June, 2022 (Revised) 1 RULES OF THE TENNESSEE BOARD OF

June, 2022 (Revised) 1

RULES

THE TENNESSEE BOARD OF OPTOMETRY

CHAPTER 1045-02

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY

TABLE OF CONTENTS

1045-02-.01 Fees

1045-02-.11 Scope of Practice

1045-02-.02 Licensure Process

1045-02-.12 Primary Eye Care Procedures

1045-02-.03 Examinations

1045-02-.13 Optometric Professional Corporations and

1045-02-.04 License Renewal

Optometric Professional Limited Liability

1045-02-.05 Continuing Education

Companies

1045-02-.06 Board Meetings, Members’ Authority and

1045-02-.14 Optometric Records

Records

1045-02-.15 Consumer Right-To-Know Requirements

1045-02-.07 Diagnostic and Therapeutic Certification

1045-02-.16 Tamper-Resistant Prescriptions

1045-02-.08 Corporate or Business Names and Advertising

1045-02-.17 Minimum Discipline for Opioid Prescribing

1045-02-.09 Ocular and Contact Lens Prescriptions and

1045-02-.18 Telehealth in the Practice of Optometry

Office Equipment

1045-02-.10 Disciplinary Actions, Civil Penalties, Declaratory

Orders, Screening Panels, Assessment of Costs,

and Subpoenas

1045-02-.01 FEES.

(1) The fees authorized by the Optometry Practice Act (T.C.A. §§ 63-8-101, et seq.) and other

applicable statutes to be established in amount by the Board are established as follows:

(a) Application Fee – A non-refundable fee to be paid

each time an application for initial licensure is filed. $250.00

(b) Reinstatement Fee – A non-refundable fee to be paid

each time an application for reinstating an expired $200.00

license is filed.

(d) Licensure Renewal Fee – A non-refundable fee to be $275.00

paid biennially by all licensees except Inactive Volunteers.

This fee also applies to licensees who reactivate a retired

license or who reactivate an inactive license.

(e) Biennial State Regulatory Fee $10.00

(f) Inactive Volunteer Licensure Renewal Fee $0.00

(2) All fees may be paid in person, by mail or electronically by cash, check, money order, or by

credit and/or debit cards accepted by the Division. If the fees are paid by certified, personal

or corporate check they must be drawn against an account in a United States Bank, and

made payable to the Tennessee Board of Optometry.

Authority: T.C.A. §§ 4-3-1011(b), 4-5-202, 4-5-204, 9-4-5117, 63-8-111, 63-8-112, 63-8-112(1), 63-8-

115, 63-8-119, 63-8-128, and 63-8-133. Administrative History: Original rule filed May 15, 1981;

effective July 22, 1981. Amendment filed October 13, 1983; effective November 14, 1983. Repeal and

new rule filed November 30, 1990; effective January 14, 1991. Amendment filed August 2, 1995; effective

October 16, 1995. Amendment filed December 11, 1998; effective February 23, 1999. Amendment filed

September 13, 2002; effective November 27, 2002. Amendment filed June 10, 2004; effective August 24,

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.01, continued)

June, 2022 (Revised) 2

2004. Amendment filed October 18, 2004; effective January 1, 2005. Amendment filed July 29, 2015;

effective October 27, 2015.

1045-02-.02 LICENSURE PROCESS. It is the intent of the Optometry Practice Act and the Board to

require the highest level of education from all persons who apply for licensure in Tennessee. To become

licensed to practice Optometry in Tennessee a person must comply with the following procedures and

requirements:

(1) An applicant must obtain from the Board administrative office an application form that must

be completed and submitted along with all required documentation and fees to the Board

administrative office.

(2) An applicant shall pay the application fee as provided in Rule 1045-02-.01(1).

(3) An applicant shall cause to be submitted directly to the Board administrative office a certified

transcript mailed by an accredited college or school of optometry which clearly shows the

degree and the date received. The college or school of optometry must be accredited by one

(1) of the following:

(a) Accreditation Council on Optometric Education (ACOE)

(b) National Commission on Accrediting

(4) An applicant shall submit to the Board administrative office a recent “passport style”

photograph of himself/herself.

(5) An applicant shall submit to and successfully complete the Board’s licensure examination

pursuant to Rule 1045-02-.03.

(6) If an applicant is or has been licensed to practice optometry in any other state, the

documentation required by T.C.A. § 63-8-115(b) shall be submitted along with the

application.

(7) An applicant shall submit to the Board administrative office satisfactory evidence of good

moral character. Satisfactory evidence of good moral character requires at a minimum two

letters of reference from optometric practitioners on the signators’ letterhead.

(8) An applicant shall cause to be submitted to the Board’s administrative office directly from the

vendor identified in the Board’s licensure application materials, the result of a criminal

background check.

