The board shall have the power to:
    1. (1) Deny, restrict or condition a license;
    2. (2) Permanently or temporarily withhold issuance of a license;
    3. (3) Suspend, limit or restrict a previously issued license, for such time and in such manner as the board may determine;
    4. (4) Reprimand, suspend, revoke or take such other disciplinary action in relation to an applicant or license holder as the board, in its discretion, may deem proper; or
    5. (5) Permanently revoke a license.
  2. (b) The grounds upon which the board shall exercise such power include, but are not limited to, circumstances in which the person:
    1. (1) Is guilty of fraud or deceit in the procurement or holding of the license;
    2. (2) Has been convicted of a felony in a court of competent jurisdiction, either within or outside of this state, unless the conviction has been reversed and the holder of the license discharged or acquitted or if the holder has been pardoned with full restoration of civil rights, in which case the license shall be restored;
    3. (3) Is or has been afflicted with any medical problem, disability or addiction that, in the opinion of the board, would impair professional competence;
    4. (4) Has knowingly aided and abetted a person who is not a license holder or is not otherwise authorized pursuant to this chapter to perform the duties of a license holder under this chapter;
    5. (5) Has undertaken or engaged in any practice beyond the scope of duties permitted a license holder under this chapter;
    6. (6) Has impersonated a license holder or former license holder or is under an assumed name performing the duties authorized to be performed only by a licensed person;
    7. (7) Has been found guilty of violations of a code of ethics, which the board shall establish by regulation;
    8. (8) Is or has been found guilty of incompetence or negligence in performance as a license holder;
    9. (9) Acts in a manner unprofessional, dishonorable or unethical or has been found guilty of unprofessional, dishonorable or unethical conduct;
    10. (10) Violates, or attempts to violate, directly or indirectly, or assists or aids in the violation of, or conspires to violate, any provision of this chapter or any lawful order of the board issued pursuant to this chapter or any of the rules or regulations promulgated pursuant to this chapter, or any criminal statute of the state;
    11. (11) Is habitually intoxicated or engages in personal misuse of any drugs or the use of intoxicating liquors, narcotics, controlled substances, controlled substance analogues or other drugs or stimulants in such manner as to adversely affect the person's ability to practice; or
    12. (12) Has received disciplinary action from another state or territory of the United States that has licensed or certified the person to practice in that state for any acts or omissions that would constitute grounds for discipline of a person licensed in this state. A certified copy of the initial or final order, or other equivalent document memorializing the disciplinary action from the disciplining state or territory, shall constitute prima facie evidence of violation of this section and shall be sufficient grounds upon which to deny, restrict or condition licensure or renewal or to discipline a person licensed in this state.
  3. (c) An action taken under this section shall be subject to the applicable provisions of the Fresh Start Act that are compiled in chapter 1, part 1 of this title.
§ 63-3-205. Application.
  1. (a) On and after January 1, 2008, no person shall practice orthotics, prosthetics or pedorthics in this state, or hold out as being able to practice either profession, or dispense an orthosis, prosthesis or pedorthic device, unless such person is licensed in accordance with the requirements of this part.
  2. (b) Until January 1, 2008, a person certified by the American Board for Certification in Orthotics and Prosthetics, Inc., with the title of Certified Orthotist (CO), Certified Prosthetist (CP) or Certified Orthotist-Prosthetist (CPO), or by the Board for Orthotist/Prosthetist Certification with the title of Board of Orthotic Certification — Orthotist (BOCO) or Board of Certification — Prosthetist (BOCP), or holding similar certifications from other accrediting bodies with equivalent educational requirements and examination standards, may apply for and may be granted orthotic or prosthetic licensure under this part, upon payment of the required fee. After January 1, 2008, any applicant for initial licensure as an orthotist or a prosthetist shall meet the requirements of this part regarding license.
  3. (c) Until January 1, 2008, a person certified as a Certified Pedorthist (CPED) by the Board of Certification in Pedorthics, Inc., or a person certified as a CO, CP or CPO by the American Board for Certification in Orthotics and Prosthetics, Inc., or certified as a BOCO or BOCP by the Board for Orthotist/Prosthetist Certification, or holding similar certifications from other accrediting bodies with equivalent educational requirements and examination standards, may apply for and may be granted pedorthic licensure under this part, upon payment of the required fee. After that date, any applicant for initial licensure as a pedorthist shall meet the requirements of this part regarding licensure.
  4. (d) Notwithstanding any other provision of this part to the contrary, a person who has practiced full time for a minimum of the past five (5) years in a prosthetic/orthotic facility as an orthotist or prosthetist or in a pedorthic facility as a pedorthist may file an application with the board before January 1, 2007, in order to continue to practice orthotics, prosthetics or pedorthics and may be issued a license to practice orthotics, prosthetics or pedorthics under this part without examination, upon receipt by the division of payment of the licensing fee required and after the board has completed an investigation of the applicant's work history. The investigation may include, but is not limited to, completion by the applicant of a questionnaire regarding the applicant's work history and scope of practice.
§ 63-3-206. Order from licensed health care provider required to provide care or services.
  1. A licensed orthotist, prosthetist or pedorthist may provide care or services only if the care or services are provided pursuant to an order from a licensed health care practitioner authorized to issue such an order.
§ 63-3-207. Scope of practice.
  1. (a) The scope of practice of a licensed orthotist, prosthetist or pedorthist shall not include the right to diagnose a medical problem or condition or the right to give medical advice as to the nature, cause or treatment for the problem or condition for which the orthotic, prosthetic or pedorthic device is being dispensed; however, the scope of practice of a licensed orthotist, prosthetist or pedorthist does include the right to provide information or demonstration regarding the proper use and care of the device and to make adjustments to the device as needed.
  2. (b) No person shall dispense or sell an over-the-counter or off-the-shelf device based upon an image of the customer's limb captured by the person through a mold, cast, scanning device, digital appliance, or pressure sensitive device, unless the customer has first presented to that person a written prescription for that device from a health care practitioner authorized by law to write such a prescription.
§ 63-3-208. Interpretation of part.
  1. (a) Nothing in this part or in the rules adopted by the board pursuant to this part shall be interpreted to limit or restrict a health care practitioner licensed under this title from engaging in the full scope of practice of such person's profession, training or services. Nothing in this part or in the rules adopted by the board pursuant to this part shall be interpreted or permitted to limit or restrict individuals acting under the supervision and control of a pharmacist or pharmacy licensed under this title or home medical equipment provider licensed under title 68 from measuring, fitting or adjusting any non-custom-fabricated and fitted device, including, but not limited to, over-the-counter or off-the-shelf devices, so long as such individual does not create a cast, mold or scan of a part of the human body for the purpose of constructing a medical device to treat a patient's medical condition and so long as such individual meets one (1) of the following criteria for such device:
    1. (1) Documented training from a manufacturer or training from a licensed or certified orthotist, prosthetist or pedorthist;
    2. (2) Certification or registration as a fitter of orthotic, prosthetic or pedorthic devices from a nationally recognized board or association such as the Board for Orthotist/Prosthetist Certification (BOC), the Board of Certification for Pedorthists, the National Community Pharmacists Association (NCPA) or the American Board for Certification in Orthotics and Prosthetics (ABC); or
    3. (3) Direct supervision by a trained and experienced, or certified or registered, fitter of orthotic, prosthetic or pedorthic devices.
  2. (b) Nothing in this part or in the rules adopted by the board pursuant to this part shall be interpreted or permitted to limit or restrict individuals acting under the supervision and control of a pharmacist or pharmacy licensed under this title or home medical equipment provider licensed under title 68 from measuring, fitting or adjusting any non-custom-fabricated and fitted pedorthic devices, including, but not limited to, diabetic shoes, so long as such individual meets the criteria of either subdivision (a)(2) or (a)(3) and so long as the individual does not create a cast, mold or scan of a part of the human body for the purpose of constructing a medical device to treat a patient's medical problem.
§ 63-3-209. Construction of part.
  1. Nothing in this part shall be construed to restrict:
    1. (1) The practice of orthotics, prosthetics or pedorthics by a person who is employed by the federal government or any bureau, division or agency of the federal government while in the discharge of the employee's official duties;
    2. (2) The practice of orthotics, prosthetics or pedorthics by:
      1. (A) A student enrolled in a school of orthotics, prosthetics or pedorthics;
      2. (B) A resident continuing such resident's clinical education in a residency accredited by the National Commission on Orthotic and Prosthetic Education; provided, that such person has first registered as a resident with the board; or
      3. (C) A student in a qualified work experience program or internship in pedorthics; or
    3. (3) The measuring, fitting or adjusting of an orthotic device by an employee or authorized representative of an orthosis manufacturer registered with the federal food and drug administration, when such employee or representative is supervised by a licensed health care professional authorized by law to prescribe, measure or fit such device, and the measuring, fitting or adjusting of such device occurs in the office of such licensed health care professional or in a health care facility.
§ 63-3-210. Violation of part.
  1. (a) Any person who practices in this state without having first complied with this part commits a Class C misdemeanor; provided, however, that, for a period of one (1) year after January 1, 2006, an offense under this section shall only result in a warning and such person shall have thirty (30) days to comply with this part.
  2. (b) The board of registration in podiatry shall inform persons to be regulated by this part of the regulations to be imposed by this part.
§ 63-3-211. Injunction — Jurisdiction.
  1. (a) The board is authorized to petition any circuit or chancery court having jurisdiction over any person who is practicing without a license, or to whom a license has been denied or whose license has been suspended or revoked by action of the board to enjoin such person from continuing to practice within this state.
  2. (b) Jurisdiction is conferred upon the circuit and chancery courts of this state to hear and determine all such causes and to exercise full and complete jurisdiction in such injunctive proceedings.
§ 63-3-212. Screening panels in investigative and disciplinary process.
  1. (a) The board may utilize one (1) or more screening panels in its investigative and disciplinary process, to assure that complaints filed and investigations conducted are meritorious and to act as a mechanism for resolution of complaints or diversion to professional peer review organizations or impaired professionals' associations or foundations of those cases that the board, through established guidelines, deems appropriate.
  2. (b) The screening panel has the authority to administer oaths to witnesses.
  3. (c) Members of a screening panel may be drawn from the membership of the board or may be appointed by the board. Nonboard members shall meet the requirements of membership on the board and may include a consumer member. A board member serving on a panel shall not participate in a contested case involving any matter heard by the panel.
§ 63-3-213. Appointments to the board.
  1. (a) To assist in the implementation and administration of this part, the governor shall initially appoint to the board one (1) person who is eligible for licensure as an orthotist, or prosthetist or pedorthist.
  2. (b) That person's term of office on the board shall be three (3) years. Upon expiration of that person's term, the governor shall appoint a person licensed under this part to fill this position on the board.
  3. (c) A person may serve more than one (1) term in this position on the board.
  4. (d) The governor may remove this member of the board from office for neglect of duties, malfeasance in office, incompetence or professional misconduct.
  5. (e) The governor may fill a vacancy in this position upon the member's resignation or death.
  6. (f) In making appointments to this position on the board, the governor shall consider persons recommended by the professional organization of orthotists, prosthetists and pedorthists in Tennessee.
  7. (g) The person filling this position on the board shall receive the same per diem and reimbursement for travel and other necessary expenses that is received by other members of the board.
  8. (h) The person filling this position shall have the right to vote on all matters considered by the board.
§ 63-3-214. Use of non-licensed persons.
  1. A licensed orthotist or prosthetist may utilize one (1) or more non-licensed persons to assist in:
    1. (1) The performance of minor repairs on devices which have been previously dispensed to patients; and
    2. (2) The performance of other tasks approved by the board of podiatric medical examiners.
Chapter 4 Chiropractors
§ 63-4-101. Practice of chiropractic — Education and clinical training — Scope of practice.
  1. (a)
    1. (1) As used in this chapter, unless the context otherwise requires:
      1. (A) “Diagnosis” means:
        1. (i) The differential diagnosis of human ailments through examination and evaluation of patients and through diagnostic procedures necessary to clinically correlate a physical examination to a diagnostic impression;
        2. (ii) The ordering of X-rays, advanced diagnostic imaging, and other diagnostic procedures;
        3. (iii) The performance of X-rays and other non-invasive diagnostic procedures, as well as minimally invasive procedures for which the chiropractic physician has received training by an institution accredited by the Council on Chiropractic Education or its successor and which have been approved by the board of chiropractic examiners after consultation with the board of medical examiners; and
        4. (iv) The collection of blood, urine, saliva, and hair for analysis; provided, however, venipuncture shall only be done by a phlebotomist or other person who is properly trained to draw blood;
      2. (B) “Differential diagnosis” means the examination of body systems and structures of a patient to determine the source, nature, and extent of a disease or other physical condition for the purpose of establishing an appropriate plan of care for the patient, which may include referral to another provider for care that is outside the scope of practice of a chiropractic physician;
      3. (C) “Practice of chiropractic” means the diagnosis and treatment of patients, as defined in subdivisions (a)(1)(B) and (a)(1)(D); and
      4. (D) “Treatment” means:
        1. (i) The treatment of neuromuscular, musculoskeletal, and related conditions through the use of chiropractic adjustment and manipulation; physical agent modalities; manual, rehabilitative, and other therapeutic care; and mechanical, chemical, electrical, and thermal methods;
        2. (ii) The use of acupuncture by a chiropractic physician who has completed two hundred fifty (250) hours of an accredited acupuncture course and has passed the National Board of Chiropractic Examiners Acupuncture Exam;
        3. (iii) The location and removal of interference with nerve transmission and nerve function;
        4. (iv) The making of appropriate referrals to other healthcare professionals for conditions that are outside the scope of practice of a chiropractic physician;
        5. (v) The ordering of durable medical equipment for patients who need such equipment to assist in the restoration of their health under the plan of care for treatment of their neuromuscular, musculoskeletal, and related conditions; and
        6. (vi) The provision of supportive care with due regard for nutrition, hygiene, sanitation, and rehabilitation designed to assist in the restoration and maintenance of a patient's health.
    2. (2) Nothing in this chapter authorizes a chiropractic physician to engage in the practice of medicine and surgery or osteopathy, as defined in chapters 6 and 9 of this title, or to prescribe legend drugs or controlled substances.
  2. (b) As used in this chapter, “chiropractic physician” means a person who is a graduate of a chiropractic college accredited by the Council on Chiropractic Education or its successor, or is a graduate of an international chiropractic college approved by the board of chiropractic examiners, and who has received a license issued by the board of chiropractic examiners.
  3. (c)
    1. (1) No person licensed under this title may perform a spinal manipulation or spinal adjustment without first having the legal authority to differentially diagnose and having received a minimum of four hundred (400) hours of classroom instruction in spinal manipulation or spinal adjustment and a minimum of eight hundred (800) hours of supervised clinical training at a facility where spinal manipulation or spinal adjustment is a primary method of treatment. “Spinal manipulation” and “spinal adjustment” are interchangeable terms that identify a method of skillful and beneficial treatment where a person uses direct thrust to move a joint of the patient's spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity. A violation of this section is an unlawful practice of chiropractic and is grounds for the offending health care provider's licensing board to suspend, revoke or refuse to renew such provider's license or take other disciplinary action allowed by law.
    2. (2) Nothing in this subsection (c) shall in any way apply to the scope of practice of:
      1. (A) An osteopathic physician licensed under chapter 9 of this title; or
      2. (B) Any person who practices medicine or surgery who is licensed under chapter 6 of this title.
§ 63-4-102. Board — Members and officers — Terms of appointment — Quorum — Administrative support.
  1. (a) There shall be a board of chiropractic examiners, referred to as “board” in this chapter, consisting of five (5) chiropractic physicians, residents in Tennessee who have been actively engaged in the practice of their profession in Tennessee for a period of at least five (5) years, one (1) member who is a chiropractic X-ray technician or chiropractic therapy assistant and who has been certified in this state for not less than two (2) years, and one (1) consumer member who is not affiliated with the practice of chiropractic. The members of the board shall be appointed by the governor and shall hold office for a term of five (5) years commencing on May 1 and expiring on April 30, five (5) years thereafter.
  2. (b) All vacancies occurring on the board by reason of death or resignation shall be filled by the governor for the unexpired term.
  3. (c) In making appointments to the board, the governor shall strive to ensure that at least one (1) person serving on the board is sixty (60) years of age or older and that at least one (1) person serving on the board is a member of a racial minority.
  4. (d) In order to stagger the terms of office, for the year 2000 the governor shall appoint the board members for transition terms in the following manner:
    1. (1) One (1) chiropractic physician and one (1) consumer member for one (1) year with the term to expire on April 30, 2001;
    2. (2) One (1) chiropractic physician for a two-year term to expire on April 30, 2002;
    3. (3) One (1) chiropractic physician for a three-year term to expire on April 30, 2003;
    4. (4) One (1) chiropractic physician and one (1) consumer member for a four-year term to expire April 30, 2004; and
    5. (5) One (1) chiropractic physician for a five-year term to expire April 30, 2005.
  5. (e) Any person appointed shall be eligible for successive appointments, in the discretion of the governor, and all members shall hold office until the appointment of their successors.
  6. (f) No chiropractor shall be eligible for appointment unless such chiropractor is actively engaged in the practice of the profession of chiropractic within this state.
  7. (g) Further, no persons shall be eligible for appointment on the board who at the time are actively engaged in the practice, or holding themselves out as practitioners, of any other branch of the healing arts.
  8. (h) The governor has the discretion to seek recommendations and nominations from the Tennessee Chiropractic Association in making appointments to the board.
  9. (i) The board is authorized to annually elect from among its members a president, vice president and secretary and to create such officers it deems necessary for its efficient operations. Four (4) members of the board shall constitute a quorum, and a majority of those present shall be necessary to pass or reject any official business.
  10. (j) The board shall be provided administrative support by the division of health related boards, referred to as the “division” in this chapter.
§ 63-4-103. Powers and duties of board.
  1. It is the duty of the board to:
    1. (1) Examine applicants and have licenses issued to practice chiropractic to all applicants who have successfully passed the examination approved by the board or whose applications for license by reciprocity have been acted upon favorably by the board;
    2. (2) Conduct hearings to revoke or suspend any license or certificate under the authority of this or any previous laws authorizing the holder thereof to practice chiropractic for violations by the licensee of any of the provisions of this chapter; and
    3. (3) Sponsor, conduct or approve such educational programs as are necessary to carry out and make effective this chapter.
    4. (4) [Deleted by 2024 amendment.]
§ 63-4-104. Meetings of board.
  1. The board shall hold one (1) regular meeting in each year and such additional meetings at such times and places as it may determine.
§ 63-4-105. Disposition of fees — Operating expenses — Compensation.
  1. (a) All fees and moneys from whatever source coming into the hands of the board shall be paid by the board to the state treasurer and become a part of the general fund.
  2. (b) The commissioner of finance and administration shall make allotments out of the general fund for the proper expenditures of the board, and no expenditure may be made by the board until the allotment for the expenditure has been made by the commissioner. The allotments for the operation of the board shall be disbursed under the general budgetary laws of the state.
  3. (c) Each member of the board shall receive one hundred dollars ($100) per diem when actually engaged in the discharge of that member's official duties and, in addition, be reimbursed for all travel and other necessary expenses. The secretary of the board shall, in lieu of the per diem provided by this section, receive a salary not to exceed one hundred dollars ($100) per month as set annually by the board. All reimbursement for travel expenses shall be in accordance with the comprehensive travel regulations as promulgated by the department of finance and administration and approved by the attorney general and reporter.
§ 63-4-106. Rules and regulations.
  1. The board is authorized to adopt such rules and regulations as are necessary to carry out and enforce this chapter and that are consistent with this chapter. Rules and regulations of the board shall be subject to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
§ 63-4-107. License requirement.
  1. It is unlawful for any person to practice chiropractic within this state without having procured a license.
§ 63-4-108. Eligibility for licensure.
  1. Any person of good moral character is eligible for licensure, if that person:
    1. (1) Is a graduate of a chiropractic college having status with the commission on accreditation of the Council on Chiropractic Education, or its successor, or graduated from an international chiropractic college approved by the board;
    2. (2) Has attended a chiropractic college for four (4) school years of not less than nine (9) months each; and
    3. (3) Submits to the board proof of additional parachiropractic education as follows:
      1. (A) For applicants matriculating in a chiropractic college prior to year 2000, the applicant must provide a transcript of grades showing a minimum of two (2) full academic years of college or university work of at least sixty (60) semester hours or its equivalent from an accredited institution; or
      2. (B) For applicants matriculating in a chiropractic college in year 2000 and beyond, proof that a bachelor's level education or its equivalent has been obtained from an accredited college or university.
§ 63-4-109. Application for licensure.
  1. (a) Application for licensure shall be made to the board in writing or via online application.
  2. (b) The application shall be accompanied by the applicant's photograph and shall state the name, age, sex and place of residence of the applicant, the name and location of the school or college from which the applicant was graduated, the length of time devoted to the study of chiropractics and the date of graduation.
  3. (c) All applications shall be signed and sworn to by the applicant.
  4. (d)
    1. (1) When the board receives a completed application for initial licensure from an applicant, then the board shall, within sixty (60) days from the date the board receives the completed application:
      1. (A) Render a decision on the application; or
      2. (B) Inform the applicant of the need to appear before the board.
    2. (2) As used in this subsection (d), “completed application” means an application that satisfies all statutory and board rule requirements.
§ 63-4-110. Examination.
  1. The examination of applicants for a license to practice chiropractic will consist of the national board examination as directed by the board. Each applicant must successfully pass all examinations before receiving a license to practice.
§ 63-4-111. Reciprocity.
  1. (a) Applicants possessing a valid unrestricted license to practice chiropractic in another state or other regulated jurisdiction for a period of two (2) full years are not required to be examined pursuant to § 63-4-110 and may obtain a license by fulfilling the following:
    1. (1) Providing documentation from the state or jurisdiction of prior practice attesting to the length of time in practice, together with any disciplinary action taken against the licensee while in practice;
    2. (2) Passing the Special Purposes Examination for Chiropractors (SPEC) by the national board or its successor; and
    3. (3) Fulfilling all other requirements of this chapter.
  2. (b)
    1. (1) When the board receives a completed application for licensure from an applicant who is licensed in another state or territory of the United States or in the District of Columbia, then the board shall, within sixty (60) days from the date the board receives the completed application:
      1. (A) Render a decision on the application; or
      2. (B) Inform the applicant of the need to appear before the board.
    2. (2) As used in this subsection (b), “completed application” means an application that satisfies all statutory and board rule requirements.
§ 63-4-112. Registration and renewal — Continuing education — Reinstatement — Retirement.
  1. (a) Each licensed practitioner of chiropractic shall register the practitioner's license and renew the practitioner's certificate of registration as provided in §§ 63-1-107 and 63-1-108.
  2. (b) In addition, every licensed chiropractor shall apply to the board for a renewal of the licensed chiropractor's certificate of fitness and pay a renewal fee as set annually by the board. Each application shall be made on a form to be furnished by the board.
  3. (c)
    1. (1) The board shall renew such licensee's certificate of fitness upon application made in due form and upon payment of all required fees.
    2. (2)
      1. (A) When requested, licensees shall provide the board satisfactory proof of the licensee's attendance at a chiropractic education program or programs conducted by either the American Chiropractic Association, the International Chiropractors Association, the Tennessee Chiropractic Association, or any other educational program approved or conducted by the board which consists of the minimum number of hours established hereunder for the period beginning the preceding January 1. Prior approval of such a course may be obtained by submitting the following information to the board's administrative office at least thirty (30) days prior to the scheduled date of the course:
        1. (i) A course description or outline;
        2. (ii) Names of all lecturers;
        3. (iii) Brief resume of all lecturers;
        4. (iv) Number of hours of educational credit requested;
        5. (v) Date of course;
        6. (vi) Copies of materials to be utilized in the course; and
        7. (vii) How verification of attendance is to be documented.
      2. (B) Each chiropractic physician must retain independent documentation of continuing education hours attained for a period of four (4) years from the end of the calendar year in which the training is received. Such proof must be produced for inspection and verification, if requested in writing by the board during its verification process.
    3. (3) The minimum number of hours of required continuing education shall be at least twelve (12) hours in any calendar year.
    4. (4) The board may, in its sole discretion, waive the annual education requirement in cases of retirement, certified illness, disability or other undue hardships.
  4. (d)
    1. (1) When any such licensee fails to renew the licensee's certificate of fitness and pay the annual renewal fee within sixty (60) days after renewal becomes due as provided in this section and/or fails to meet the annual education requirements of this section, the license of such person shall be automatically revoked at the expiration of sixty (60) days after the renewal was required, without further notice or hearing.
    2. (2) Any person whose license is automatically revoked as provided in this subsection (d) may make application in writing to the board for the reinstatement of such license, and, upon good cause being shown, the board, in its discretion, may reinstate such license upon the payment of all past due fees and the payment of fifty dollars ($50.00) and upon further conditions as the board may require.
  5. (e) Any person licensed to practice by this chapter who has retired or may hereafter retire from such practice in this state shall not be made to register as required by this chapter if such person files with this board an affidavit on a form to be furnished by the board, which affidavit shall state the date on which such person retired from such practice and such other facts as shall tend to verify such retirement as the board shall deem necessary. If such person thereafter desires to reengage in such practice in this state, such person shall apply for reinstatement with the board on a form provided by the board, provide proof of continuing education as established by the board and shall meet other requirements as may be set by the board.
§ 63-4-113. Applicability of health laws — Birth certificates prohibited.
  1. (a) Chiropractic practitioners shall observe and be subject to all state and municipal regulations relating to the control of contagious and infectious diseases and any and all matters pertaining to public health, reporting to proper health officers the same as other practitioners.
  2. (b) Nothing in this chapter shall permit any chiropractor to make or execute a birth certificate.
§ 63-4-114. Denial, suspension or revocation of license or certificate.
  1. (a) The board has the duty and authority to suspend for a specified time, within the discretion of the board, or to revoke any license to practice chiropractic, or to otherwise discipline any licensee or refuse to grant any certificate of fitness, whenever the licensee or applicant is found guilty of any of the following acts or offenses:
    1. (1) Fraud in procuring a license or certificate;
    2. (2) Conviction of a felony for violations of any law of the state or of the United States;
    3. (3) Habitual intoxication or personal misuse of any drugs or the use of intoxicating liquors, narcotics, controlled substances, controlled substance analogues or other drugs or stimulants in such manner as to adversely affect the person's ability to practice chiropractic;
    4. (4) Immoral, unethical, unprofessional or dishonorable conduct;
    5. (5)
      1. (A) In-person solicitation, telemarketing, or telephonic solicitation by licensees, employees of licensees, agents of licensees, or independent contractors of licensees to victims of an accident or disaster, unless it is a victim with whom a licensee has a family or prior professional relationship, shall be considered unethical if carried out within thirty (30) days of the accident or disaster;
      2. (B) Telemarketing transcripts shall be maintained for a period of two (2) years following their utilization;
      3. (C) A log of contacts shall be maintained for a period of two (2) years following a telemarketing encounter; and
      4. (D) This subdivision (5) shall not prohibit solicitation by targeted direct mail advertising or other forms of written, radio, or television advertising; provided, that the advertising does not involve coercion, duress, or harassment and is not false, deceptive, or misleading;
    6. (6) Division of fees or agreeing to split or divide fees received for professional services with any person for bringing or referring a patient;
    7. (7) Professional connection or association with any person, firm or corporation in any manner in an effort to avoid and circumvent this chapter or lending one's name to another for the illegal practice of chiropractic by such person;
    8. (8) Rebating or offering to rebate to an insured any payment by the insured's third-party payor to the licensee for services or treatments rendered under the insured's policy;
    9. (9) Submitting to any third-party payor a claim for a service or treatment at an inflated fee or charge or a greater fee or charge than the usual fee the licensee charges for that service or treatment when the service or treatment is rendered without third-party reimbursement;
    10. (10) Submitting to any third-party payor a claim for a service or treatment at a fee or charge in an amount greater than that advertised for such service or treatment at the time of the rendering of the service or treatment that is the subject matter of the claim;
    11. (11) Knowingly or purposefully incorrectly reporting services rendered, reporting incorrect treatment dates or reporting charges for services not rendered for the purpose of obtaining payment from a third-party payor;
    12. (12) Any other unprofessional or unethical conduct that may be specified by the board from time to time by means of rules and regulations duly published and promulgated by the board or the violation of any provision of this chapter;
    13. (13) The advertising of chiropractic business in which untrue or misleading statements are made or causing the publication or circulation of fraudulent advertising relative to any disease, human ailment or condition;
    14. (14) Invasion of a field of practice in which the licensee is not licensed to practice or is not within the limits of the licensee's respective callings as determined by the board;
    15. (15) Gross health care liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence in the course of chiropractic practice; and
    16. (16) Making false, fraudulent, misleading, extravagant or grossly improbable claims or statements as to the efficacy or value of the science or practice of chiropractic.
  2. (b) An action taken under this section shall be subject to the applicable provisions of the Fresh Start Act that are compiled in chapter 1, part 1 of this title.
§ 63-4-115. Procedure for suspension, revocation or denial of certificate or license.
  1. (a) In enforcing this section, the board shall, upon probable cause, have the authority to compel an applicant or licensee or certificate holder to submit to a mental and/or physical examination, by a designated committee of at least three (3) practicing physicians, including a psychiatrist where a question of mental condition is involved. The applicant or licensee or certificate holder may have an independent physical or mental examination, which examination report shall be filed with the board for consideration. The committee will submit a report of its findings to the board for use in any hearing that may thereafter ensue.
  2. (b) The board, on its own motion, may investigate any report indicating that a chiropractor is or may be in violation of this chapter. Any chiropractor, any chiropractic society or association or any other person who in good faith shall report to the board any information that a chiropractor is or may be in violation of any provisions of this chapter shall not be subject to suit for civil damages as a result thereof.
  3. (c) All proceedings by the board to deny a certificate of fitness, to revoke or suspend any certificate of fitness or license or to otherwise discipline a licensee shall be subject to and conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
  4. (d) An elected officer of the board and a hearing officer, arbitrator or mediator, if any, has the authority to administer oaths to witnesses and, upon probable cause being established, issue subpoenas for the attendance of witnesses and the production of documents and records.
  5. (e) The board may utilize one (1) or more screening panels in its investigative and disciplinary process to assure that complaints filed and investigations conducted are meritorious and to act as a mechanism for diversion to professional peer review organizations and/or impaired professionals, associations or foundations those cases that the board, through established guidelines, deems appropriate. Upon diversion, such entities shall retain the same immunity as provided by law for the board.
  6. (f) The screening panels shall consist of as many members as the board directs, but shall include at least one (1) but no more than three (3) licensed chiropractors, who may be members of the board or may serve either voluntarily or through employment by or under contract with the board.
  7. (g) The activities of the screening panels and any mediation or arbitration sessions shall not be construed as meetings of an agency for purposes of the open meetings laws, compiled in title 8, chapter 44, and shall remain confidential. The members of the screening panels, mediators and arbitrators have a deliberative privilege and the same immunity as provided by law for the board and are not subject to deposition or subpoena to testify regarding any matter or issues raised in any contested case, criminal prosecution or civil lawsuit that may result from or be incident to cases processed before them.
  8. (h) Notwithstanding any provision of the Uniform Administrative Procedures Act to the contrary, hearing officers are authorized to and may hear board mediation, arbitration or disciplinary contested cases, but may not issue final orders in contested case matters. Notwithstanding any of §§ 4-5-314 and 4-5-315, that may be or are inconsistent, such hearing officers may only issue findings of fact and conclusions of law, which shall be referred directly to the board or a duly constituted panel thereof for final action. The board or duly constituted panel, after hearing testimony or arguments from both parties regarding the appropriate disciplinary action and, if allowed by the board, arguments on any controversy raised by the hearing officer's or designee's order, shall issue a final order to include the imposition of what, if any, disciplinary action is deemed appropriate. Only the board or a duly constituted panel thereof shall have the authority to issue final orders that dispose of a pending contested case, regardless of whether the issues resulting in the dispositive action are procedural, substantive, factual or legal. If a hearing officer is not available when a contested case, or any motion filed therein requiring action, is ready and scheduled to be heard or fails to timely prepare findings and conclusions pursuant to board established guidelines, the board or a duly constituted panel thereof may rule on the motions and/or hear the contested case or utilize the record compiled before the hearing officers and prepare its own findings of fact, conclusions of law and then issue a final order. With regard to findings or conclusions issued by the hearing officer or any mediator or arbitrator, the board or any duly constituted panel thereof that reviews the case may do any of the following:
    1. (1) Adopt the hearing officer's, mediator's or arbitrator's findings of fact and conclusions of law, in whole or in part;
    2. (2) Make its own findings of fact and conclusions of law, based solely on the record and the expertise of the members of the board or panel, in addition to or in substitution of those made by the hearing officer, mediator or arbitrator;
    3. (3) Remand the matter back to the hearing officer, mediator or arbitrator for action consistent with the board or panel findings and conclusions in the matter; or
    4. (4) Reverse the hearing officer's, mediator's or arbitrator's findings and/or dismiss the matter entirely.
  9. (i) The board retains jurisdiction to modify or refuse to modify, upon request of any party, any of its orders issued pursuant to this section in compliance with procedures established by the board. The board, pursuant to duly promulgated rules, may, whenever a final order is issued after a disciplinary contested case hearing that contains findings that a licensee or other person has violated any provision of this chapter, assess the costs directly related to the prosecution of the case against the licensee or person.
  10. (j) Any elected officer of the board, or any duly appointed or elected chair or any panel of the board or any screening panel and any hearing officer, arbitrator or mediator has the authority to administer oaths to witnesses and, upon probable cause being established, issue subpoenas for the attendance of witnesses and the production of documents and records.
§ 63-4-116. Enjoining violations.
  1. (a)
    1. (1) The board, in addition to the powers and duties expressly granted by this chapter in the matter of suspension or revocation of a license and in the matter of the refusal to issue a certificate, is authorized and empowered to petition any circuit or chancery court having jurisdiction to enjoin any person who is practicing or attempting to practice chiropractic without possessing a valid license to so practice and to enjoin any person, firm or corporation from performing any act or rendering any service that constitutes the practice of chiropractic as defined by this chapter.
    2. (2) No injunction bond shall be required of the board.
    3. (3) Jurisdiction is conferred upon the circuit and chancery courts of the state to hear and determine such cases as chancery causes and to exercise full and complete jurisdiction in such injunctive proceedings.
  2. (b) The board is also authorized and empowered to petition any circuit or chancery court having jurisdiction to enjoin any person who is violating § 63-4-114(a)(5). No injunction bond shall be required of the board in such proceedings, and jurisdiction is conferred upon the circuit and chancery courts of this state to hear such cases.
§ 63-4-117. Violations.
  1. (a) Any person who violates any provision of this chapter commits a Class B misdemeanor.
  2. (b) Any person who has been enjoined by a court of competent jurisdiction from performing any acts or rendering any services that constitute the practice of chiropractic, who thereafter willfully violates the terms of the injunction by again performing such acts or rendering such services commits a Class E felony.
§ 63-4-118. Immunity of reviewers from liability.
  1. Any chiropractor who serves on any peer review committee or on any other committee, board, commission or other entity constituted by any statewide chiropractic association, local chiropractic society or governmental or quasi-governmental agency for the purpose of reviewing and evaluating chiropractic acts of other chiropractors or chiropractic auxiliary personnel, shall be immune from liability with respect to any action taken by that chiropractor in good faith and without malice as a member of such committee, board, commission or other entity.
§ 63-4-119. X-ray operators.