(9) Inactive Volunteer Licensure – Applicants who intend to exclusively practice Optometry

without compensation on patients who receive optometric services from organizations

granted a determination of exemption pursuant to Section 501(c)(3) of the Internal Revenue

Code may obtain an inactive volunteer license to do so as follows:

(a) Applicants who currently hold a valid Tennessee license to practice Optometry issued

by the Board pursuant to this rule which is in good standing must:

1. Retire their active licenses pursuant to the provisions of Rule 1045-02-.04(7)(a)

and:

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.02, continued)

June, 2022 (Revised) 3

2. Have submitted to the Board Administrative Office directly from the qualified

organization proof of the determination of exemption issued pursuant to Section

501(c)(3) of the Internal Revenue Code; and

3. Certify that they are practicing Optometry exclusively on the patients of the

qualified entity and that such practice is without compensation.

(b) Applicants who do not currently hold a valid Tennessee license to practice Optometry

must comply with all provisions of paragraphs (1) through (8) of this rule.

reinstatement and reactivation as provided by Rules 1045-02-.04. These licenses are

also subject to disciplinary action for the same causes and pursuant to the same

procedures as active licenses.

(10) Application Review, Approval, and Denial

(a) Initial review of all applications to determine whether or not the application file is

complete may be delegated to the Board's administrator or designee, provided that

final approval of all applications is made and ratified by the Board.

(b) If an application is incomplete when received by the Board’s Administrative Office, or if

the reviewing Board member or the Board’s designee determine additional information

is required from an applicant before an initial determination can be made, the Board

administrator shall notify the applicant of the information required. The applicant shall

cause the requested information to be received in the Administrative Office on or

before the sixtieth (60th) day after receipt of the notification.

1. Such notifications shall be sent certified mail, return receipt requested, from the

Administrative Office.

2. If requested information is not timely received, the application file will be

considered abandoned and will be closed by the administrator. If that occurs, the

applicant shall be notified that the Board will not consider issuance of a license

until a new completed application and fees are submitted. The Board may, in its

discretion, keep a file open past this deadline if special circumstances warrant.

determined that the applicant has met all the requirements for licensure, renewal or

reinstatement may issue an applicant a temporary authorization to practice, as

described in T.C.A. § 63-1-142, subject to ratification by the full Board at its next

regularly scheduled meeting. If the Board member or designee cannot make such a

determination, the applicant shall be advised that the Board will consider the

application at its next regularly scheduled meeting.

(d) The Board or its designee may delay a decision on an application for any applicant

from whom the Board wishes additional information.

(e) If after reviewing the completed application the Board denies, limits, conditions or

restricts the issuance of a license, the action shall become final and the following shall

occur:

1. A notification of the denial, limitation, condition or restriction shall be sent by the

Administrative Office by certified mail, return receipt requested, that contains the

specific reasons for denial, limitation, condition or restriction, and such

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.02, continued)

June, 2022 (Revised) 4

notification shall contain all the specific statutory or rule authority for the denial,

limitation, condition or restriction.

2. The notification, when appropriate, shall also contain a statement of the

applicant's right to request a contested case hearing under the Tennessee

Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.) to contest the denial,

limitation, condition or restriction and the procedure necessary to accomplish that

action.

(i) An applicant has a right to a contested case hearing only if the licensure

denial, limitation, condition or restriction is based on subjective or

discretionary criteria.

(ii) An applicant may be granted a contested case hearing if the licensure

denial, limitation, condition or restriction is based on an objective, clearly

defined criteria only if after review and attempted resolution by the Board's

Administrative Staff, the application can not be approved and the reasons

for continued denial, limitation, condition or restriction present genuine

issues of fact and/or law which are appropriate for appeal. Requests for a

hearing must be made in writing to the Administrative Office within thirty

(30) days of the receipt of the notice of denial, limitation, condition or

restriction from the Board.

(f) The initial determination procedures of this rule will not apply if the Board makes a final

determination on any application during its meetings.

(g) If the Board finds it has erred in the issuance of a license, it will give written notice by

certified mail of its intent to revoke or cancel the license. The notice will allow the

applicant the opportunity to meet the requirements for licensure within thirty (30) days

from the date of receipt of the notification. If the applicant does not concur with the

stated reason and the intent to revoke or cancel the license, the applicant shall have

the right to proceed according to subparagraph (e) of this rule.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-8-112, and 63-8-115. Administrative History: Original rule

filed May 15, 1981; effective July 22, 1981. Amendment filed October 13, 1983; effective November 14,

1983. Repeal and new rule filed November 30, 1990; effective January 14, 1991. Amendment filed

October 29, 1991; effective December 13, 1991. Amendment filed August 26, 1998; effective November

9, 1998. Amendment filed July 22, 2002; effective October 5, 2002. Amendment filed September 7, 2004;

effective November 21, 2004. Amendments filed March 17, 2006; effective May 31, 2006. Amendment

filed March 22, 2007; effective June 9, 2007.

1045-02-.03 EXAMINATIONS.