  1. (a)
    1. (1) The board shall adopt rules and regulations that shall establish minimum educational standards and criteria for persons operating X-ray equipment for diagnostic purposes in chiropractic physicians' offices.
    2. (2) These regulations may include, but are not limited to, provisions for grandfathering, waiver, reciprocity, renewal, continuing education, fees, examination and hardship cases.
  2. (b) No person shall perform X-ray procedures in a chiropractic physician's office who does not meet these standards and who has not received a certificate of proficiency from the board.
§ 63-4-120. Externship certificates.
  1. (a) The board may issue an externship certificate to practice chiropractic, to be used only under supervision of a licensed chiropractor, upon payment of a fee as set by the board, to a chiropractor who meets all qualifications and requirements for licensure pursuant to this chapter and who has applied to take the examinations as provided in § 63-4-110.
  2. (b) Externs will be allowed to perform all diagnostic tests and therapeutic interventions as allowed providers licensed by this chapter.
  3. (c) Externship is to last no longer than three hundred sixty-five (365) days from date of certificate issuance. Applicants who provide proof of illness or hardship that hindered their ability to comply with § 63-4-110 may, at the board's discretion, be allowed a second year of externship.
  4. (d) The board may revoke an extern's certificate for violation of any portion of this chapter for failure to maintain proper supervision. “Supervision” is defined as direct oversight by a Tennessee licensed chiropractor. The supervisor shall be on the facility premises while the extern is conducting patient care.
  5. (e) The board reserves the right to adopt any rules and regulations as the board may deem appropriate for externs and the administration of externship program.
  6. (f) One hundred dollars ($100) shall be the administrative fee for applying to and participating in the externship program for each year of externship.
§ 63-4-121. Chiropractic preceptor program.
  1. (a) The board will allow the chiropractic preceptor program (CPP) to function in the state so long as the preceptor and the intern meet the qualifications as specified by the chiropractic preceptor program advisory committee, or its equivalent; and provided, all guidelines of the committee are followed.
  2. (b) The board reserves the right to adopt any rules and regulations as the board may deem appropriate for the administration of this program.
§ 63-4-122. Advertising.
  1. (a) The board shall adopt rules and regulations to regulate the nature, manner, content and extent of advertising by practitioners who are under the jurisdiction of such board.
  2. (b) Any licensed chiropractor who advertises or announces to the public that the licensed chiropractor is a certified acupuncturist shall be deemed to have engaged in false, misleading or deceptive advertising.
§ 63-4-123. Minimum educational standards and criteria.
  1. (a)
    1. (1) The board shall adopt rules that establish minimum educational standards and criteria for chiropractic therapy assistants performing physical agent modalities, physical treatment, and clinical services that are within the scope of practice of a chiropractic physician and, under the supervision of a chiropractic physician, either in the office of the chiropractic physician or in the presence of the chiropractic physician at another location.
    2. (2) These regulations shall include, but not be limited to, provisions for grandfathering, waiver, reciprocity, renewal, continuing education, fees, examination and hardship cases.
  2. (b) No person shall perform therapeutic procedures in a chiropractic physician's office who does not meet these standards and who has not received a certificate of proficiency from the board.
§ 63-4-124. Special volunteer license for practice in free health clinic — Exemption from fees — Renewal.
  1. A chiropractor licensed pursuant to this chapter under a special volunteer license who is a medical practitioner, as defined by § 63-1-201, engaged in practice at a free health clinic shall not be subject to license fees under this chapter. The board of chiropractic examiners may issue a special volunteer license, as such license is defined in § 63-1-201, to qualified applicants without fee or charge. Such license shall be for a period of two (2) years and may be renewed on a biennial basis.
Chapter 5 Dentists
Part 1 Dentists
§ 63-5-101. Board of dentistry.
  1. (a) The practice of dentistry and of dental hygiene shall be under the direct supervision of a board to be known as the board of dentistry, referred to in this chapter as the “board.”
  2. (b) The administrative duties pursuant to licensure and the collection of fees for licensure shall be vested in the division of health related boards of the department of health, referred to in this chapter as the “division.”
§ 63-5-102. Composition of board.
  1. The board shall consist of seven (7) practicing dentists, two (2) practicing dental hygienists and one (1) practicing registered dental assistant, whose duty it is to carry out this chapter. Of the seven (7) dentists, two (2) shall be appointed from each grand division of the state, and the appointment of the other dentists shall alternate among the grand divisions on an equal basis, but without regard to consecutive terms of a board member.
§ 63-5-103. Appointment of members — Term of office — Removal.
  1. (a)
    1. (1) The dentist members of the board may be appointed by the governor from lists of qualified nominees submitted by interested dentist groups including, but not limited to, the Tennessee Dental Association. No person is eligible for appointment as a dentist member of the board unless such person has been an actual and bona fide resident and a legally licensed practicing dentist of this state for a period of five (5) years or more immediately preceding such appointment.
    2. (2) The dental hygienist members may be appointed by the governor from lists of qualified nominees submitted by interested dental hygienist groups including, but not limited to, the Tennessee Dental Hygienists Association. No person is eligible for appointment as a dental hygienist member of the board unless that person has been an actual and bona fide resident and a legally licensed practicing dental hygienist of this state for a period of five (5) years or more immediately preceding such appointment.
    3. (3) The dental assistant member may be appointed by the governor from lists of qualified nominees submitted by interested dental assistant groups including, but not limited to, the Tennessee Dental Assistants' Association. No person is eligible for appointment as a dental assistant member of the board unless that person has been an actual and bona fide resident and has been a legally registered and practicing dental assistant of this state for a period of five (5) years or more immediately preceding such appointment.
  2. (b) The governor shall consult with interested dental groups, including, but not limited to, the Tennessee Dental Association, the Tennessee Dental Hygienists Association and the Tennessee Dental Assistants' Association to determine qualified persons to fill the positions as provided in subsection (a).
  3. (c) The terms of members of the board are three (3) years, with the terms staggered so that the terms of no more than three (3) members expire each year. No member is eligible to serve on the board for more than three (3) consecutive full terms, but any person thus ineligible shall thereafter be eligible for nomination and appointment to the board, as provided in this section, after three (3) years have elapsed since that person's previous service on the board.
  4. (d)
    1. (1) The governor shall make appointments to the board not later than one (1) month after the expiration of the term of office of any member, and such or further delay in the appointment must be deducted from the term of the appointment. The governor shall fill vacancies occurring on the board by death or resignation for the unexpired term from lists submitted to the governor as provided in this section. If the vacancy is not filled within thirty (30) days by the governor, then the board shall fill the vacancy for the unexpired term. A person is not eligible for appointment to the board if the person is employed by or with a dental supply business or dental laboratory.
    2. (2) In making appointments to the board, the governor shall strive to ensure that at least one (1) person serving on the board is sixty (60) years of age or older and that at least one (1) person serving on the board is a member of a racial minority.
  5. (e) Members of the board shall continue in office until the expiration of the terms for which they were respectively appointed and until such time as their successors have been duly appointed.
  6. (f)
    1. (1) A member of the board may be removed upon one (1) or more of the following grounds:
      1. (A) The refusal or inability for any reason of a board member to perform that member's duties as a member of the board in an efficient, responsible and professional manner;
      2. (B) The misuse of office by a member of the board to obtain personal, pecuniary or material gain or advantage for that member or another through such office; or
      3. (C) The violation of this chapter or of any of the rules and regulations of the board hereafter properly promulgated.
    2. (2) The proceedings for such removal shall be in accordance with title 8, chapter 47.
§ 63-5-104. Board meetings and officers — Records — Copy of law to licensees.
  1. (a)
    1. (1) The board shall meet at least annually and at such times and places as it may deem necessary for the proper discharge of its duties.
    2. (2) At its annual meeting the board shall elect from its membership a president, vice president and secretary-treasurer.
    3. (3) A majority of the members shall constitute a quorum for the transaction of business.
    4. (4) The proceedings of the board shall be recorded and shall constitute a public record.
  2. (b) The board shall maintain and make available to the division a permanent record that shall list the name, address and license or certificate number of all persons licensed to practice dentistry and of all persons certified as dental specialists, licensed as dental hygienists and registered as dental assistants.
  3. (c) The board shall mail a copy of the law regulating the practice of dentistry to each person who is hereafter licensed to practice dentistry or dental hygiene.
§ 63-5-105. Powers of board.
  1. The board has the following powers and duties in addition to the powers and duties granted to or imposed upon it by the other sections of this chapter:
    1. (1) Prescribe rules and regulations for examination of candidates;
    2. (2) Conduct examinations to ascertain the qualifications and fitness of applicants for licenses to practice dentistry and of applicants for certificates to practice a specialty in dentistry or licenses to practice as a dental hygienist or registered as a dental assistant;
    3. (3) Provide standards by which dental schools and colleges, graduate dental programs in hospital settings, schools of dental hygiene and courses of instruction for dental assistants are approved;
    4. (4) Issue licenses to applicants who successfully pass the examination for the practice of dentistry and dental hygiene, to issue certificates to specialists in dentistry who successfully pass the respective examinations for such certificates and to register dental assistants who meet such standards of competency as the board may require by rules and regulations and who pay a nonrefundable application fee as set annually by the board;
    5. (5) Conduct hearings to revoke, suspend or otherwise lawfully discipline the holder of any license or certificate issued under the authority of this chapter or any previous laws authorizing the holder thereof to practice dentistry, a specialty in dentistry, dental hygiene or as a certified and/or registered dental assistant for violations by the licensee or certificate holder of any of the provisions of this chapter or any rule of the board hereafter properly promulgated by the board;
    6. (6) Provide for any evaluations, including onsite, of facilities, equipment and personnel of dentists who use general anesthesia, deep sedation or conscious sedation as the board determines appropriate in the interest of public safety; and
    7. (7) To make such rules and regulations and establish such fees as are necessary to carry out and make effective this chapter.
§ 63-5-106. Annual report of board.
  1. The board shall make an annual report of its proceedings and activities to the governor, with copies to be made available to any interested parties.
§ 63-5-107. License requirement.
  1. (a) It is unlawful for any person to practice dentistry, a specialty in dentistry or dental hygiene in this state, except those who are now licensed or certified as such pursuant to law and those who may hereafter be licensed or certified and registered pursuant to this chapter.
  2. (b) It is unlawful for any person so licensed or certified to practice dentistry or to practice dental hygiene in any calendar year unless or until such person has paid the annual renewal fee for that year as provided in this chapter.
  3. (c)
    1. (1)
      1. (A) Each person licensed as a dentist or a dental hygienist in accordance with this chapter or registered as a dental assistant pursuant to the rules of the board is required to attend and complete each year, except in the year of initial licensure or registration, the number of hours of board approved continuing education courses prescribed by the board, subject to a minimum of twelve (12) and a maximum of thirty (30) clock hours; provided, that beginning January 3, 2003, in lieu of the annual continuing education requirement, each person licensed as a dentist or dental hygienist or registered as a dental assistant is required to attend and complete during each two-year cycle, except for the two-year cycle of initial licensure, the number of hours of board approved continuing education courses that are prescribed by the board, subject to a minimum of twenty-four (24) and a maximum of sixty (60) clock hours. However, for the purposes of the biennial continuing education requirement for dental hygienists, no more than fifty percent (50%) of such continuing education requirement may be earned from on-line or web-based courses. Sponsors of such courses shall submit a sufficient description of course content to the board in order to obtain approval. The board may approve all, part or none of the course at its discretion. Additional procedures for implementing this requirement may be adopted by the board in its regulations. The board may waive all or part of the continuing education requirements in unusual situations in which an applicant for renewal has demonstrated inability to attend such courses not attributable to fault of the applicant. The board shall have discretion to require completion of continuing education courses of a type and number of hours satisfactory to the board in cases involving license renewal of dentists or dental hygienists who have not actively practiced or have been retired from practice for more than two (2) years. In addition to the foregoing, all applicants shall provide proof of current CPR certification by an organization approved by the board unless such requirement is waived by the board in its discretion; provided, that no dentist who obtains a waiver from the board for CPR requirements shall practice dentistry unless a dentist, dental hygienist or dental assistant who is currently certified in CPR is present.
      2. (B)
        1. (i) For purposes of this subdivision (c)(1), a live, interactive webinar is:
          1. (a) Considered to be in-person continuing education; and
          2. (b) Not considered remote attendance of an online or web-based course.
        2. (ii) As used in this subdivision (c)(1)(B), “live, interactive webinar” means an internet-based broadcast in which viewers may interact with a presenter in real time.
      3. (2) The board may, but is not required to, monitor or verify certificates of completion submitted by applicants for license renewal. In its discretion, by random sample or in individual cases, the board may require proof of attendance or otherwise investigate compliance with this subsection (c).
§ 63-5-108. Practice of dentistry and dental hygiene defined.
  1. (a) Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment, by nonsurgical, surgical or related procedures, of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body, provided by a dentist within the scope of such dentist's education, training, and experience, in accordance with the ethics of the profession and applicable law.
  2. (b) Any person is deemed to be practicing dentistry who, either gratuitously or for a salary, fee, money or other remuneration, paid or to be paid, directly to the operator or to any person or agency:
    1. (1) Diagnoses, prescribes for or treats any disease, pain, deformity, deficiency, injury, disorder and condition of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Such diagnosis and treatment may include the use of a complete or limited physical evaluation of patients by a board eligible or board certified oral and maxillofacial surgeon or a resident in an approved oral and maxillofacial surgery program practicing in a hospital setting;
    2. (2) Extracts human teeth;
    3. (3) Repairs or fills cavities in human teeth;
    4. (4) Corrects malformations of human teeth or of the jaws;
    5. (5) Performs any oral and maxillofacial surgery;
    6. (6) Subject to subsection (d), takes an impression of the human tooth, teeth or jaws, leading to either:
      1. (A) The fabrication of a model upon which will be constructed a replacement of natural teeth by artificial substitutes; or
      2. (B) The fabrication of a cosmetic metal apparatus to be worn in the human mouth, whether or not the apparatus features silver, gold or platinum caps, jeweled inlays or any other cosmetic features;
    7. (7) Furnishes, supplies, constructs, alters, reproduces or repairs any prosthetic denture, bridge, crown, appliance or any other structure to be used or worn in the human mouth as a substitute for natural teeth, except on the written work order of a licensed and registered dentist;
    8. (8) Places or adjusts such appliance or structure in the human mouth;
    9. (9) Delivers the same to any person other than the licensed and registered dentist upon whose written work order the work was performed;
    10. (10) Offers to the public by any method to furnish, supply, construct, reproduce, reline, repair or otherwise process any prosthetic denture, bridge, appliance or other structure to be worn in the human mouth;
    11. (11) Gives interpretations of dental radiographs;
    12. (12) Administers an anesthetic, except for a topical anesthetic in connection with a dental operation; provided, however, that a duly licensed dentist may delegate the administration of local anesthetic to dental hygienists who possess a permit to do so issued by the board. The board shall establish the qualifications, criteria and curricula required for issuance of permits to administer local anesthetic, by infiltration or by block, to duly licensed dental hygienists;
    13. (13) Uses the words, “Dentist,” “Dental Surgeon,” “Oral Surgeon,” “Oral and Maxillofacial Surgeon,” or letters “D.D.S.,” “D.M.D.,” or any other words, letters, title, or descriptive matter that in any way represents the person as being able to diagnose, treat, prescribe or operate for any disease, pain, deformity, deficiency, injury, disorder, and condition of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body;
    14. (14) States, or permits to be stated by any means or method whatsoever, that the person can or will attempt to perform dental operations or services or to render diagnosis in connection therewith;
    15. (15) Is the operator of a place where dental operations or dental services are performed; or
    16. (16) Authorizes the practice of “teledentistry” which, as used in this section, means the delivery of dental health care and patient consultation through the use of telehealth systems and technologies, including live, two-way interactions between a patient and a dentist licensed in this state using audiovisual telecommunications technology, or the secure transmission of electronic health records and medical data to a dentist licensed in this state to facilitate evaluation and treatment of the patient outside of a real-time or in-person interaction. Dentists who are licensed in this state and who deliver services using teledentistry shall establish protocols for the practice that should include proper methods of keeping the patient fully informed; proper safeguards ensuring that all state and federal laws and regulations relative to the privacy of health information are followed; proper documentation of all services or treatment rendered via teledentistry; proper procedures to ensure the referral of those patients requiring treatment beyond what can be provided via teledentistry to a dentist licensed in this state; and any such requirements as prescribed by the board of dentistry. Any and all services provided via teledentistry shall be consistent with the in-person provision of those services. Any and all services provided via teledentistry shall comply with this chapter and shall be provided in accordance with the rules of the board of dentistry.
  3. (c)
    1. (1) A dental hygienist is an individual who has graduated from a dental hygiene program accredited by the American Dental Association's Commission on Dental Accreditation (CODA) and is licensed under this chapter to practice dental hygiene.
    2. (2) The practice of dental hygiene means the performance of preventive, educational, and therapeutic services including the removal of all hard and soft deposits and the stain from the human teeth to the depth of the gingival sulcus, polishing natural and restored surfaces of teeth, performing clinical examination of teeth and surrounding tissues for diagnosis by the dentist, and performing other procedures that may be delegated by the dentist, under the supervision of a licensed dentist.
    3. (3) No person shall practice dental hygiene in a manner that is separate or independent from a supervising dentist, or establish or maintain an office or a practice that is primarily devoted to the provision of dental hygiene services.
    4. (4) A dental hygienist shall perform, under direct supervision only, root planing, subgingival curettage, administering nitrous oxide, and local anesthesia.
    5. (5) Under general supervision a dental hygienist may provide to patients, for not more than fifteen (15) consecutive business days, all other dental hygiene services not otherwise limited to direct supervision by this chapter or rules adopted by the board, if all of the following requirements are met:
      1. (A) The dental hygienist has at least one (1) year, full-time, or an equivalent amount of experience practicing dental hygiene;
      2. (B) The dental hygienist complies with written protocols for emergencies that the supervising dentist establishes;
      3. (C) The supervising dentist examined the patient not more than eleven (11) months prior to the date the dental hygienist provides the dental hygiene services;
      4. (D) The dental hygienist provides dental hygiene services to the patient in accordance with a written treatment plan developed by the supervising dentist for the patient; and
      5. (E) The patient is notified in advance of the appointment that the supervising dentist will be absent from the location and that the dental hygienist cannot diagnose the patient's dental health care status.
  4. (d) Any duly licensed and registered dentist may assign to duly licensed and registered dental hygienists, registered dental assistants and/or practical dental assistants, as defined by the board in rules and regulations, any tasks or procedures to be performed in the dentist's office for which a licensed and registered dentist exercises direct supervision and full responsibility, except those procedures requiring the professional judgment or skill of a dentist; provided, that duties involving the removal of hard and soft deposits by scaling or curretage from the surfaces of human teeth are assigned only to duly licensed and registered dental hygienists. The board has the authority to permit registered dental assistants to apply sealants to and to polish human teeth, and the board has the discretion to establish criteria and curricula as necessary to ensure that such registered dental assistants are qualified to apply sealants and perform polishing. For eligibility to perform polishing, passage of a clinical and didactic examination is required. The board is authorized to permit licensed and registered dental hygienists and registered dental assistants to insert, pack, carve and finish amalgam and intracoronal nonmetallic restorations and take final impressions for fixed and removable prosthetic appliances, under the direct supervision and full responsibility of a licensed dentist, and the board shall establish such criteria and curricula as it determines in its discretion are necessary or appropriate to ensure that such hygienists and assistants are qualified to perform such procedures. Tasks and procedures assignable to licensed and registered dental hygienists shall include those enumerated in the board's regulations as of January 1, 1990, and such other additional tasks and procedures as the board may deem appropriate in the future. Procedures requiring professional judgment or skill not assignable to such dental hygienists and dental assistants include the following:
    1. (1) Diagnosis and treatment planning; oral surgery, the cutting of hard and/or soft tissues, excluding any cutting of such tissues involved in subgingival scaling, root planing and gingival curettage, and any intra-oral procedures that would affect the function and/or efficiency of an appliance that, when worn by the patient, would come in direct contact with hard or soft tissue and that could result in tissue irritation or injury;
    2. (2) The placing of permanent fillings or restorations in or on teeth except as provided in this subsection (d); and
    3. (3) Administration of a general or local anesthetic, except for a topical anesthetic in connection with a dental operation; provided, however, that dental hygienists who possess a permit issued pursuant to subdivision (b)(12) may administer a local anesthetic but only under the direct supervision of a licensed and registered dentist who is physically present at the same office location and time and in accordance with rules and regulations of the board.
  5. (e) Notwithstanding any provision of law to the contrary, a dental hygienist may administer nitrous oxide analgesia if directed by a dentist to do so, in accordance with rules and regulations of the board of dentistry, under the direct supervision of a licensed and registered dentist. Patients who have been administered nitrous oxide shall be monitored appropriately.
  6. (f)
    1. (1) Except as provided in subdivisions (f)(2) and (3), a licensed dentist shall not allow, under general supervision, more than three (3) dental hygienists to work at any one (1) time.
    2. (2) A dentist may supervise, under direct supervision, no more than ten (10) dental hygienists while the dentist and each hygienist is providing dental services on a volunteer basis through a nonprofit provider of free mobile clinics in this state.
    3. (3) A dentist may supervise, under general supervision, no more than five (5) dental hygienists if the dentist and dental hygienists work for the department of health, a county or metropolitan health department, or an entity that participates in the state safety net program for the uninsured. A dentist supervising dental hygienists under this subdivision (f)(3) must do so in accordance with protocols established by the department of health or a county or metropolitan health department.
  7. (g) Any duly licensed and registered dentist who uses general anesthesia, deep sedation or conscious sedation in that dentist's practice, at a level to be determined by the board, must secure a permit from the board by meeting the standards as set in rules and regulations and by paying fees set by the board. Such permit is subject to renewal at intervals upon payment of a fee as set by the board in rules and regulations. Any dental facility in which general anesthesia, deep sedation or conscious sedation is administered by such dentist is subject to standards as may be specified in rules and regulations of the board, including, but not limited to, a facility permit.
  8. (h)
    1. (1) Notwithstanding any law to the contrary, the practice of dental hygiene also includes prescriptive authority limited to fluoride agents, topical oral anesthetic agents, and nonsystemic oral antimicrobials that:
      1. (A) Are not controlled substances under state and federal drug laws; and
      2. (B) Do not require a license from the federal drug enforcement agency.
    2. (2) Prescriptive authority under this section must be:
      1. (A) Exercised under the general supervision of a licensed dentist;
      2. (B) Pursuant to rules promulgated by the board; and
      3. (C) In compliance with all applicable laws concerning prescription packaging, labeling, and record keeping requirements.
    3. (3) A prescription written by a dental hygienist under this part must be reviewed by a dentist within thirty (30) days.
    4. (4) The board shall determine by rule the educational and training requirements necessary for a dental hygienist to exercise prescriptive authority pursuant to this section.
    5. (5) The board shall determine by rule the percentage of fluoride or any other active ingredient in any medication that may be prescribed by a dental hygienist under this subsection (h).
§ 63-5-109. Exemptions.
  1. The following persons, acts, practices and operations are exempt from the other provisions of this chapter:
    1. (1) The practice of their professions by physicians or surgeons licensed as such under the laws of this state, unless they practice dentistry as a specialty;
    2. (2) The practice of dentistry and dental hygiene in the discharge of their official duties by graduate dentists and by dental hygienists in the United States public health service, army, navy, air force, coast guard or veterans administration;
    3. (3) The practice of dentistry by licensed dentists or the practice of dental hygiene by licensed dental hygienists of other states or countries at meetings of the Tennessee Dental Association or Pan Tennessee Dental Association, or component parts thereof, alumni meetings of dental colleges or any other like dental organizations while appearing as clinicians;
    4. (4) Licensed dentists or dental hygienists of other states who are called into Tennessee by licensed dentists of this state for consultative or operative purposes if the board or its designee gives discretionary advance approval in each such instance;
    5. (5) The practice of dentistry or of dental hygiene by graduates of schools or colleges recognized by the board who are duly licensed in other states in the discharge of their official duties in state-supported institutions or official health agencies or other special projects approved by the board between the time of their employment as such and the next examination and licensing by the board;
    6. (6) The practice of dentistry or of dental hygiene by students under the supervision of instructors in any dental school, college or dental department of any school, college, university or school of dental hygiene recognized by the board, but such activities shall not be carried on for profit;
    7. (7) The giving by a registered nurse anesthetist of any anesthetic for a dental operation under the direct supervision of a licensed dentist;
    8. (8) The construction, reproduction, restoration, alteration or repair of bridges, crowns, dentures or any other prosthetic or orthodontic appliances or materials to be used or worn as substitutes for natural teeth or for correction or regulation of natural teeth, upon order, prescription or direction of a licensed dentist, when the impressions, casts or models thereof have been made or taken by a licensed and registered dentist, a licensed and registered dental hygienist under the direct supervision of a licensed and registered dentist or a registered dental assistant under the direct supervision of a licensed and registered dentist; provided, that such prosthetic dentures or orthodontic appliances or bridges or the services rendered in construction, repair, restoration or alteration thereof are not advertised, other than in a professional or trade journal, or by direct mail to licensed dentists or other laboratories and are not sold or delivered directly or indirectly to the public by any unlicensed person or dental laboratory, either as principal or as agent;
    9. (9) Dental interns and externs or graduates of dental and dental hygiene schools or colleges recognized by the board employed by licensed hospitals or other agencies recognized and approved by the board;
    10. (10) Personnel involved in research or developmental projects, approved by the board, that are under the auspices and direction of a recognized educational institution or the department of health;
    11. (11) Graduates of dental schools or colleges serving as clinical instructors in board-recognized teaching institutions, while performing only those duties required by and under the supervision of such teaching institutions, upon completing prescribed registration forms and payment of a fee as set by the board; however, such exemption shall be confined to the interim immediately prior to the next scheduled applicable examination of the board and shall not be extended if the applicant does not successfully pass the examination;
    12. (12) Dentists and dental hygienists duly licensed in other states who desire to work with special projects recognized and approved by the board may do so under the sponsorship of a local dentist and the auspices of the local dental society for a period of six (6) months;
    13. (13) Dentists or dental hygienists duly licensed in other states practicing within authorized Tennessee department of health programs or programs affiliated with the Tennessee department of health for a period not to exceed twenty-four (24) months;
    14. (14) The application of fluoride varnish to the teeth of at-risk, underserved persons in or under the auspices of a state, county or municipal public health clinic by public health nurses or nurse practitioners;
    15. (15) The application of dental sealants to the teeth of individuals in a setting under the direction of a state or local health department by licensed hygienists, without requiring an evaluation by a dentist prior to such application, under a protocol established by the state or a metropolitan health department; or
    16. (16) The application of topical fluoride to the teeth of individuals in a setting under the direction of a state or local health department by licensed hygienists, without requiring an evaluation by a dentist prior to such application, under a protocol established by the state or a metropolitan health department.
§ 63-5-110. Application for license — Reciprocity.
  1. (a)
    1. (1) A person desiring to obtain a license to practice dentistry in this state shall make application to the board. The application must be accompanied by a certificate showing that the applicant is a graduate of an accredited dental school or college or from the dental department of a university approved by the board.
    2. (2) The applicant shall be at least eighteen (18) years of age, a citizen of the United States or Canada or legally entitled to live within the United States and of good moral character and reputation.
    3. (3) The application must be accompanied by the applicant's photograph and by a nonrefundable application fee as set by the board in rules and regulations.
  2. (b) The board is authorized to cause a license to be issued to an applicant of good moral character and professional competence who is licensed to practice dentistry in another state, which shall include the District of Columbia or a territory of the United States, if the board determines to its satisfaction that the applicant meets all of the following requirements:
    1. (1) Currently holds a valid license to practice dentistry in another state and provides a copy of such license, and also provides the name of another state in which the applicant is or has been licensed;
    2. (2) Absence of any pending disciplinary charges or action in another state or any current investigation by a disciplinary authority or another state and provides pertinent information about any disciplinary action imposed against the applicant in any other state, which the board is to evaluate and determine whether such is disqualifying for licensure in this state;
    3. (3) Has not failed previously an examination for licensure to practice dentistry in Tennessee;
    4. (4) Graduation from a dental school or college duly accredited by the American Dental Association Commission on Dental Accreditation;
    5. (5) Demonstrates intent to actively practice or teach in Tennessee;
    6. (6) Has, pursuant to the authority of a state dental licensing board or boards:
      1. (A) Practiced dentistry in another state or states for at least five (5) years;
      2. (B) Taught in an American Dental Association accredited institution for at least five (5) years;
      3. (C) Any combination of subdivision (b)(6)(A) or subdivision (b)(6)(B) for at least five (5) years;
      4. (D) Practiced dentistry for at least two (2) years in another state or states and, in addition, presents satisfactory evidence of passing an examination administered by another state substantially equivalent to the examination required for initial licensure in Tennessee, the appropriateness of such examinations to be evaluated and determined by the board;
      5. (E) Taught for at least two (2) years in an American Dental Association accredited institution and, in addition, presents satisfactory evidence of passing an examination administered by a regional testing agency or a clinical board examination administered by another state substantially equivalent to the examination required for initial licensure in Tennessee, the appropriateness of such examination to be evaluated and determined by the board; or
      6. (F) Any combination of subdivision (b)(6)(D) or subdivision (b)(6)(E) for at least two (2) years; and
    7. (7) Payment of a nonrefundable application fee as set by the board.
  3. (c) The board is authorized, in its discretion, to issue a limited license for educational purposes to any dentist who is duly licensed to practice in any other state who meets the requirements of the board and who submits satisfactory evidence of good moral character and professional competence, including a certificate to that effect from the licensing or registration board from all states in which the applicant has held a license, upon payment of a nonrefundable fee as set by the board.
  4. (d) The board shall direct the division to issue a license to an applicant, without the necessity of further examination except as required by § 63-5-113, if the board determines that the applicant meets all of the following qualifications:
    1. (1) Is a graduate with either a D.D.S. or D.M.D. degree of an accredited dental school or college or of a dental department of a university approved by the board;
    2. (2) Is licensed to practice dentistry in another state, the District of Columbia, the Commonwealth of Puerto Rico or a dependency of the United States;
    3. (3) Has successfully completed a graduate training program in a recognized specialty branch of dentistry; and
    4. (4) Is currently duly licensed to practice medicine in this state.
  5. (e) The board is authorized, in its discretion, to issue a limited license for the practice of dentistry in American Dental Association accredited institutions or dental education programs or in federally-designated health professional shortage areas, if the applicant meets the following requirements:
    1. (1) Is a graduate of a school of dentistry with a degree substantially equivalent to either a D.D.S. or D.M.D. degree;
    2. (2) Has successfully completed a graduate training program in a recognized specialty branch of dentistry from an advanced specialty program accredited by the American Dental Association;
    3. (3) Has successfully completed the national board examinations;
    4. (4) Payment of nonrefundable fee, as set by the board;
    5. (5) Provides satisfactory evidence of good moral character and professional competency;
    6. (6) Provides proof of naturalization or ability to live and work in the United States; and
    7. (7) Meets other requirements as set by the board.
§ 63-5-111. Examinations — Issuance or denial of licenses.
  1. (a)
    1. (1) The board may conduct examinations at such times and places as it may designate and charge each examinee a fee for each examination taken as set annually by the board.
    2. (2) In addition to examinations conducted pursuant to subdivision (a)(1), the board shall recognize a certificate granted by the American Dental Association's Commission on National Board Dental Examinations and may accept the results of its own board examination or the results of an examination conducted by one (1) or more of the regional testing agencies.
    3. (3) An examination described in this subsection (a) may be written or oral, or both; shall include subjects as may be designated by the board; and may also include practical tests, working operations, and demonstrations, within the discretion of the board. An examination may be conducted on a live human patient or a non-patient-based model may be used.
  2. (b)
    1. (1) If the applicant shall successfully pass the examination and shall be found worthy, the board shall direct the division to issue a license to that applicant.
    2. (2) The board may, within its discretion, refuse to grant a certificate to any person found guilty of making false statements, cheating or of any fraud or deception, either in applying for or in taking the examination.
    3. (3) The board may, within its discretion, refuse to issue a license to any person who fails to apply for the same within ninety (90) days following notification of successful completion of all requirements for the licensure.
§ 63-5-112. Specialists.
  1. (a) No licensed dentist shall claim to the public to be a specialist, or be specially qualified in any particular branch of dentistry or to be giving special attention to any branch of dentistry, or claim to limit the dentist's practice to any branch of dentistry, until that dentist has complied with the additional requirements established by the board and has been issued a certificate by the board authorizing that dentist so to do. The board is authorized to certify “specialists” in the following branches of dentistry:
    1. (1) Dental public health;
    2. (2) Endodontics;
    3. (3) Oral and maxillofacial pathology;
    4. (4) Oral and maxillofacial surgery;
    5. (5) Orthodontics and dentofacial orthopedics;
    6. (6) Pediatric dentistry;
    7. (7) Periodontics;
    8. (8) Prosthodontics;
    9. (9) Oral and maxillofacial radiology; and
    10. (10) Any other branch of dentistry hereafter recognized as a specialty by the American Dental Association and approved by the board.
  2. (b) Oral and maxillofacial surgeons are held to the same standard of care as physicians licensed under chapters 6 or 9 of this title.
  3. (c) In considering or acting upon matters related to specialists or special areas of dentistry, the board shall utilize as consultants one (1) or more knowledgeable persons certified in the applicable specialty or knowledgeable in the special area.
§ 63-5-113. Examination and certification of specialists.
  1. (a) Any dentist duly licensed in this state who has completed a minimum of two (2) years of graduate education in a dental school accredited by the Commission on Dental Accreditation or the equivalent thereof in a specialty branch of dentistry or who has otherwise met the requirements of the rules promulgated by the board may apply for a certificate as a specialist.
  2. (b) The board may recognize specialty certification of those dentists licensed through the licensure criteria provisions of § 63-5-110, if the requirements for certification in the original state are substantially equivalent to those requirements in this state.
  3. (c) No one shall offer or conduct any school, course, or program that grants credentialed status or that graduates individuals for credentialed status, or its equivalent, in any particular branch of dentistry or any specific area of the practice of dentistry that is not listed as a recognized specialty in § 63-5-112. Dental, dental hygiene, and dental assisting colleges, schools, or programs in this state that are accredited by the Commission on Dental Accreditation are exempt from this subsection (c).
§ 63-5-114. Dental hygienists — Examination — Licensure — Reciprocity.
  1. (a) The board is authorized to issue a license to practice dental hygiene to applicants who are citizens of the United States or Canada or who are legally entitled to live within the United States, who have graduated and received a diploma from a dental hygiene program accredited by the American Dental Association's Commission on Dental Accreditation, that provides a minimum of two (2) academic years of dental hygiene curriculum and that may be completed in a period of time less than two (2) years, in or through an institution of higher education accredited by an agency recognized by the United States department of education to offer college-level programs and who have successfully passed such examinations as may be established by the board. The board may recognize a certificate granted by the joint commission of national dental examinations or accept the results of the southern regional testing agency, or either organization, in lieu of or subject to such examinations as may be required by the board.
  2. (b)
    1. (1) Each applicant for a license as a dental hygienist shall pay a nonrefundable application fee to the board, as set annually by the board.
    2. (2) Any applicant submitting to an examination conducted by the board shall, in addition to the application fee, pay a nonrefundable examination fee as set annually by the board.
    3. (3) The license shall be of the type and kind agreed upon by the board.
  3. (c) The secretary of the board shall keep a separate register showing the names and addresses of all dental hygienists so licensed by the board.