(1) Applicants Graduating Prior to January 1, 1992 – Unless applicants choose to qualify

pursuant to paragraph (2), all such applicants must, in addition to having successfully

completed all parts of the pre-1992 National Board of Examiners in Optometry (NBEO)’s

examinations, unless waived, and the Association of Regulatory Boards of Optometry or its

predecessor organization’s examination, successfully complete the Board’s clinical

examination which is Part III of the NBEO’s examination.

(a) The Board adopts as its written licensure examinations those administered by the

National Board of Examiners in Optometry and the Association of Regulatory Boards of

Optometry or its predecessor organization as they existed through December 31, 1991

for all applicants graduating prior to January 1, 1992.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.03, continued)

June, 2022 (Revised) 5

(b) The fees to take the examinations administered by the National Board of Examiners in

Optometry are set out and collected by that organization.

and the Association of Regulatory Boards of Optometry as to the passing scores for

their respective examinations and certification directly from the organizations of such

applicant scores to the Board shall constitute successful completion of those

examinations.

(2) Applicants Graduating On or After January 1, 1992.

(a) All such applicants must successfully complete all parts of the revised format National

Board of Examiners in Optometry’s examination which includes clinical skills

assessment.

(b) The Board adopts as its written licensure examinations those administered by the

National Board of Examiners in Optometry and the Association of Regulatory Boards of

Optometry or its predecessor organization as they exist after January 1, 1992 for all

applicants graduating on or after January 1, 1992.

Optometry are set out and collected by that organization.

(d) The Board adopts the determination of the National Board of Examiners in Optometry

as to the passing scores for their examination and certification sent directly from them

to the Board of such applicant scores shall constitute successful completion of those

examinations.

(3) Jurisprudence Examination. All applicants for licensure must successfully complete the

Board’s jurisprudence examination as a prerequisite to licensure.

(a) The Board shall mail a jurisprudence examination to all applicants for licensure.

(b) The applicant shall include a completed jurisprudence examination when his/her

completed application for licensure is sent to the Board’s administrative office located

at 665 Mainstream Drive, Nashville, TN 37243.

(d) The scope and content of the examination shall be determined by the Board but limited

to statutes and regulations governing the practice of optometry (Tennessee Code

Annotated §§ 63-8-101, et seq., and Chapter 1045-02 of the Official Compilation, Rules

and Regulations of the State of Tennessee). Copies of the applicable statutes and

regulations can be obtained at the Board’s Internet web page, and are also available

upon request from the Board’s administrative office.

(e) The format of the examination shall be “open-book.”

(f) Correctly answering ninety percent (90%) of the examination questions shall constitute

successful completion of the jurisprudence exam.

(g) If the Board determines that the applicant has failed to successfully complete the

jurisprudence examination, the applicant will be mailed another examination and

he/she must continue to retake the examination until it has been successfully

completed before the application will be deemed complete and presented to the Board

for consideration.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.03, continued)

June, 2022 (Revised) 6

(4) The Board may, by majority vote, waive the passage of Parts 1 and 2 of the National Board’s

Examinations for applicants graduating prior to 1984 (the year in which Tennessee required

passage of the National Boards), provided the applicants meet each of the following

requirements:

(a) Are duly licensed to practice optometry in at least one other state;

(b) Meet all other requirements for full licensure under the Tennessee Optometry law; and

the applicants are licensed and from federal service (military, veterans administration,

public health, etc.), if applicable and from accredited institutions of higher learning

where applicants have been optometric educators if applicable.

(5) Notwithstanding the above, the Board may, by majority vote, waive the passage of all parts of

the National Board’s Examination and may accept proof of clinical competency in lieu of

submission to clinical examination by the Board where the applicant is in good standing and

practicing in another state with clinical competency examinations comparable to that of the

State of Tennessee.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-8-107(c), 63-8-112, 63-8-112(1) & (3), and 63-8-115.

Administrative History: Original rule filed May 15, 1981; effective July 22, 1981. Amended by Public

Chapter 969; effective July 1, 1984. Repeal and new rule filed November 30, 1990; effective January 14,

1991. Amendment filed October 29, 1991; effective December 13, 1991. Amendment filed August 2,

1995; effective October 16, 1995. Amendment filed October 11, 1999; effective December 25, 1999.

Amendment filed September 13, 2002; effective November 27, 2002. Amendment filed March 2, 2009;

effective May 16, 2009; however, stay of the effective date filed May 14, 2009 by the Tennessee Board of

Optometry; new effective date July 13, 2009.

1045-02-.04 LICENSE RENEWAL. All optometrists licensed by the Board must renew those licenses to

be able to legally continue in practice. Licensure renewal is governed by the following:

(1) The due date for renewal is the last day of the month in which a licensee’s birthdate falls

pursuant to the Division of Health Related Boards’ biennial birthdate renewal system.

(a) Internet Renewals – Individuals may apply for renewal and pay the necessary fees via

the Internet. The application to renew can be accessed at:

https://apps.tn.gov/hlrs/

(b) Paper Renewals – For individuals who have not renewed their license online via the

Internet, a renewal application form will be mailed to each individual licensed by the

Board to the last address provided to the Board. Failure to receive such notification

does not relieve the licensee from the responsibility of meeting all requirements for

renewal.