  4. (d) The board is authorized in its discretion to issue a license by criteria approval to any dental hygienist who:
    1. (1) Is licensed and has, pursuant to that license, actively engaged in practice for three (3) years or more in another state or states;
    2. (2) Is a graduate of and has received a diploma from a dental hygiene program accredited by the American Dental Association's Commission on Dental Accreditation that provides a minimum of two (2) academic years of dental hygiene curriculum and that may be completed in a period of time less than two (2) years, in or through an institution of higher education accredited by an agency recognized by the United States department of education to offer college-level programs; and
    3. (3) Submits satisfactory evidence of good moral character and professional competence, including a certificate to that effect from the licensing or registration board from all states in which the applicant has held a license, upon payment of a nonrefundable fee as set by the board.
  5. (e) The board is authorized in its discretion to issue a limited license for educational purposes to any dental hygienist who is duly licensed or registered to practice in any other state, who meets the requirements of the board and who submits satisfactory evidence of good moral character and professional competence, including a certificate to that effect from the licensing or registration board from all states in which the applicant has held a license, upon payment of a nonrefundable fee as set by the board.
  6. (f) The board may in its discretion revoke a license to any person who fails to register the license with the board within ninety (90) days following notification of licensure.
§ 63-5-115. Employment of and practice by hygienists and assistants.
  1. (a) A duly licensed and registered dentist may employ licensed and registered dental hygienists, registered dental assistants and practical dental assistants. Such licensed and registered dental hygienists may practice as authorized in this section or § 63-5-108 only in the office of and under the direct and/or general supervision of a licensed and registered dentist, in authorized public health programs or at other locations otherwise authorized by this chapter. Such registered and/or practical dental assistants may practice as authorized in this section or § 63-5-108 only in the office of and under the direct supervision of a licensed and registered dentist except in authorized public health programs. No provisions in this chapter shall be construed as authorizing any licensed and registered dental hygienists, registered dental assistants or practical dental assistants to practice as such except as provided in this section.
  2. (b) Definitions.
    1. (1) Direct Supervision. As used in this chapter regarding supervision of licensed and registered dental hygienists or registered dental assistants, “direct supervision” means the continuous presence of a supervising dentist within the physical confines of the dental office when licensed and registered dental hygienists or registered dental assistants perform lawfully assigned duties and functions;
    2. (2) General Supervision. As used in this chapter, “general supervision” is defined as those instances when the dentist is not present in the dental office or treatment facility while procedures are being performed by the dental hygienist, but the dentist has personally diagnosed the condition to be treated, has personally authorized the procedures being performed and will evaluate the performance of the dental hygienist.
  3. (c) Licensed and registered dental hygienists and registered dental assistants are specifically permitted to participate unsupervised in educational functions involving organized groups or health care institutions regarding preventive oral health care. Dental hygienists are permitted to participate in health screenings and similar activities; provided, that no remuneration is given by the organized group to any hygienist or the hygienist's employer for participating in these activities.
  4. (d)
    1. (1) Settings in which licensed and registered hygienists may engage in the provision of preventive dental care under the general supervision of a dentist through written protocol include nursing homes, skilled care facilities, nonprofit clinics and public health programs. Dental hygienists licensed and registered pursuant to this chapter are specifically permitted to render such preventive services as authorized in § 63-5-108 or by regulation of the board, as prescribed by the supervising dentist under a written protocol. Dental hygienists rendering such services shall be under the general supervision of a licensed dentist as specified in a written protocol between the supervising dentist and the hygienist which must be submitted in advance to the board. No dentist may enter into a written protocol with more than three (3) dental hygienists at any one time nor may any hygienist be engaged in a written protocol with more than three (3) dentists at any one time. The supervising dentist must process all patient billings. Each written protocol will be valid for a period of two (2) years at which time it must be renewed through resubmission to the board. Should a dentist cease to be the employer/supervisor of a dental hygienist where a written protocol is in force and on file with the board, the dentist must notify the board within ten (10) working days by certified mail, return receipt requested or electronic mail that the written protocol is no longer in force.
    2. (2) Licensed and registered dental hygienists working under written protocol, in addition to those requirements enumerated under the general supervision as authorized by § 63-5-108(c)(5), must have actively practiced as a licensed dental hygienist for at least five (5) years and have practiced two thousand (2,000) hours in the preceding five (5) years or taught dental hygiene courses for two (2) of the proceeding three (3) years in a dental hygiene program accredited by the American Dental Association's Commission on Dental Accreditation and completed six (6) hours of public health continuing education within the past two (2) years; provided, that, after satisfying the requirement of this subsection (d), in subsequent years the hygienist may work on a part-time basis.
    3. (3) Each written protocol, required for off-site practice under general supervision, shall be submitted to the board by certified mail, return receipt requested and shall include at a minimum:
      1. (A) The name, address, telephone number and license number of the employer (supervising) dentist;
      2. (B) The name, address, telephone number and license number of the dental hygienist;
      3. (C) The name, address, telephone number and other pertinent identification from all locations where the dental hygiene services are to be performed; and
      4. (D) A statement signed by the dentist that the dentist and the dental hygienist that meets all minimum standards for general supervision as well as those required for practice under a written protocol as stipulated in this section and § 63-5-108.
    4. (4) The board will receive each written protocol submitted and keep those on file which meet the minimum requirements enumerated in subdivision (d)(3). Those received by the board and determined not to be complete shall be returned to the submitting dentist within thirty (30) days of receipt with a request for the additional information required. The dentist may then resubmit an amended written protocol to the board.
  5. (e) Teledentistry shall not alter or amend the supervision requirements or procedures authorized for licensed and registered dental hygienists or registered dental assistants. Any licensed and registered dental hygienist who, under the supervision of a dentist, assists the dentist in providing dental health services or care using teledentistry is only authorized to perform those services that the dental hygienist is authorized to perform during an in-person patient encounter under general supervision. Services provided by registered dental hygienists through teledentistry should be provided under written protocol in accordance with subsection (d).
§ 63-5-116. Penalties for unauthorized practice by hygienist or assistant.
  1. (a) The board may revoke or suspend the license of, assess a civil penalty for each separate violation against or otherwise lawfully discipline any dentist who permits any licensed and registered dental hygienist, registered dental assistant and/or practical dental assistant operating under that dentist's supervision to perform any acts or services other than those authorized by this chapter.
  2. (b) The board may also revoke or suspend the license or registration of, assess a civil penalty for each separate violation against or otherwise lawfully discipline any dental hygienist or dental assistant violating any of the provisions of this chapter.
§ 63-5-117. License renewal.
  1. (a) Each licensed dentist shall pay an annual renewal fee to the board, payable in advance. The secretary of the board shall notify each licensed dentist that such renewal fee is due.
  2. (b) Each licensed dental hygienist shall pay an annual renewal fee to the board as set by the board, payable in advance, for the ensuing year on or before December 31 of each year, which fees shall become part of the fees of the board and handled in the same manner as other fees of the board. The secretary shall notify all licensed dental hygienists prior to December 31 of each year that the fee is due.
  3. (c) Each registered dental assistant shall pay a biennial renewal fee to the board as set by the board, payable in advance, for the ensuing two (2) years on or before December 31 of each even year, which fees shall become a part of the fees of the board to be handled in the same manner as other fees of the board. The secretary shall notify all registered dental assistants prior to December 31 of each even year that such fee is due.
  4. (d) When any licensed dentist, licensed dental hygienist or registered dental assistant fails to register and pay the registration fee within sixty (60) days after registration becomes due as provided in this section, the license or certificate of such person shall be automatically revoked at the expiration of sixty (60) days after the registration was required, without further notice or hearing. Any person whose license or certificate is automatically revoked as provided in this subsection (d) may make application in writing to the Tennessee board of dental examiners for the reinstatement of such license or certificate, and, upon good cause being shown, the board in its discretion may reinstate such license or certificate upon payment of all past-due renewal fees and upon the further payment of a sum as set by the board.
  5. (e)
    1. (1) Notwithstanding any provision of this chapter to the contrary, the division, with the approval of the commissioner, shall establish a system of license renewals at alternative intervals that will allow for the distribution of the license workload as uniformly as is practicable throughout the calendar year. Licenses issued under the alternative method are valid for twenty-four (24) months and shall expire on the last day of the last month of the license period; however, during a transition period, or at any time thereafter when the board determines that the volume of work for any given interval is unduly burdensome or costly, either the licenses or renewals, or both of them, may be issued for terms of not less than six (6) months nor more than eighteen (18) months. The fee imposed for any license under the alternative interval method for a period of other than twenty-four (24) months shall be proportionate to the annual fee and modified in no other manner, except that the proportional fee shall be rounded off to the nearest quarter of a dollar (25¢).
    2. (2) No renewal application will be accepted after the last day of the month following the license expiration date under the alternative method authorized in subdivision (e)(1).
§ 63-5-118. Certificate to licensee removing from state.
  1. Anyone who is licensed or certified and is an ethical practitioner of dentistry or dental hygiene in the state and who is of good moral character, who shall desire to change residence to another state, territory, the District of Columbia or to a foreign country, upon application to the board, shall receive a special certificate or endorsement signed by the secretary and bearing the seal of the board, which shall attest such facts, the date of licensure or certification and such other facts as may be deemed necessary. The nonrefundable fee for each certificate or endorsement shall be set by the board.
§ 63-5-119. Disbursement of fees, fines and penalties — Operating expenses — Compensation — Conference attendance.
  1. (a) All fees coming into the hands of the board, including examination fees, renewal fees, fines and penalties, shall be paid by the board to the state treasurer and become part of the general fund. The commissioner of finance and administration shall make allotments out of the general fund of at least eighty-five percent (85%) of the funds paid into the general fund by the board for the proper expenditures of the board, and no expenditure shall be made by the board until allotment for the expenditure has been made by the commissioner. Such allotments for the operation of the board shall be disbursed under the general budgetary laws of the state.
  2. (b) The members of the board shall receive as compensation the sum of one hundred dollars ($100) for each day they are actually engaged in the duties of the board in Tennessee, and all necessary expenses incurred in attending the meetings of the board. All reimbursements for travel expenses shall be in accordance with the comprehensive travel regulations as promulgated by the department of finance and administration and approved by the attorney general and reporter.
  3. (c) All fines, fees and penalties provided for in this chapter, whether imposed or required by the board or assessed or imposed by a court, judge or jury, shall belong to and be paid to the board.
  4. (d) The secretary of the board shall, in addition to the per diem provided by this section, receive a salary not to exceed five hundred dollars ($500) per month as set annually by the board.
  5. (e)
    1. (1) The board may select one (1) or more of its members to attend, at the expense of the board, annual meetings of such agencies and associations as the Southern Regional Testing Agency, American Association of Dental Examiners and the Southern Conference of Dental Deans and Examiners, where attendance is necessary and important to the proper functioning of the board.
    2. (2) The members of the board may receive as compensation for attendance at such annual meetings the sum of fifty dollars ($50.00) for each day they are actually engaged in the duties of the board at such annual meetings.
§ 63-5-120. Exhibit of license.
  1. The holder of the license to practice dentistry or dental hygiene shall, at all times, upon request, exhibit such license along with the annual renewal receipt to any of the members of the board, or its authorized agent, or to any officer of the law.
§ 63-5-121. Dental practice to be owned by dentist — Exception for death or disability.
  1. (a) Except where dental services are regularly made available to employees by their employer or where dental services are being provided by an official agency of the state government or any subdivision, any nonprofit organization or hospital, it is unlawful:
    1. (1) For any licensed dentist to practice dentistry as an employee of any person or other entity not engaged primarily in the practice of dentistry; or
    2. (2) For an owner of an active dental practice to be other than a dentist duly licensed to practice in this state.
  2. (b) In the event that a dentist is deceased or becomes substantially disabled, the estate or agent of such dentist may employ another dentist or dentists for a period of not more than two (2) years to provide services to patients until the practice can be sold or otherwise disposed of or closed.
  3. (c)
    1. (1) Nothing in this section shall be construed to prohibit a charitable clinic from employing or contracting with a dentist; provided, that the contractual relationship between the dentist and the charitable clinic is evidenced by a written contract, job description, or documentation, containing language that does not restrict the dentist from exercising independent professional judgment in diagnosing and treating patients.
    2. (2) For the purposes of this subsection (c), the term “charitable clinic” means an entity that meets the following standards:
      1. (A) Has received a determination of exemption from the internal revenue service under 26 U.S.C. § 501(c)(3) or is a distinct part of an entity that has received such a determination of exemption;
      2. (B) Has clinical facilities located in this state;
      3. (C) Has a primary mission to provide health care or dental care services to low-income, uninsured, or underserved individuals;
      4. (D) Provides one or more of the following services for free or at a discounted rate:
        1. (i) Medical care;
        2. (ii) Dental care;
        3. (iii) Mental health care; or
        4. (iv) Prescription medications;
      5. (E) Utilizes volunteer healthcare professionals and nonclinical volunteers; and
      6. (F) Is not required to be licensed under § 68-11-202(a)(1).
§ 63-5-122. Drug prescriptions.
  1. (a) Licensed dentists of this state may dispense, prescribe or otherwise distribute drugs rational to the practice of dentistry, and any prescriptions shall be written in accordance with state and federal drug laws.
  2. (b) Licensed pharmacists of this state may fill prescriptions of licensed dentists of this state for any drug necessary or proper to the practice of dentistry.
  3. (c) Any handwritten prescription order for a drug prepared by a dentist who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription. The handwritten prescription order must contain the name of the prescribing dentist, the name and strength of the drug prescribed, the quantity of the drug prescribed, handwritten in letters or in numerals, instructions for the proper use of the drug, and the month and day that the prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing dentist must sign the handwritten prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home or an assisted care living facility as defined in § 68-11-201.
  4. (d) Any typed or computer-generated prescription order for a drug issued by a dentist who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription order. The typed or computer generated prescription order must contain the name of the prescribing dentist, the name and strength of the drug prescribed, the quantity of the drug prescribed, recorded in letters or in numerals, instructions for the proper use of the drug, and the month and day that the typed or computer generated prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing dentist must sign the typed or computer generated prescription order on the day it is issued, unless it is a standing order issued in a hospital, nursing home or an assisted care living facility as defined in § 68-11-201.
  5. (e) Nothing in this section shall be construed to prevent a dentist from issuing a verbal prescription order.
  6. (f)
    1. (1) All handwritten, typed or computer-generated prescription orders must be issued on either tamper-resistant prescription paper or printed utilizing a technology that results in a tamper-resistant prescription that meets the current centers for medicare and medicaid service guidance to state medicaid directors regarding § 7002(b) of the United States Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, P.L. 110-28, and meets or exceeds specific TennCare requirements for tamper-resistant prescriptions.
    2. (2) Subdivision (f)(1) shall not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the doctor or other person authorized to write prescriptions writes the order into the hospital medical record and then the order is given directly to the hospital pharmacy and the patient never has the opportunity to handle the written order, a nursing home or an assisted care living facility as defined in § 68-11-201 or inpatients or residents of a mental health hospital or residential facility licensed under title 33 or individuals incarcerated in a local, state or federal correctional facility.
§ 63-5-123. Administration of COVID-19 vaccine by dentist.
  1. (a) As used in this section, “COVID-19” means an infectious respiratory disease caused by the coronavirus named SARS-CoV-2, or a mutation of that coronavirus.
  2. (b) Notwithstanding a law to the contrary, a dentist licensed under this chapter may administer a vaccination against COVID-19 if the dentist has received appropriate training as recommended by the Centers for Disease Control and Prevention.
§ 63-5-124. Grounds for denial, suspension or revocation of licenses — Examinations — Investigations of reports — Civil penalties — Costs — Oaths and subpoenas.
  1. (a) The board has the power and it is its duty to deny, suspend, revoke or otherwise restrict or condition the license of, assess a civil penalty for each separate violation against or otherwise lawfully discipline the holder of any license to practice dentistry or any certificate to practice a dental specialty, any license to practice dental hygiene or practice as a registered dental assistant, whenever the licensee or certificate holder is guilty of violating any of the provisions of this chapter or of the following acts or offenses:
    1. (1) Unprofessional, dishonorable or unethical conduct;
    2. (2) A violation or attempted violation, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, this chapter or any lawful order of the board issued pursuant thereto or any criminal statute of this state;
    3. (3) Making false or misleading statements or representations, being guilty of fraud or deceit in obtaining admission to practice or in being guilty of fraud or deceit in the practice of dentistry or dental hygiene or as a registered dental assistant;
    4. (4) Gross health care liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence in the course of professional practice;
    5. (5) Habitual intoxication or personal misuse of any drugs or the use of intoxicating liquors, narcotics, controlled substances, controlled substance analogues or other drugs or stimulants, such as, but not limited to, nitrous oxide sedation, in such manner as to adversely affect the person's ability to practice dentistry, dental hygiene or as a registered dental assistant;
    6. (6) Conviction of a felony, conviction of any offense under state or federal drug laws, or conviction of any offense involving moral turpitude. However, an action taken under this subdivision (a)(6) shall be subject to the applicable provisions of the Fresh Start Act that are compiled in chapter 1, part 1 of this title;
    7. (7) Making or signing in one's professional capacity any certificate that is known to be false at the time one makes or signs such certificate;
    8. (8) Dispensing, prescribing or otherwise distributing any controlled substance or any other drug not in the course of professional practice, or not in good faith to relieve pain and suffering or not to cure an ailment, physical infirmity or disease;
    9. (9) Engaging in the practice of dentistry, dental hygiene or as a registered dental assistant when mentally or physically unable to safely do so;
    10. (10) Solicitation by agents or persons of professional patronage or profiting by the acts of those representing themselves to be agents of the licensee or the certificate holder;
    11. (11) Division of fees or agreeing to split or divide fees received for professional services with any person for bringing or referring a patient;
    12. (12) Conducting the practice of dentistry so as to permit directly or indirectly an unlicensed person to perform services or work that under this chapter can be done legally only by persons licensed to practice dentistry or dental hygiene or as a registered dental assistant;
    13. (13) Professional connection or association with any person, firm or corporation in any manner in an effort to avoid and circumvent this chapter, or lending one's name to another for the illegal practice of dentistry by such person;
    14. (14) Claiming to the public to be a specialist in some particular branch of dentistry without being certified by the board as such;
    15. (15) Payment or acceptance of commissions in any form or manner on fees for professional services, references, consultations, pathological reports, radiographs, prescriptions or on other services or articles supplied to patients;
    16. (16) Having work done by or obtaining work from a dental laboratory without issuing a written work order as provided in § 63-5-108;
    17. (17) Giving of testimonials, directly or indirectly, concerning the supposed virtue of secret therapeutic agents or proprietary preparations, such as remedies, vaccines, mouth washes, dentifrices or other articles or materials that are offered to the public, claiming radical cure or prevention of diseases by their use;
    18. (18) Any other unprofessional or unethical conduct that may be specified by the board by the means of rules and regulations duly published and promulgated by the board or the violation of any provision of this chapter;
    19. (19)
      1. (A) A dentist shall not, on behalf of that dentist, that dentist's partner or associate or any other dentist affiliated with that dentist or that dentist's facility, use or participate in the use of any form of public communication containing a false, fraudulent, misleading or deceptive statement or claim;
      2. (B) Moreover, the fact of promulgation of any forms of public communication covered or prohibited in this section or the rules and regulations promulgated hereunder shall be prima facie evidence that the dentist named either used or permitted the use of the public communication;
      3. (C) A licensed dentist is authorized to use personal professional cards, appointment cards, announcements and related materials and appropriate signs and listings indicating the dentist's office and specialty in accordance with rules and regulations promulgated by the board;
    20. (20) Dispensing, prescribing or otherwise distributing any controlled substance, controlled substance analogue or other drug to any person in violation of any law of the state or of the United States; or
    21. (21) Disciplinary action against a person licensed to practice dentistry or dental hygiene or registered to practice as a dental assistant by another state or territory of the United States for any acts or omissions that would constitute grounds for discipline of a person licensed or registered in this state. A certified copy of the initial or final order, or other equivalent document memorializing the disciplinary action from the disciplining state or territory, shall constitute prima facie evidence of a violation of this section and shall be sufficient grounds upon which to deny, restrict or condition licensure/registration or renewal and/or discipline a person licensed in this state.
  2. (b)
    1. (1) In enforcing this section, the board shall, upon probable cause, have the authority to compel an applicant or license or certificate holder to submit to a mental and/or physical examination, by a designated committee of at least three (3) practicing physicians, including a psychiatrist where a question of mental condition is involved. The applicant or license or certificate holder may have an independent physical or mental examination, which examination report shall be filed with the board for consideration. The committee will submit a report of its findings to the board for use in any hearing that may thereafter ensue.
    2. (2) The board may, upon finding of probable cause, require a dentist, dental hygienist or dental assistant to complete drug and/or alcohol treatment through a program designated by, or contracting with, the board. The board in its discretion is authorized to share information, interviews, reports, statements, memoranda or other data at the program director's request. Information shared between the board and the program director shall be deemed not to violate laws requiring confidentiality of investigations or peer review records protected under § 63-5-131.
  3. (c) The board, on its own motion, may investigate any report indicating that a dentist, dental hygienist or dental assistant is or may be in violation of this chapter. Any dentist, dental hygienist, dental assistant, dental or dental related society or association, or any other person who in good faith reports to the board any information that a dentist, dental hygienist or dental assistant is or may be in violation of any provisions of this chapter, is not subject to suit for civil damages as a result thereof.
  4. (d) In assessing a civil penalty pursuant to this chapter, the board should consider the following:
    1. (1) The harm or potential harm of the violation to the public health and welfare;
    2. (2) The extent to which the public was exposed to such harm or potential harm;
    3. (3) The rate, duration and severity of the violations;
    4. (4) The value of the penalty as a deterrent to future violations;
    5. (5) Attempts by the violator to mitigate the harm to the public; and
    6. (6) Such other specific criteria as the board may wish to establish by duly promulgated regulation.
  5. (e) The board, pursuant to duly promulgated rules, may, whenever a final order is issued after a disciplinary contested case hearing that contains findings that a licensee or other person has violated any provision of this chapter, assess the costs directly related to the prosecution of the case, including investigatory costs, against the licensee or person.
  6. (f)
    1. (1) Any elected officer of the board or any duly appointed or elected chair has the authority to administer oaths to witnesses. Upon probable cause being established, the board, by a vote of two-thirds (⅔) of the members to which the board is entitled, may issue subpoenas for the attendance of witnesses and the production of documents and records.
    2. (2) Service of a subpoena issued by the board shall be made by the sheriff of the county of residence of the licensee or person upon whom the subpoena is served.
    3. (3)
      1. (A) A licensee or person served by subpoena shall have thirty (30) days to request in writing a hearing before the board for the sole purpose of making a special appearance to quash or modify the subpoena. The subpoena for attendance of the person or the production of books and records shall be stayed until the board votes upon the request to quash or modify the subpoena. A majority vote of the members to which the board is entitled is required to quash or modify a subpoena.
      2. (B) A motion to appeal from a decision by the board regarding a request to quash or modify a subpoena shall be made to the chancery court in Davidson County within fifteen (15) days of such decision.
    4. (4) If any witness fails or refuses to obey a subpoena issued by it, the board is authorized to make application to any court of record in this state within the jurisdiction of which the witness is found or resides; and the court shall have power to attach the body of the witness and compel the witness to appear before the board and give testimony or produce books, records or papers as ordered. Any failure to obey the court order may be punished by the court issuing the order as a civil contempt.
    5. (5) Each witness who appears before the board by order of the board shall receive for attendance the compensation provided by law for attendance of witnesses in a court of record, which shall be paid from the funds of the board in the same manner as all other expenses of the board are paid.
§ 63-5-125. Administrative procedures.
  1. All proceedings for disciplinary action against a licensee or certificate holder under this chapter shall be conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
§ 63-5-126. Enjoining unlawful practice.
  1. (a) The board, in addition to the powers and duties expressly granted by this chapter in the matter of suspension or revocation of a license and in the matter of the refusal to issue a certificate, is authorized and empowered to petition any circuit or chancery court having jurisdiction to enjoin any person who is practicing or attempting to practice dentistry or dental hygiene without possessing a valid license to so practice and to enjoin any person, firm or corporation from performing any act or rendering any service that constitutes the practice of dentistry or dental hygiene as defined in § 63-5-108. No injunction bond shall be required of the board.
  2. (b) Jurisdiction is conferred upon the circuit and chancery courts of the state to hear and determine such causes as chancery causes and to exercise full and complete jurisdiction in such injunctive proceedings.
§ 63-5-127. District attorneys general to assist board.
  1. The board at all times has the power to call upon the district attorneys general for the state in the various districts to assist the board. It is the duty of all district attorneys general throughout the state to assist the board, upon its request, in any suit for injunction or prosecution instituted by the board without charge or additional compensation to the district attorneys general.
§ 63-5-128. Criminal penalties.
  1. (a) Any person who violates any provision of § 63-5-107(a) commits a Class B misdemeanor.
  2. (b) After being convicted of any violation of § 63-5-107(a), any person who again violates § 63-5-107(a) commits a Class E felony.
  3. (c) Any person who has been enjoined by a court of competent jurisdiction from performing any acts or rendering any services that constitute the practice of dentistry as defined in § 63-5-108, who thereafter willfully violates the terms of the injunction by again performing such acts or rendering such services, commits a Class E felony.
§ 63-5-129. Retirement.
  1. Any person licensed to practice dentistry or dental hygiene in this state who has retired or may hereafter retire from such practice in this state is not required to register as required by this chapter; provided, that such person files with the board an affidavit on a form to be furnished by the board, which affidavit states the date on which such person retired from such practice and other such facts as tend to verify such retirement as the board deems necessary. If such person thereafter reengages in the practice of dentistry or dental hygiene in this state, such person shall apply for registration with the board as provided by this chapter.
§ 63-5-130. Armed forces or public health service.
  1. Any person licensed to practice dentistry or dental hygiene in this state who is an officer in the commissioned dental corps of the army, navy, air force or the public health service of the United States shall not be required to register as required in this chapter. Such person shall file with the board an affidavit on a form to be furnished by the board, which affidavit shall state the date on which such person entered the army, navy, air force or the public health service of the United States and such other facts as tend to verify such service as the board shall deem necessary. When such person resigns or is honorably discharged from one (1) of the aforementioned services and engages in the practice of dentistry or dental hygiene in this state or any other state, such person shall, within thirty (30) days, apply for registration with the board as provided for in this chapter.
§ 63-5-131. Immunity of peer review committee from liability — Confidentiality.
  1. (a) As used in this section, “peer review committee” or “committee” means any committee, board, commission or other entity constituted by any statewide dental association or local dental society for the purpose of receiving and evaluating dental acts of other dentists or dental auxiliary personnel or their personal conduct as it relates to the performance of their professional duties.
  2. (b) Any dentist who serves on any peer review committee or on any other committee is immune from liability with respect to any action taken by the dentist in good faith and without malice as a member of such committee, board, commission or other entity.
  3. (c) Dentists, dental hygienists and registered dental assistants, members of boards of directors or trustees of any publicly supported or privately supported hospital or other such provider of health care, or any other individual appointed to any committee, as such term is described in subsection (a), are immune from liability to any patient, individual or organization for furnishing information, data, reports or records to any such committee or for damages resulting from any decision, opinions, actions and proceedings rendered, entered or acted upon by such committees undertaken or performed within the scope or functions of the duties of such committees, if made or taken in good faith and without malice and on the basis of facts reasonably known or reasonably believed to exist.
  4. (d) All information, interviews, reports, statements, memoranda or other data furnished to any such peer review committee or other entity and any findings, conclusions or recommendations resulting from the proceedings of such committee or other entity are privileged. The records and proceedings of any such committee or other entity are confidential and shall be used by such committee or other entity and the members thereof only in the exercise of the proper functions of the committee or other entity and shall not become public record nor be available for court subpoena or discovery proceedings. Nothing contained in this subsection (d) applies to records, documents or information otherwise available from original sources, such records, documents or information not to be construed as immune from discovery or use in any civil proceeding solely due to presentation to the committee.
§ 63-5-132. Inactive licenses to perform pro bono services.
  1. The board of dentistry shall establish by rule an inactive license category that allows dentists to perform services without compensation only for those persons receiving services from organizations that have received a determination of exemption under § 501(c)(3) of the Internal Revenue Code. Such inactive license category shall not authorize any other practice of dentistry.
§ 63-5-133. Dental referral service.
  1. (a) A dental referral service shall not participate in the advertising of, or operate, a dental referral service unless it meets all of the following requirements:
    1. (1) Its patient referrals result from patient-initiated responses to the dental referral service's advertising;
    2. (2) It discloses to any prospective patient in its advertising that participating dentists have paid a fee for participation in the service;
    3. (3) It does not impose a fee on participating dentists dependent on the number of referrals or amount of professional fees paid by the patient to the dentist; and
    4. (4) It duly registers with the board, providing all information reasonably required by the board.
  2. (b) Participating dentists shall not enter into an agreement to accept for dental care or treatment a person referred or recommended by a dental referral service unless the dental referral service meets all the requirements of subsection (a). Participating dentists shall charge no more than their usual and customary fees to any patient so referred or recommended.
  3. (c)
    1. (1) “Dental referral service” is a person, firm, partnership, association, corporation, agent or employee of any of the foregoing that engages in any business or service for profit that in whole or in part includes the referral or recommendation of persons to a dentist for any form of dental care or treatment.
    2. (2) “Participating dentist” is a dentist duly licensed under this chapter who has paid a fee to a dental referral service in order to be included in its referral service.
  4. (d) A dental referral service that advertises shall include in each advertisement legible or audible language, or both, a disclaimer containing all the following statements or information:
    1. (1) The advertisement is paid for by participating dentists who have paid a fee to participate; and
    2. (2) No representation is made about the quality of the dental services to be performed or expertise of the participating dentists, and that participating dentists are not more or less qualified than dentists who are not participating in the service.
  5. (e) Dental referral service advertisements shall not do any of the following:
    1. (1) Advertise or solicit patients in a manner that contains a false, fraudulent, misleading or deceptive statement in any material respect;
    2. (2) Publish or circulate, directly or indirectly, any false, fraudulent, misleading or deceptive statement as to the skill or methods of practice of any participating dentist;
    3. (3) Contain a statement or make a recommendation that the dental referral service provides referrals to the most qualified dentists or dental practice; or
    4. (4) Advertise a review process or a screening that misleads the public into thinking a participating dentist has obtained special recognition or joined a selective group of licensed dentists by being a participating dentist in the dental referral service.
§ 63-5-134. Special volunteer license for practice in free health clinic — Exemption from fees — Renewal.
  1. A dentist or a dental hygienist licensed pursuant to this chapter under a special volunteer license who is a medical practitioner, as defined by § 63-1-201, engaged in practice at a free health clinic shall not be subject to license fees under this chapter. The board of dentistry may issue a special volunteer license, as such license is defined in § 63-1-201, to qualified applicants without fee or charge. Such license shall be for a period of two (2) years and may be renewed on a biennial basis.
Part 2 Dentist and Dental Hygienist Compact [Enactment contingent upon adoption; see the Compiler's Notes.]
§ 63-5-201. Short title. [Enactment contingent upon adoption; see the Compiler's Notes.]
  1. This part is known and may be cited as the “Dentist and Dental Hygienist Compact.”
§ 63-5-202. Text of compact. [Enactment contingent upon adoption; see the Compiler's Notes.]
  1. The Dentist and Dental Hygienist Compact is enacted into law and entered into by this state with all states legally joining therein in the form substantially as follows:
    1. Dentist and Dental Hygienist Compact
      1. Section 1. Title and Purpose.
        1. This statute shall be known and cited as the Dentist and Dental Hygienist Compact. The purposes of this Compact are to facilitate the interstate practice of dentistry and dental hygiene and improve public access to dentistry and dental hygiene services by providing Dentists and Dental Hygienists licensed in a Participating State the ability to practice in Participating States in which they are not licensed. The Compact does this by establishing a pathway for Dentists and Dental Hygienists licensed in a Participating State to obtain a Compact Privilege that authorizes them to practice in another Participating State in which they are not licensed. The Compact enables Participating States to protect the public health and safety with respect to the practice of such Dentists and Dental Hygienists, through the State's authority to regulate the practice of dentistry and dental hygiene in the State. The Compact:
          1. A. Enables Dentists and Dental Hygienists who qualify for a Compact Privilege to practice in other Participating States without satisfying burdensome and duplicative requirements associated with securing a License to practice in those States;
          2. B. Promotes mobility and addresses workforce shortages through each Participating State's acceptance of a Compact Privilege to practice in that State;
          3. C. Increases public access to qualified, licensed Dentists and Dental Hygienists by creating a responsible, streamlined pathway for Licensees to practice in Participating States;
          4. D. Enhances the ability of Participating States to protect the public's health and safety;
          5. E. Does not interfere with licensure requirements established by a Participating State;
          6. F. Facilitates the sharing of licensure and disciplinary information among Participating States;
          7. G. Requires Dentists and Dental Hygienists who practice in a Participating State pursuant to a Compact Privilege to practice within the Scope of Practice authorized in that State;
          8. H. Extends the authority of a Participating State to regulate the practice of dentistry and dental hygiene within its borders to Dentists and Dental Hygienists who practice in the State through a Compact Privilege;
          9. I. Promotes the cooperation of Participating States in regulating the practice of dentistry and dental hygiene within those States; and
          10. J. Facilitates the relocation of military members and their spouses who are licensed to practice dentistry or dental hygiene.
      2. Section 2. Definitions.
        1. As used in this Compact, unless the context requires otherwise, the following definitions shall apply:
          1. A. “Active Military Member” means any individual in full-time duty status in the armed forces of the United States, including members of the National Guard and Reserve.
          2. B. “Adverse Action” means disciplinary action or encumbrance imposed on a License or Compact Privilege by a State Licensing Authority.
          3. C. “Alternative Program” means a non-disciplinary monitoring or practice remediation process applicable to a Dentist or Dental Hygienist approved by a State Licensing Authority of a Participating State in which the Dentist or Dental Hygienist is licensed. This includes, but is not limited to, programs to which Licensees with substance abuse or addiction issues are referred in lieu of Adverse Action.
          4. D. “Clinical Assessment” means examination or process, required for licensure as a Dentist or Dental Hygienist as applicable, that provides evidence of clinical competence in dentistry or dental hygiene.
          5. E. “Commissioner” means the individual appointed by a Participating State to serve as the member of the Commission for that Participating State.
          6. F. “Compact” means this Dentist and Dental Hygienist Compact.
          7. G. “Compact Privilege” means the authorization granted by a Remote State to allow a Licensee from a Participating State to practice as a Dentist or Dental Hygienist in a Remote State.
          8. H. “Continuing Professional Development” means a requirement, as a condition of License renewal, to provide evidence of successful participation in educational or professional activities relevant to practice or area of work.
          9. I. “Criminal Background Check” means the submission of fingerprints or other biometric-based information for a License applicant for the purpose of obtaining that applicant's criminal history record information, as defined in 28 C.F.R. § 20.3(d) from the Federal Bureau of Investigation and the State's criminal history record repository as defined in 28 C.F.R. § 20.3(f).
          10. J. “Data System” means the Commission's repository of information about Licensees, including, but not limited to, examination, licensure, investigative, Compact Privilege, Adverse Action, and Alternative Program.