(2) To be eligible for licensure renewal, an optometrist must submit to the Board administrative

office on or before the due date for renewal all the following:

(a) A completed Board approved application form.

(b) The biennial renewal fee as provided in Rule 1045-02-.01(1)(d).

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.04, continued)

June, 2022 (Revised) 7

(3) The Board, in cases of documented illness, disability, other undue hardship or retirement,

may

(a) Waive the continuing education requirements; and/or

(b) Waive the renewal fee (but not the state regulatory fee); or

(d) To be considered for a waiver of continuing education requirements, or for an

extension of the deadline to complete the continuing education requirements, an

optometrist must request such in writing with supporting documentation before the end

of the calendar year in which the continuing education requirements were not met.

(e) To be considered for a waiver of the renewal fee, an optometrist must request such in

writing with supporting documentation on or before the renewal due date.

(4) Licensees who fail to comply with the renewal rules or notification received by them

concerning failure to timely renew shall have their licenses processed pursuant to Rule 1200-

10-01-.10, unless a waiver or deadline extension is granted pursuant to paragraph (3) of this

rule.

(5) Reinstatement of an Expired License – Reinstatement of a license that has expired may be

accomplished upon meeting the following conditions:

(a) Payment of all past due renewal fees and state regulatory fees, pursuant to Rule 1045-

02-.01; and

(b) Payment of the reinstatement fee, pursuant to Rule 1045-02-.01; and

for every year the license was expired, pursuant to Rule 1045-02-.05.

(6) License renewal and reinstatement applications hereunder shall be treated as license

applications, and review and decisions shall be governed by Rule 1045-02-.02.

(7) Retirement of Licenses.

(a) Licensees who wish to retain their licenses but not actively practice may avoid

compliance with the licensure renewal process by:

1. Submitting a Board approved affidavit of retirement form to the Board

Administrative Office; and

2. Submitting any documentation which may be required by the form to the Board

Administrative Office.

(b) Licensees whose licenses have been retired may reenter active practice by:

1. Submitting a written request for licensure reactivation to the Board Administrative

Office; and

2. Paying the biennial renewal fee as provided in Rule 1045-02-.01(1)(d).

3. Appearing before the Board, a Board member or Board designee for interviews

regarding continued competence, if requested after review.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.04, continued)

June, 2022 (Revised) 8

4. The Board, a Board member, or designee after the interview may require

remedial education and/or examination passage prior to licensure reinstatement.

5. If reactivation was requested prior to the expiration of one (1) year from the date

of retirement, the Board may require payment of the reinstatement fee, past due

renewal fees, and state regulatory fees as provided in Rule 1045-02-.01; and

a written request showing a satisfactory need for reentry into practice. Board approval

must be received and may be granted for only a limited period of time.

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-1-107, 63-8-112, 63-8-119, and 63-8-120.

Administrative History: Original rule filed May 15, 1981; effective July 22, 1981. Repeal and new rule

filed November 30, 1990; effective January 14, 1991. Amendment filed August 2, 1995; effective October

16, 1995. Amendment filed July 22, 2002; effective October 5, 2002. Amendment filed April 4, 2003;

effective June 18, 2003. Amendments filed May 21, 2019; effective August 19, 2019.

1045-02-.05 CONTINUING EDUCATION.

(1) Effective January 1, 2020, an Optometrist with a renewal date in the year 2020 and beyond

must complete forty (40) hours of Board approved continuing education during the twenty-

four (24) months that precede the licensure renewal month.

(a) For those who are therapeutically certified, a minimum of twenty-five (25) of the forty

(40) hours of continuing education is required in courses pertaining to ocular disease

and related systemic disease, as described in subparagraph (2)(e). At least two (2) of

these twenty-five (25) hours shall be a course or courses designed specifically to

address controlled substance prescribing practices. Any course related to controlled

substance prescribing practices must include instruction in the Department’s treatment

guidelines on opioids, benzodiazepines, barbituates, and carisoprodol and may include

topics such as medicine addiction, risk management tools, and other topics approved

by the Board.

(b) Each licensee shall maintain current certification in cardiopulmonary resuscitation

(CPR). Such certification shall be obtained from a course approved or offered by the

American Heart Association, the American Red Cross, or any other entity approved by

the Board.

education requirements. This documentation must be retained for a period of four (4)

years from the end of the calendar year in which the continuing education was

required. This documentation must be produced for inspection and verification, if

requested in writing by the Board during its verification process. The Board will not

maintain continuing education files.

(d) The individual must, within thirty (30) days of a request from the Board, provide

evidence of continuing education activities. Certificates verifying the individual’s

attendance or original letters from course providers are such evidence.

(2) Approval of Continuing Education

(a) For those courses requiring Board approval, the information required by subparagraph

(2)(d) must be submitted to the Board at least thirty (30) days prior to the actual date of

the course. However, no prior approval is required for the following:

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.05, continued)

June, 2022 (Revised) 9

1. Educational courses approved by the Association of Regulatory Boards of

Optometry’s Council on Optometric Practitioner Education.

2. Educational courses sponsored by an organization listed on the Board’s website

with the Tennessee Department of Health.

(b) Grand rounds of clinical optometric education (grand clinical rounds) performed in

clinical treatment facilities shall be credited as follows:

1. One (1) hour of credit is received for two (2) hours of attendance.

2. No more than six (6) hours of continuing education credit during the two (2) year

period described in paragraph (1) shall be granted to a licensee for attending

grand clinical rounds.

3. Grand clinical rounds must be submitted to the Board for pre-approval.

must be pre-approved by the Board or by a vendor approved by the Board for offering

such courses.

(d) All courses submitted for approval must contain the following information:

1. A course description or outline;

2. Names of all lecturers;

3. Brief resume of all lecturers;

4. Number of hours of educational credit requested;

5. Category of approval requested; and

6. Date of course.

(e) Courses will be classified by the Board as one (1) of the following categories:

1. Clinical Optometry – These courses shall pertain to general optometry, functional

vision/pediatrics, and contact lenses.

2. Ocular Disease – These courses shall pertain to the treatment and management

of ocular disease (anterior and posterior), refractive surgery management, peri-

operative management of ophthalmic surgery, and glaucoma.

3. Related Systemic Disease – These courses shall pertain to systemic/ocular

disease, principles of diagnosis, pharmacology, and neuro-optometry.

4. (Optometric) Business Management – These courses shall pertain to practice

management and/or ethics/jurisprudence. The total number of (Optometric)

Business Management hours that will be accepted is eight (8) hours of the forty

(40) hour requirement.

(f) Continuing education courses may include:

1. Lecture type courses;

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.05, continued)

June, 2022 (Revised) 10

2. Fifteen (15) hours of the forty (40) hour requirement may be completed in any of

the following multi-media formats:

(i) The Internet

(ii) Closed circuit television

(iii) Satellite broadcasts

(iv) Correspondence courses

(v) Videotapes

(vi) CD-ROM

(vii) DVD

(viii) Teleconferencing

(ix) Videoconferencing

(x) Distance learning

(g) Proof of attendance -

1. Proof of attendance must be given to each optometrist attending an approved

course by the providers of the course.

2. It is the responsibility of the optometrist attending the continuing education

program to ascertain whether the program is approved by the Board and the

category of approval.

3. The Board shall notify all providers requiring course approval of its denial or

approval. If a course is denied credit for continuing education, the provider of the

course may petition the Board for a hearing on the merits of the matter. The

appeal may be heard by the Board at a regularly scheduled meeting.

4. Waiver of continuing education requirements or extension of the deadline to

complete such requirements may be made by the Board on an individual basis

as provided in Rule 1045-02-.04(3).

(3) Continuing Education Tracking System

(a) Each licensee shall submit to the Selected Contractor proof of completion for each

continuing education course taken. The proof of completion shall be submitted to the

Selected Contractor within thirty (30) days of receipt.

(b) Each licensee is responsible for reviewing the information contained in the system to

ensure its accuracy.

Tennessee licensed optometrists who attended the continuing education course. The

roster shall be submitted to the Selected Contractor within thirty (30) days after the

course date.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.05, continued)

June, 2022 (Revised) 11

(4) A licensee is exempt from the Continuing Education requirements for the calendar year that

he/she graduated from an accredited college or school of optometry.

(5) Continuing education course approval decisions pursuant to this rule may be preliminarily

made upon review by any Board member or a Board designee.

(6) Violations

(a) Any licensee who falsely certifies attendance and completion of the required hours of

continuing education requirements, or who does not or can not adequately substantiate

completed continuing education hours with the required documentation, may be subject

to disciplinary action.

(b) Prior to the institution of any disciplinary proceedings, a letter shall be issued to the last

known address of the individual stating the facts or conduct which warrant the intended

action.

all lawful requirements for the retention of the license.

(d) Any licensee who fails to show compliance with the required continuing education

hours in response to the notice contemplated by subparagraph (5)(b) above may be

subject to disciplinary action.

(e) Continuing education hours obtained as a result of compliance with the terms of a

Board Order in any disciplinary action shall not be credited toward the continuing

education hours required to be obtained in any renewal period.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-107, 63-8-112, 63-8-119, and 63-8-120. Administrative

History: Original rule filed May 15, 1981; effective July 22, 1981. Amendment filed November 12, 1982;

effective December 13, 1982. Amendment by Public Chapter 969; effective July 1, 1984. Repeal and new

rule filed November 30, 1990; effective January 14, 1991. Amendment filed February 14, 1994; effective

April 30, 1994. Amendment filed December 11, 1998; effective February 23, 1999. Amendment filed

January 4, 2002; effective March 20, 2002. Amendment filed July 22, 2002; effective October 5, 2002.