          11. K. “Dental Hygienist” means an individual who is licensed by a State Licensing Authority to practice dental hygiene.
          12. L. “Dentist” means an individual who is licensed by a State Licensing Authority to practice dentistry.
          13. M. “Dentist and Dental Hygienist Compact Commission” or “Commission” means a joint government agency established by this Compact comprised of each State that has enacted the Compact and a national administrative body comprised of a Commissioner from each State that has enacted the Compact.
          14. N. “Encumbered License” means a License that a State Licensing Authority has limited in any way other than through an Alternative Program.
          15. O. “Executive Board” means the Chair, Vice Chair, Secretary, and Treasurer and any other Commissioners as may be determined by Commission Rule or bylaw.
          16. P. “Jurisprudence Requirement” means the assessment of an individual's knowledge of the laws and Rules governing the practice of dentistry or dental hygiene, as applicable, in a State.
          17. Q. “License” means current authorization by a State, other than authorization pursuant to a Compact Privilege, or other privilege, for an individual to practice as a Dentist or Dental Hygienist in that State.
          18. R. “Licensee” means an individual who holds an unrestricted License from a Participating State to practice as a Dentist or Dental Hygienist in that State.
          19. S. “Model Compact” means the model for the Dentist and Dental Hygienist Compact on file with the Council of State Governments or other entity as designated by the Commission.
          20. T. “Participating State” means a State that has enacted the Compact and been admitted to the Commission in accordance with the provisions herein and Commission Rules.
          21. U. “Qualifying License” means a License that is not an Encumbered License issued by a Participating State to practice dentistry or dental hygiene.
          22. V. “Remote State” means a Participating State where a Licensee who is not licensed as a Dentist or Dental Hygienist is exercising or seeking to exercise the Compact Privilege.
          23. W. “Rule” means a regulation promulgated by an entity that has the force of law.
          24. X. “Scope of Practice” means the procedures, actions, and processes a Dentist or Dental Hygienist licensed in a State is permitted to undertake in that State and the circumstances under which the Licensee is permitted to undertake those procedures, actions, and processes. Such procedures, actions, and processes and the circumstances under which they may be undertaken may be established through means, including, but not limited to, statute, regulations, case law, and other processes available to the State Licensing Authority or other government agency.
          25. Y. “Significant Investigative Information” means information, records, and documents received or generated by a State Licensing Authority pursuant to an investigation, that includes notification and an opportunity to respond if required by state law, for which a determination has been made that there is probable cause to believe that the Licensee has violated a statute or regulation that is considered more than a minor infraction for which the State Licensing Authority could pursue Adverse Action against the Licensee.
          26. Z. “State” means any state, commonwealth, district, or territory of the United States of America that regulates the practices of dentistry and dental hygiene.
          27. AA. “State Licensing Authority” means an agency or other entity of a State that is responsible for the licensing and regulation of Dentists or Dental Hygienists.
      3. Section 3. State Participation in the Compact.
        1. A. In order to join the Compact and thereafter continue as a Participating State, a State must:
          1. 1. Enact a compact that is not materially different from the Model Compact as determined in accordance with Commission Rules;
          2. 2. Participate fully in the Commission's Data System;
          3. 3. Have a mechanism in place for receiving and investigating complaints about its Licensees and License applicants;
          4. 4. Notify the Commission, in compliance with the terms of the Compact and Commission Rules, of any Adverse Action or the availability of Significant Investigative Information regarding a Licensee and License applicant;
          5. 5. Fully implement a Criminal Background Check requirement, within a time frame established by Commission Rule, by receiving the results of a qualifying Criminal Background Check;
          6. 6. Comply with the Commission Rules applicable to a Participating State;
          7. 7. Accept the National Board Examinations of the Joint Commission on National Dental Examinations or another examination accepted by Commission Rule as a licensure examination;
          8. 8. Accept for licensure that applicants for a Dentist License graduate from a predoctoral dental education program accredited by the Commission on Dental Accreditation, or another accrediting agency recognized by the United States Department of Education for the accreditation of dentistry and dental hygiene education programs, leading to the Doctor of Dental Surgery (D.D.S.) or Doctor of Dental Medicine (D.M.D.) degree;
          9. 9. Accept for licensure that applicants for a Dental Hygienist License graduate from a dental hygiene education program accredited by the Commission on Dental Accreditation or another accrediting agency recognized by the United States Department of Education for the accreditation of dentistry and dental hygiene education programs;
          10. 10. Require for licensure that applicants successfully complete a Clinical Assessment;
          11. 11. Have Continuing Professional Development requirements as a condition for License renewal; and
          12. 12. Pay a participation fee to the Commission as established by Commission Rule.
        2. B. Providing alternative pathways for an individual to obtain an unrestricted License does not disqualify a State from participating in the Compact.
        3. C. When conducting a Criminal Background Check, the State Licensing Authority shall:
          1. 1. Consider that information in making a licensure decision;
          2. 2. Maintain documentation of completion of the Criminal Background Check and background check information to the extent allowed by State and federal law; and
          3. 3. Report to the Commission whether it has completed the Criminal Background Check and whether the individual was granted or denied a License.
        4. D. A Licensee of a Participating State who has a Qualifying License in that State and does not hold an Encumbered License in any other Participating State, shall be issued a Compact Privilege in a Remote State in accordance with the terms of the Compact and Commission Rules. If a Remote State has a Jurisprudence Requirement, a Compact Privilege will not be issued to the Licensee unless the Licensee has satisfied the Jurisprudence Requirement.
      4. Section 4. Compact Privilege.
        1. A. To obtain and exercise the Compact Privilege under the terms and provisions of the Compact, the Licensee shall:
          1. 1. Have a Qualifying License as a Dentist or Dental Hygienist in a Participating State;
          2. 2. Be eligible for a Compact Privilege in any Remote State in accordance with D, G, and H of this section;
          3. 3. Submit to an application process whenever the Licensee is seeking a Compact Privilege;
          4. 4. Pay any applicable Commission and Remote State fees for a Compact Privilege in the Remote State;
          5. 5. Meet any Jurisprudence Requirement established by a Remote State in which the Licensee is seeking a Compact Privilege;
          6. 6. Have passed a National Board Examination of the Joint Commission on National Dental Examinations or another examination accepted by Commission Rule;
          7. 7. For a Dentist, have graduated from a predoctoral dental education program accredited by the Commission on Dental Accreditation, or another accrediting agency recognized by the United States Department of Education for the accreditation of dentistry and dental hygiene education programs, leading to the Doctor of Dental Surgery (D.D.S.) or Doctor of Dental Medicine (D.M.D.) degree;
          8. 8. For a Dental Hygienist, have graduated from a dental hygiene education program accredited by the Commission on Dental Accreditation or another accrediting agency recognized by the United States Department of Education for the accreditation of dentistry and dental hygiene education programs;
          9. 9. Have successfully completed a Clinical Assessment for licensure;
          10. 10. Report to the Commission Adverse Action taken by any non-Participating State when applying for a Compact Privilege and, otherwise, within thirty (30) days from the date the Adverse Action is taken;
          11. 11. Report to the Commission when applying for a Compact Privilege the address of the Licensee's primary residence and thereafter immediately report to the Commission any change in the address of the Licensee's primary residence; and
          12. 12. Consent to accept service of process by mail at the Licensee's primary residence on record with the Commission with respect to any action brought against the Licensee by the Commission or a Participating State, and consent to accept service of a subpoena by mail at the Licensee's primary residence on record with the Commission with respect to any action brought or investigation conducted by the Commission or a Participating State.
        2. B. The Licensee must comply with the requirements of subsection A of this section to maintain the Compact Privilege in the Remote State. If those requirements are met, the Compact Privilege will continue as long as the Licensee maintains a Qualifying License in the State through which the Licensee applied for the Compact Privilege and pays any applicable Compact Privilege renewal fees.
        3. C. A Licensee providing dentistry or dental hygiene in a Remote State under the Compact Privilege shall function within the Scope of Practice authorized by the Remote State for a Dentist or Dental Hygienist licensed in that State.
        4. D. A Licensee providing dentistry or dental hygiene pursuant to a Compact Privilege in a Remote State is subject to that State's regulatory authority. A Remote State may, in accordance with due process and that State's laws, by Adverse Action revoke or remove a Licensee's Compact Privilege in the Remote State for a specific period of time and impose fines or take any other necessary actions to protect the health and safety of its citizens. If a Remote State imposes an Adverse Action against a Compact Privilege that limits the Compact Privilege, that Adverse Action applies to all Compact Privileges in all Remote States. A Licensee whose Compact Privilege in a Remote State is removed for a specified period of time is not eligible for a Compact Privilege in any other Remote State until the specific time for removal of the Compact Privilege has passed and all encumbrance requirements are satisfied.
        5. E. If a License in a Participating State is an Encumbered License, the Licensee shall lose the Compact Privilege in a Remote State and shall not be eligible for a Compact Privilege in any Remote State until the License is no longer encumbered.
        6. F. Once an Encumbered License in a Participating State is restored to good standing, the Licensee must meet the requirements of subsection A of this section to obtain a Compact Privilege in a Remote State.
        7. G. If a Licensee's Compact Privilege in a Remote State is removed by the Remote State, the individual shall lose or be ineligible for the Compact Privilege in any Remote State until the following occur:
          1. 1. The specific period of time for which the Compact Privilege was removed has ended; and
          2. 2. All conditions for removal of the Compact Privilege have been satisfied.
        8. H. Once the requirements of subsection G of this section have been met, the Licensee must meet the requirements in subsection A of this section to obtain a Compact Privilege in a Remote State.
      5. Section 5. Active Military Member or Their Spouses.
        1. An Active Military Member and their spouse shall not be required to pay to the Commission for a Compact Privilege the fee otherwise charged by the Commission. If a Remote State chooses to charge a fee for a Compact Privilege, it may choose to charge a reduced fee or no fee to an Active Military Member and their spouse for a Compact Privilege.
      6. Section 6. Adverse Actions.
        1. A. A Participating State in which a Licensee is licensed shall have exclusive authority to impose Adverse Action against the Qualifying License issued by that Participating State.
        2. B. A Participating State may take Adverse Action based on the Significant Investigative Information of a Remote State, so long as the Participating State follows its own procedures for imposing Adverse Action.
        3. C. Nothing in this Compact shall override a Participating State's decision that participation in an Alternative Program may be used in lieu of Adverse Action and that such participation shall remain non-public if required by the Participating State's laws. Participating States must require Licensees who enter any Alternative Program in lieu of discipline to agree not to practice pursuant to a Compact Privilege in any other Participating State during the term of the Alternative Program without prior authorization from such other Participating State.
        4. D. Any Participating State in which a Licensee is applying to practice or is practicing pursuant to a Compact Privilege may investigate actual or alleged violations of the statutes and regulations authorizing the practice of dentistry or dental hygiene in any other Participating State in which the Dentist or Dental Hygienist holds a License or Compact Privilege.
        5. E. A Remote State shall have the authority to:
          1. 1. Take Adverse Actions as set forth in Section 4.D against a Licensee's Compact Privilege in the State;
          2. 2. In furtherance of its rights and responsibilities under the Compact and the Commission's Rules, issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses, and the production of evidence. Subpoenas issued by a State Licensing Authority in a Participating State for the attendance and testimony of witnesses, or the production of evidence from another Participating State, shall be enforced in the latter State by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage, and other fees required by the service statutes of the State where the witnesses or evidence are located; and
          3. 3. If otherwise permitted by State law, recover from the Licensee the costs of investigations and disposition of cases resulting from any Adverse Action taken against that Licensee.
        6. F. Joint Investigations
          1. 1. In addition to the authority granted to a Participating State by its Dentist or Dental Hygienist licensure act or other applicable State law, a Participating State may jointly investigate Licensees with other Participating States.
          2. 2. Participating States shall share any Significant Investigative Information, litigation, or compliance materials in furtherance of any joint investigation initiated under the Compact.
        7. G. Authority to Continue Investigation
          1. 1. After a Licensee's Compact Privilege in a Remote State is terminated, the Remote State may continue an investigation of the Licensee that began when the Licensee had a Compact Privilege in that Remote State.
          2. 2. If the investigation yields what would be Significant Investigative Information had the Licensee continued to have a Compact Privilege in that Remote State, the Remote State shall report the presence of such information to the Data System as required by Section 8.B.6 as if it was Significant Investigative Information.
      7. Section 7. Establishment and Operation of the Commission.
        1. A. The Compact Participating States hereby create and establish a joint government agency whose membership consists of all Participating States that have enacted the Compact. The Commission is an instrumentality of the Participating States acting jointly and not an instrumentality of any one (1) State. The Commission shall come into existence on or after the effective date of the Compact as set forth in Section 11A.
        2. B. Participation, Voting, and Meetings
          1. 1. Each Participating State shall have and be limited to one (1) Commissioner selected by that Participating State's State Licensing Authority or, if the State has more than one (1) State Licensing Authority, selected collectively by the State Licensing Authorities.
          2. 2. The Commissioner shall be a member or designee of such Authority or Authorities.
          3. 3. The Commission may by Rule or bylaw establish a term of office for Commissioners and may by Rule or bylaw establish term limits.
          4. 4. The Commission may recommend to a State Licensing Authority or Authorities, as applicable, removal or suspension of an individual as the State's Commissioner.
          5. 5. A Participating State's State Licensing Authority, or Authorities, as applicable, shall fill any vacancy of its Commissioner on the Commission within sixty (60) days of the vacancy.
          6. 6. Each Commissioner shall be entitled to one (1) vote on all matters that are voted upon by the Commission.
          7. 7. The Commission shall meet at least once during each calendar year. Additional meetings may be held as set forth in the bylaws. The Commission may meet by telecommunication, video conference, or other similar electronic means.
        3. C. The Commission shall have the following powers:
          1. 1. Establish the fiscal year of the Commission;
          2. 2. Establish a code of conduct and conflict of interest policies;
          3. 3. Adopt Rules and bylaws;
          4. 4. Maintain its financial records in accordance with the bylaws;
          5. 5. Meet and take such actions as are consistent with the provisions of this Compact, the Commission's Rules, and the bylaws;
          6. 6. Initiate and conclude legal proceedings or actions in the name of the Commission; provided, that the standing of any State Licensing Authority to sue or be sued under applicable law shall not be affected;
          7. 7. Maintain and certify records and information provided to a Participating State as the authenticated business records of the Commission, and designate a person to do so on the Commission's behalf;
          8. 8. Purchase and maintain insurance and bonds;
          9. 9. Borrow, accept, or contract for services of personnel, including, but not limited to, employees of a Participating State;
          10. 10. Conduct an annual financial review;
          11. 11. Hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of the Compact, and establish the Commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters;
          12. 12. As set forth in the Commission Rules, charge a fee to a Licensee for the grant of a Compact Privilege in a Remote State and thereafter, as may be established by Commission Rule, charge the Licensee a Compact Privilege renewal fee for each renewal period in which that Licensee exercises or intends to exercise the Compact Privilege in that Remote State. Nothing herein shall be construed to prevent a Remote State from charging a Licensee a fee for a Compact Privilege or renewals of a Compact Privilege, or a fee for the Jurisprudence Requirement if the Remote State imposes such a requirement for the grant of a Compact Privilege;
          13. 13. Accept any and all appropriate gifts, donations, grants of money, other sources of revenue, equipment, supplies, materials, and services, and receive, utilize, and dispose of the same; provided, that at all times the Commission shall avoid any appearance of impropriety and/or conflict of interest;
          14. 14. Lease, purchase, retain, own, hold, improve, or use any property, real, personal, or mixed, or any undivided interest therein;
          15. 15. Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property real, personal, or mixed;
          16. 16. Establish a budget and make expenditures;
          17. 17. Borrow money;
          18. 18. Appoint committees, including standing committees, which may be composed of members, State regulators, State legislators or their representatives, and consumer representatives, and such other interested persons as may be designated in this Compact and the bylaws;
          19. 19. Provide and receive information from, and cooperate with, law enforcement agencies;
          20. 20. Elect a Chair, Vice Chair, Secretary, and Treasurer and such other officers of the Commission as provided in the Commission's bylaws;
          21. 21. Establish and elect an Executive Board;
          22. 22. Adopt and provide to the Participating States an annual report;
          23. 23. Determine whether a State's enacted compact is materially different from the Model Compact language such that the State would not qualify for participation in the Compact; and
          24. 24. Perform such other functions as may be necessary or appropriate to achieve the purposes of this Compact.
        4. D. Meetings of the Commission
          1. 1. All meetings of the Commission that are not closed pursuant to this subsection shall be open to the public. Notice of public meetings shall be posted on the Commission's website at least thirty (30) days prior to the public meeting.
          2. 2. Notwithstanding subsection D.1 of this section, the Commission may convene an emergency public meeting by providing at least twenty-four (24) hours' prior notice on the Commission's website, and any other means as provided in the Commission's Rules, for any of the reasons it may dispense with notice of proposed rulemaking under Section 9.L. The Commission's legal counsel shall certify that one of the reasons justifying an emergency public meeting has been met.
          3. 3. Notice of all Commission meetings shall provide the time, date, and location of the meeting, and if the meeting is to be held or accessible via telecommunication, video conference, or other electronic means, the notice shall include the mechanism for access to the meeting through such means.
          4. 4. The Commission may convene in a closed, non-public meeting for the Commission to receive legal advice or to discuss:
            1. a. Non-compliance of a Participating State with its obligations under the Compact;
            2. b. The employment, compensation, discipline, or other matters, practices, or procedures related to specific employees or other matters related to the Commission's internal personnel practices and procedures;
            3. c. Current or threatened discipline of a Licensee or Compact Privilege holder by the Commission or by a Participating State's Licensing Authority;
            4. d. Current, threatened, or reasonably anticipated litigation;
            5. e. Negotiation of contracts for the purchase, lease, or sale of goods, services, or real estate;
            6. f. Accusing any person of a crime or formally censuring any person;
            7. g. Trade secrets or commercial or financial information that is privileged or confidential;
            8. h. Information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy;
            9. i. Investigative records compiled for law enforcement purposes;
            10. j. Information related to any investigative reports prepared by or on behalf of or for use of the Commission or other committee charged with responsibility of investigation or determination of compliance issues pursuant to the Compact;
            11. k. Legal advice;
            12. l. Matters specifically exempted from disclosure to the public by federal or Participating State law; and
            13. m. Other matters as promulgated by the Commission by Rule.