Amendment filed September 13, 2002; effective November 27, 2002. Amendment filed April 4, 2003;

effective June 18, 2003. Amendment filed June 10, 2004; effective August 24, 2004. Amendments filed

February 26, 2009; effective May 12, 2009. Amendment filed March 2, 2009; effective May 16, 2009;

however, stay of the effective date filed by the Tennessee Board of Optometry; new effective date July

13, 2009. Amendments filed August 9, 2012; effective November 7, 2012. Amendment filed July 29,

2015; effective October 27, 2015. Amendments filed May 21, 2019; effective August 19, 2019.

1045-02-.06 BOARD MEETINGS, MEMBERS’ AUTHORITY AND RECORDS.

(1) The Board shall meet annually and elect officers.

(2) Minutes of the Board meetings and all records, documents, applications, and correspondence

will be maintained in the administrative offices of the Board.

(3) All requests, applications, notices, complaints, other communications and correspondence

shall be directed to the administrative office of the Board. Any requests or inquiries requiring

a Board decision or official Board action except documents relating to disciplinary actions,

declaratory orders or hearing requests must be received fourteen (14) days prior to a

scheduled Board meeting and will be retained in the administrative office and presented to

the Board at the next scheduled Board meeting.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.06, continued)

June, 2022 (Revised) 12

(4) Any member of the Board or a Board designee is vested with the authority to review and

preliminarily approve licensure applications and continuing education courses. All such

approvals shall be subsequently submitted to the full Board for its consideration for

ratification.

(5) The Board shall elect one member to serve as consultant to the Division of Health Related

Boards to make determinations for the Board in the following areas:

(a) Whether and what type disciplinary actions should be instituted upon complaints

received or investigations conducted by the Division.

(b) Whether and under what terms a disciplinary action might be informally settled. Any

matter proposed for informal settlement must be subsequently considered by the full

Board and either adopted or rejected.

.04(3). Any such decision must be subsequently considered by the full Board and either

adopted or rejected.

(d) Whether and under what conditions a licensee who has failed to timely renew pursuant

to Rule 1045-02-.04(4) may be allowed to renew. All such actions must be

subsequently considered by the full Board and either adopted, rejected or modified.

(e) Whether and under what circumstances a retired license may be reinstated. All such

decisions must be subsequently considered by the full Board and either, approved,

rejected or modified.

(6) Reconsiderations and Stays – The Board authorizes the member who chaired the Board for a

contested case to be the agency member to make the decisions authorized pursuant to Rule

1360-04-01-.18 regarding petitions for reconsiderations and stays in that case.

(7) Requests for written verification of a licensee’s current status or a Certificate of Identification

(Certificate of Fitness in Division Law) must be made in writing to the Board administrative

office.

(8) Requests for duplicate or replacement licenses must be made in writing to the Board

administrative office and contain the information required by T.C.A. § 63-8-112(9) and be

accompanied by the fee provided in Rule 1045-02-.01(1)(c).

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-142, 63-8-107(a), 63-8-107(b), 63-8-111, 63-8-112, 63-8-

112(1), 63-8-112(8), 63-8-112(9), 63-8-115, 63-8-119, 63-8-120, 63-8-120(b), 63-8-120(d), and 63-8-121

and Public Chapter 295, Acts of 1993. Administrative History: Original rule filed May 15, 1981; effective

July 22, 1981. Repeal and new rule filed November 30, 1990; effective January 14, 1991. Amendment

filed July 22, 2002; effective October 5, 2002. Amendment filed February 26, 2009; effective May 12,

2009.

1045-02-.07 DIAGNOSTIC AND THERAPEUTIC CERTIFICATION.

(1) It is the intent of the Board that all applicants for licensure as optometrists attain the highest

level of licensure available under the law including diagnostic and therapeutic certification as

provided in T.C.A. §§ 63-8-102(12)(E) and 63-8-112(4). Attaining therapeutic certification

must include attaining certification to use pharmaceutical agents by injection.

(2) Diagnosis Certification. Any applicant who submits or has submitted a transcript which

contains at least six (6) quarter hours in the courses provided in T.C.A. § 63-8-102(12)(E)

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.07, continued)

June, 2022 (Revised) 13

and becomes or became licensed to practice Optometry in Tennessee shall be diagnostically

certified.

(3) Therapeutic Certification:

(a) To certify optometrists to administer and prescribe pharmaceutical agents for

treatment, perform primary eye care procedures, the performance or ordering of

procedures and laboratory tests rational to the diagnosis of conditions or diseases of

the eye or eyelid. No optometrist shall be certified to prescribe or use pharmaceutical

agents for treatment purposes in the practice of optometry unless and until he meets all

of the following:

1. Show evidence to the Board by providing a certified transcript of ninety (90)

classroom hours in pharmacology and sixty (60) classroom hours in ocular

disease from a college or university which is accredited by an agency approved

by the Council on Post Secondary Education of the U.S. Department of

Education.

2. Show evidence to the Board by providing a certified transcript from a college or

university which is accredited by an agency approved by the Council on Post

Secondary Education of the U.S. Department of Education, of forty (40) hours of

clinical experience acquired on or after April 22, 1987. The clinical experience is

to include diagnosis and treatment of ocular disease including the use of

pharmaceutical agents.

3. Be diagnostically certified, as provided in T.C.A. § 63-8-102(12)(E) and

paragraph (2) of this rule.

4. Has taken and successfully passed the examination administered or approved by

the Board.

(b) All optometrists licensed to practice in Tennessee who are therapeutically certified by

the Board must show the Board by proof of completion of the following clinical review

courses by 7/1/94, or their equivalent obtained from the experience of current practice

and licensure in a state with a similar scope of practice act. The clinical review courses

are:

1. A 24-hour Board approved transcript quality credit clinical course as it relates to

the diagnosis, treatment, and management of glaucoma.

2. A 6-hour Board approved transcript quality credit course as it related to the

clinical application of oral medication necessary for the treatment of diseases of

the eye/eyelid including the use of controlled substances.

requirements as determined by the Board. Any optometrist not completing these

requirements will be subject to therapeutic privilege suspension until such time as the

clinical review is complete. Any optometrist aggrieved by the Board’s written decision

suspending his or her therapeutic certification privileges shall have 30 days from the

date such decision is received to request a contested case hearing under the

provisions of the Uniform Administrative Procedures Act. The Board will extend the July

1, 1994 deadline date only in cases of hardship as determined by the Board.

Graduates of accredited schools of optometry after May 5, 1993 are excluded from

these requirements. In order to obtain therapeutic certification, any optometrist

graduating before May 5, 1993 must meet the requirements of Rule 1045-02-.03 and

must complete the clinical review courses prior to licensure.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.07, continued)

June, 2022 (Revised) 14

(d) No therapeutically certified optometrist shall use pharmaceutical agents by injection

except to counter anaphylaxis until they have received approval from the Board. The

Board will not approve the use of injections until the optometrist demonstrates to the

Board's satisfaction sufficient educational training and/or clinical training, and submits

proof of current certification in cardiopulmonary resuscitation (CPR). The education

must be obtained from a course approved or offered by the American Heart

Association, the American Red Cross, or any other entity approved by the Board.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-8-102, 63-8-112, and 63-8-115. Administrative History:

Original rule filed May 15, 1981; effective July 22, 1981. Repeal and new rule filed November 30, 1990;

effective January 14, 1991. Amendment filed February 14, 1994; effective April 30, 1994. Amendment

filed January 4, 2002; effective March 20, 2002. Amendment filed March 22, 2007; effective June 9, 2007.

Amendment filed July 29, 2015; effective October 27, 2015.

1045-02-.08 CORPORATE OR BUSINESS NAMES AND ADVERTISING.

(1) Policy Statement. The lack of sophistication on the part of many members of the public

concerning optometric services, the importance of the interests affected by the choice of an

optometrist and the foreseeable consequences of unrestricted advertising by optometrists,

require that special care be taken by optometrists to avoid misleading the public. The

optometrist must be mindful that the benefits of advertising depend upon its reliability and

accuracy. Since advertising by optometrists is calculated and not spontaneous, reasonable

regulation designed to foster compliance with appropriate standards serves the public

interest without impending the flow of useful, meaningful, and relevant information to the

public.

(2) Definitions.

(a) Advertisement. Informational communication to the public in any manner designed to

attract public attention to the practice of an optometrist who is licensed to practice in

Tennessee.

(b) Licensee. Any person holding a license to practice optometry in the State of

Tennessee. Where applicable this shall include partnerships and/or corporations.

to know or rely upon making an informed decision concerning the choice of

practitioners to serve his or particular optometric needs.

(d) Bait and Switch Advertising. An alluring but insincere offer to sell a product or service

which the advertiser in truth does not intend or want to sell. Its purpose is to switch

consumers from buying the advertised merchandise, in order to sell something usually

at a higher fee or on a basis more advantageous to the advertiser.

(e) Discounted Fee. Shall mean a fee offered or charged by a person or organization for

any optometric product or service that is less than the fee the person or organization

usually offers or charges for the product or service. Products or services expressly

offered free of charge shall not be deemed to be offered at a “discounted fee.”

(3) Advertising Fees and Services.

(a) Fixed Fees. Fixed fees may be advertised for any service.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.08, continued)

June, 2022 (Revised) 15

1. It is presumed unless otherwise stated in the advertisement that a fixed fee for a

service shall include the cost of all professionally recognized components within

generally accepted standards that are required to complete the service.

2. If an optometrist advertises an examination fee or includes an examination as a

service provided in an advertised fixed fee the examination findings shall include

all pertinent tests and observations necessary to satisfy the standard of care.

The following shall constitute the professionally recognized components to be

included in the examination provided for the advertised fee and before the

prescription requested is issued:

(i) Spectacles:

(I) Visual acuity testing of each eye far and near point; and

(II) External examination including extra ocular motility and confrontation

fields; and

(III) Refraction (objective and subjective); and

(IV) Co-ordination testing; and

(V) Opthalmoscopy; and

(VI) Biomicroscopy; and

(VII) Tonometry.