          5. 5. If a meeting, or portion of a meeting, is closed, the presiding officer shall state that the meeting will be closed and reference each relevant exempting provision, and such reference shall be recorded in the minutes.
          6. 6. The Commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, and the reasons therefore, including a description of the views expressed. All documents considered in connection with an action shall be identified in such minutes. All minutes and documents of a closed meeting shall remain under seal, subject to release only by a majority vote of the Commission or order of a court of competent jurisdiction.
        5. E. Financing of the Commission
          1. 1. The Commission shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization, and ongoing activities.
          2. 2. The Commission may accept any and all appropriate sources of revenue, donations, and grants of money, equipment, supplies, materials, and services.
          3. 3. The Commission may levy on and collect an annual assessment from each Participating State and impose fees on Licensees of Participating States when a Compact Privilege is granted, to cover the cost of the operations and activities of the Commission and its staff, which must be in a total amount sufficient to cover its annual budget as approved each fiscal year for which sufficient revenue is not provided by other sources. The aggregate annual assessment amount for Participating States shall be allocated based upon a formula that the Commission shall promulgate by Rule.
          4. 4. The Commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same, nor shall the Commission pledge the credit of any Participating State, except by and with the authority of the Participating State.
          5. 5. The Commission shall keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the Commission shall be subject to the financial review and accounting procedures established under its bylaws. All receipts and disbursements of funds handled by the Commission shall be subject to an annual financial review by a certified or licensed public accountant, and the report of the financial review shall be included in and become part of the annual report of the Commission.
        6. F. The Executive Board
          1. 1. The Executive Board shall have the power to act on behalf of the Commission according to the terms of this Compact. The powers, duties, and responsibilities of the Executive Board shall include:
            1. a. Overseeing the day-to-day activities of the administration of the Compact, including compliance with the provisions of the Compact, the Commission's Rules, and bylaws;
            2. b. Recommending to the Commission changes to the Rules or bylaws, changes to this Compact legislation, fees charged to Compact Participating States, fees charged to Licensees, and other fees;
            3. c. Ensuring Compact administration services are appropriately provided, including by contract;
            4. d. Preparing and recommending the budget;
            5. e. Maintaining financial records on behalf of the Commission;
            6. f. Monitoring Compact compliance of Participating States and providing compliance reports to the Commission;
            7. g. Establishing additional committees as necessary;
            8. h. Exercising the powers and duties of the Commission during the interim between Commission meetings, except for adopting or amending Rules, adopting or amending bylaws, and exercising any other powers and duties expressly reserved to the Commission by Rule or bylaw; and
            9. i. Other duties as provided in the Rules or bylaws of the Commission.
          2. 2. The Executive Board shall be composed of up to seven (7) members:
            1. a. The Chair, Vice Chair, Secretary, and Treasurer of the Commission and any other members of the Commission who serve on the Executive Board shall be voting members of the Executive Board; and
            2. b. Other than the Chair, Vice Chair, Secretary, and Treasurer, the Commission may elect up to three (3) voting members from the current membership of the Commission.
          3. 3. The Commission may remove any member of the Executive Board as provided in the Commission's bylaws.
          4. 4. The Executive Board shall meet at least annually.
            1. a. An Executive Board meeting at which it takes or intends to take formal action on a matter shall be open to the public, except that the Executive Board may meet in a closed, non-public session of a public meeting when dealing with any of the matters covered under subsection D.4.
            2. b. The Executive Board shall give five (5) business days' notice of its public meetings, posted on its website and as it may otherwise determine to provide notice to persons with an interest in the public matters the Executive Board intends to address at those meetings.
          5. 5. The Executive Board may hold an emergency meeting when acting for the Commission to:
            1. a. Meet an imminent threat to public health, safety, or welfare;
            2. b. Prevent a loss of Commission or Participating State funds; or
            3. c. Protect public health and safety.
        7. G. Qualified Immunity, Defense, and Indemnification
          1. 1. The members, officers, executive director, employees, and representatives of the Commission shall be immune from suit and liability, both personally and in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of Commission employment, duties, or responsibilities; provided, that nothing in this paragraph shall be construed to protect any such person from suit or liability for any damage, loss, injury, or liability caused by the intentional or willful or wanton misconduct of that person. The procurement of insurance of any type by the Commission shall not in any way compromise or limit the immunity granted hereunder.
          2. 2. The Commission shall defend any member, officer, executive director, employee, and representative of the Commission in any civil action seeking to impose liability arising out of any actual or alleged act, error, or omission that occurred within the scope of Commission employment, duties, or responsibilities, or as determined by the Commission that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of Commission employment, duties, or responsibilities; provided, that nothing herein shall be construed to prohibit that person from retaining their own counsel at their own expense; and provided further, that the actual or alleged act, error, or omission did not result from that person's intentional or willful or wanton misconduct.
          3. 3. Notwithstanding subsection G.1 of this section, should any member, officer, executive director, employee, or representative of the Commission be held liable for the amount of any settlement or judgment arising out of any actual or alleged act, error, or omission that occurred within the scope of that individual's employment, duties, or responsibilities for the Commission, or that the person to whom that individual is liable had a reasonable basis for believing occurred within the scope of the individual's employment, duties, or responsibilities for the Commission, the Commission shall indemnify and hold harmless such individual; provided, that the actual or alleged act, error, or omission did not result from the intentional or willful or wanton misconduct of the individual.
          4. 4. Nothing herein shall be construed as a limitation on the liability of any Licensee for professional malpractice or misconduct, which shall be governed solely by any other applicable State laws.
          5. 5. Nothing in this Compact shall be interpreted to waive or otherwise abrogate a Participating State's state action immunity or state action affirmative defense with respect to antitrust claims under the Sherman Act, Clayton Act, or any other State or federal antitrust or anticompetitive law or regulation.
          6. 6. Nothing in this Compact shall be construed to be a waiver of sovereign immunity by the Participating States or by the Commission.
      8. Section 8. Data System.
        1. A. The Commission shall provide for the development, maintenance, operation, and utilization of a coordinated database and reporting system containing licensure, Adverse Action, and the presence of Significant Investigative Information on all Licensees and applicants for a License in Participating States.
        2. B. Notwithstanding any other provision of State law to the contrary, a Participating State shall submit a uniform data set to the Data System on all individuals to whom this Compact is applicable as required by the Rules of the Commission, including:
          1. 1. Identifying information;
          2. 2. Licensure data;
          3. 3. Adverse Actions against a Licensee, License applicant, or Compact Privilege and information related thereto;
          4. 4. Non-confidential information related to Alternative Program participation, the beginning and ending dates of such participation, and other information related to such participation;
          5. 5. Any denial of an application for licensure, and the reason(s) for such denial (excluding the reporting of any criminal history record information where prohibited by law);
          6. 6. The presence of Significant Investigative Information; and
          7. 7. Other information that may facilitate the administration of this Compact or the protection of the public, as determined by the Rules of the Commission.
        3. C. The records and information provided to a Participating State pursuant to this Compact or through the Data System, when certified by the Commission or an agent thereof, shall constitute the authenticated business records of the Commission, and shall be entitled to any associated hearsay exception in any relevant judicial, quasi-judicial, or administrative proceedings in a Participating State.
        4. D. Significant Investigative Information pertaining to a Licensee in any Participating State will only be available to other Participating States.
        5. E. It is the responsibility of the Participating States to monitor the database to determine whether Adverse Action has been taken against a Licensee or License applicant. Adverse Action information pertaining to a Licensee or License applicant in any Participating State will be available to any other Participating State.
        6. F. Participating States contributing information to the Data System may designate information that may not be shared with the public without the express permission of the contributing State.
        7. G. Any information submitted to the Data System that is subsequently expunged pursuant to federal law or the laws of the Participating State contributing the information shall be removed from the Data System.
      9. Section 9. Rulemaking.
        1. A. The Commission shall promulgate reasonable Rules in order to effectively and efficiently implement and administer the purposes and provisions of the Compact. A Commission Rule shall be invalid and have no force or effect only if a court of competent jurisdiction holds that the Rule is invalid because the Commission exercised its rulemaking authority in a manner that is beyond the scope and purposes of the Compact, or the powers granted hereunder, or based upon another applicable standard of review.
        2. B. The Rules of the Commission shall have the force of law in each Participating State; provided, however, that where the Rules of the Commission conflict with the laws of the Participating State that establish the Participating State's Scope of Practice as held by a court of competent jurisdiction, the Rules of the Commission shall be ineffective in that State to the extent of the conflict.
        3. C. The Commission shall exercise its Rulemaking powers pursuant to the criteria set forth in this section and the Rules adopted thereunder. Rules shall become binding as of the date specified by the Commission for each Rule.
        4. D. If a majority of the legislatures of the Participating States rejects a Commission Rule or portion of a Commission Rule, by enactment of a statute or resolution in the same manner used to adopt the Compact, within four (4) years of the date of adoption of the Rule, then such Rule shall have no further force and effect in any Participating State or to any State applying to participate in the Compact.
        5. E. Rules shall be adopted at a regular or special meeting of the Commission.
        6. F. Prior to adoption of a proposed Rule, the Commission shall hold a public hearing and allow persons to provide oral and written comments, data, facts, opinions, and arguments.
        7. G. Prior to adoption of a proposed Rule by the Commission, and at least thirty (30) days in advance of the meeting at which the Commission will hold a public hearing on the proposed Rule, the Commission shall provide a Notice of Proposed Rulemaking:
          1. 1. On the website of the Commission or other publicly accessible platform;
          2. 2. To persons who have requested notice of the Commission's notices of proposed rulemaking; and
          3. 3. In such other way(s) as the Commission may by Rule specify.
        8. H. The Notice of Proposed Rulemaking shall include:
          1. 1. The time, date, and location of the public hearing at which the Commission will hear public comments on the proposed Rule and, if different, the time, date, and location of the meeting where the Commission will consider and vote on the proposed Rule;
          2. 2. If the hearing is held via telecommunication, video conference, or other electronic means, the Commission shall include the mechanism for access to the hearing in the Notice of Proposed Rulemaking;
          3. 3. The text of the proposed Rule and the reason therefor;
          4. 4. A request for comments on the proposed Rule from any interested person; and
          5. 5. The manner in which interested persons may submit written comments.
        9. I. All hearings will be recorded. A copy of the recording and all written comments and documents received by the Commission in response to the proposed Rule shall be available to the public.
        10. J. Nothing in this section shall be construed as requiring a separate hearing on each Commission Rule. Rules may be grouped for the convenience of the Commission at hearings required by this section.
        11. K. The Commission shall, by majority vote of all Commissioners, take final action on the proposed Rule based on the rulemaking record.
          1. 1. The Commission may adopt changes to the proposed Rule, provided the changes do not enlarge the original purpose of the proposed Rule.
          2. 2. The Commission shall provide an explanation of the reasons for substantive changes made to the proposed Rule as well as reasons for substantive changes not made that were recommended by commenters.
          3. 3. The Commission shall determine a reasonable effective date for the Rule. Except for an emergency as provided in subsection L, the effective date of the Rule shall be no sooner than thirty (30) days after the Commission issuing the notice that it adopted or amended the Rule.
        12. L. Upon determination that an emergency exists, the Commission may consider and adopt an emergency Rule with twenty-four (24) hours' notice, with opportunity to comment; provided, that the usual rulemaking procedures provided in the Compact and in this section shall be retroactively applied to the Rule as soon as reasonably possible, in no event later than ninety (90) days after the effective date of the Rule. For the purposes of this provision, an emergency Rule is one that must be adopted immediately in order to:
          1. 1. Meet an imminent threat to public health, safety, or welfare;
          2. 2. Prevent a loss of Commission or Participating State funds;
          3. 3. Meet a deadline for the promulgation of a Rule that is established by federal law or rule; or
          4. 4. Protect public health and safety.
        13. M. The Commission or an authorized committee of the Commission may direct revisions to a previously adopted Rule for purposes of correcting typographical errors, errors in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be posted on the website of the Commission. The revision shall be subject to challenge by any person for a period of thirty (30) days after posting. The revision may be challenged only on grounds that the revision results in a material change to a Rule. A challenge shall be made in writing and delivered to the Commission prior to the end of the notice period. If no challenge is made, the revision will take effect without further action. If the revision is challenged, the revision may not take effect without the approval of the Commission.
        14. N. No Participating State's rulemaking requirements shall apply under this Compact.
      10. Section 10. Oversight, Dispute Resolution, and Enforcement.
        1. A. Oversight
          1. 1. The executive and judicial branches of State government in each Participating State shall enforce this Compact and take all actions necessary and appropriate to implement the Compact.
          2. 2. Venue is proper and judicial proceedings by or against the Commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the Commission is located. The Commission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings. Nothing herein shall affect or limit the selection or propriety of venue in any action against a Licensee for professional malpractice, misconduct, or any such similar matter.
          3. 3. The Commission shall be entitled to receive service of process in any proceeding regarding the enforcement or interpretation of the Compact or Commission Rule and shall have standing to intervene in such a proceeding for all purposes. Failure to provide the Commission service of process shall render a judgment or order void as to the Commission, this Compact, or promulgated Rules.
        2. B. Default, Technical Assistance, and Termination
          1. 1. If the Commission determines that a Participating State has defaulted in the performance of its obligations or responsibilities under this Compact or the promulgated Rules, the Commission shall provide written notice to the defaulting State. The notice of default shall describe the default, the proposed means of curing the default, and any other action that the Commission may take, and shall offer training and specific technical assistance regarding the default.
          2. 2. The Commission shall provide a copy of the notice of default to the other Participating States.
        3. C. If a State in default fails to cure the default, the defaulting State may be terminated from the Compact upon an affirmative vote of a majority of the Commissioners, and all rights, privileges, and benefits conferred on that State by this Compact may be terminated on the effective date of termination. A cure of the default does not relieve the offending State of obligations or liabilities incurred during the period of default.
        4. D. Termination of participation in the Compact shall be imposed only after all other means of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given by the Commission to the governor, the majority and minority leaders of the defaulting State's legislature, the defaulting State's State Licensing Authority or Authorities, as applicable, and each of the Participating States' State Licensing Authority or Authorities, as applicable.
        5. E. A State that has been terminated is responsible for all assessments, obligations, and liabilities incurred through the effective date of termination, including obligations that extend beyond the effective date of termination.
        6. F. Upon the termination of a State's participation in this Compact, that State shall immediately provide notice to all Licensees of the State, including Licensees of other Participating States issued a Compact Privilege to practice within that State, of such termination. The terminated State shall continue to recognize all Compact Privileges then in effect in that State for a minimum of one hundred eighty (180) days after the date of said notice of termination.
        7. G. The Commission shall not bear any costs related to a State that is found to be in default or that has been terminated from the Compact, unless agreed upon in writing between the Commission and the defaulting State.
        8. H. The defaulting State may appeal the action of the Commission by petitioning the U.S. District Court for the District of Columbia or the federal district where the Commission has its principal offices. The prevailing party shall be awarded all costs of such litigation, including reasonable attorney's fees.
        9. I. Dispute Resolution
          1. 1. Upon request by a Participating State, the Commission shall attempt to resolve disputes related to the Compact that arise among Participating States and between Participating States and non-Participating States.
          2. 2. The Commission shall promulgate a Rule providing for both mediation and binding dispute resolution for disputes as appropriate.
        10. J. Enforcement
          1. 1. The Commission, in the reasonable exercise of its discretion, shall enforce the provisions of this Compact and the Commission's Rules.
          2. 2. By majority vote, the Commission may initiate legal action against a Participating State in default in the United States District Court for the District of Columbia or the federal district where the Commission has its principal offices to enforce compliance with the provisions of the Compact and its promulgated Rules. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorney's fees. The remedies herein shall not be the exclusive remedies of the Commission. The Commission may pursue any other remedies available under federal or the defaulting Participating State's law.
          3. 3. A Participating State may initiate legal action against the Commission in the U.S. District Court for the District of Columbia or the federal district where the Commission has its principal offices to enforce compliance with the provisions of the Compact and its promulgated Rules. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorney's fees.
          4. 4. No individual or entity other than a Participating State may enforce this Compact against the Commission.
      11. Section 11. Effective Date, Withdrawal, and Amendment.
        1. A. The Compact shall come into effect on the date on which the Compact statute is enacted into law in the seventh Participating State.
          1. 1. On or after the effective date of the Compact, the Commission shall convene and review the enactment of each of the States that enacted the Compact prior to the Commission convening ("Charter Participating States") to determine if the statute enacted by each such Charter Participating State is materially different than the Model Compact.
            1. a. A Charter Participating State whose enactment is found to be materially different from the Model Compact shall be entitled to the default process set forth in Section 10.
            2. b. If any Participating State is later found to be in default, or is terminated or withdraws from the Compact, the Commission shall remain in existence and the Compact shall remain in effect even if the number of Participating States should be less than seven (7).
          2. 2. Participating States enacting the Compact subsequent to the Charter Participating States shall be subject to the process set forth in Section 7.C.23 to determine if their enactments are materially different from the Model Compact and whether they qualify for participation in the Compact.
          3. 3. All actions taken for the benefit of the Commission or in furtherance of the purposes of the administration of the Compact prior to the effective date of the Compact or the Commission coming into existence shall be considered to be actions of the Commission unless specifically repudiated by the Commission.
          4. 4. Any State that joins the Compact subsequent to the Commission's initial adoption of the Rules and bylaws shall be subject to the Commission's Rules and bylaws as they exist on the date on which the Compact becomes law in that State. Any Rule that has been previously adopted by the Commission shall have the full force and effect of law on the day the Compact becomes law in that State.