(ii) Contact Lenses:

(I) All of the components required for spectacles prescriptions; and

(II) Keratometer reading of cornea curves; and

(III) Biomicroscopic evaluation of lid health, tear film integrity and corneal

integrity; and

(IV) Application of known diagnostic lenses to each eye to include

evaluation of acuity, over refraction and biomicroscopic evaluation of

lens fit with use of chemical dyes as indicated; and

(V) Adequate patient training in lens care, solutions, application and

removal along with proper wearing schedule, warning signs, and

recall intervals; and

(VI) Medically necessary follow-up examinations.

(b) Range of Fees. A range of fees may be advertised for all services except routine

optometric services and the advertisement must disclose the factors used in

determining the actual fee, necessary to prevent deception of the public.

1. The discount fee is in fact lower than the licensee’s customary or usual fee

charged for the service; and

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.08, continued)

June, 2022 (Revised) 16

2. The licensee provides the same quality and components of service and material

at the discounted fee that are normally provided at the regular nondiscounted fee

for that service.

(d) Related Services and Additional Fees. Related services which may be required in

conjunction with the advertised services for which additional fees will be charged must

be identified as such in any advertisement. If they are not the service shall be provided

at the fee quoted in the advertisement.

(e) Time Period of Advertised Fees. Advertised fees shall be honored for those seeking

the advertised services during the entire time period stated in the advertisement

whether or not the services are actually rendered or completed within that time.

If no time period is stated in the advertisement of fees, the advertised fee shall be

honored for thirty (30) days from the last date of publication or until the next scheduled

publication whichever is later whether or not the services are actually rendered or

completed within that time.

(4) Advertising Content. The following acts or omissions in the context of advertisement by any

licensee shall subject the license to disciplinary action pursuant to T.C.A. §§ 63-8-120(5), 63-

8-120(12), 63-8-120(17) and 63-8-113(d).

(a) Claims that the services performed, personnel employed, materials or office equipment

used are professionally superior to that which is ordinarily performed, employed, or

used, or that convey the message that one licensee is better than another when

superiority of services, personnel, materials or equipment cannot be substantiated.

(b) The misleading use of an unearned or non-health degree in any advertisement.

beyond the licensee’s ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue

influence over a prospective patient.

(e) Any appeals to an individual’s anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality of competence of a service or

treatment offered by a licensee that is not reasonably verifiable.

(g) Utilization of any statistical data or other information based on performance or

prediction of future services, which creates an unjustified expectation about results that

the licensee can achieve.

(h) The communication of personally identifiable facts, data, or information about a patient

without first obtaining patient consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any material fact or law without

which the advertisement would be deceptive or misleading.

(k) Statements concerning the benefits or other attributes of procedures or products that

involve significant risks without including:

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.08, continued)

June, 2022 (Revised) 17

1. A realistic assessment of the safety and efficiency of those procedures or

products; and

2. The availability of alternatives; and

3. Where necessary to avoid deception, descriptions or assessment of the benefits

or other attributes of those alternatives.

(l) Any communication which creates an unjustified expectation concerning the potential

results of any treatment.

(m) Failure to comply with the rules governing advertisement of fees and services,

corporate or business name and advertising records.

(n) The use of “bait and switch” advertisements. Where the circumstances indicate “bait

and switch” advertising, the Board may require the licensee to furnish to the Board or

its designee data or other evidence pertaining to those sales at the advertised fee as

well as other sales.

(o) Misrepresentation of a licensee’s credentials, training, experience or ability.

(p) Failure to include the corporation, partnership or individual licensee’s name and

address and telephone number in any advertisement. Any corporation, partnership or

association which advertises by use of a trade name or otherwise fails to list all

licensees practicing at a particular location shall:

1. Upon request provide a list of all licensees practicing at that location; and

2. Maintain and conspicuously display at the licensee’s office, a directory listing all

licensees practicing at that location.

(q) Failure to disclose the fact of giving compensation or anything of value to

representatives of the press, radio, television or other communicative medium in

anticipation of or in return for any advertisement (for example, newspaper article)

unless the nature, format or medium of such advertisement make the fact of

compensation apparent.

(r) Unless otherwise provided by purchase contract after thirty (30) days, the use of the

name of any licensee formerly practicing at or associated with any advertised location

or on office signs or buildings. This rule shall not apply in the case of a retired or

deceased former associate who practiced optometry in association with one or more of

the present occupants if the status of the former associate is disclosed in any

advertisement or sign.

(s) Stating or implying that a certain licensee provides all services when any such services

are performed by another licensee.

(t) Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other

consideration to or from a third party for the referral of a patient in connection with the

performance of professional services.

(u) An ophthalmic lens, or contact lens may be guaranteed against defects but since the

degree of help from the use of or from the results obtained in the use of the same, is

dependent on some uncontrollable factors, any guarantee, warranty or representation

expressed or implied as to the degree or amount of help or improvement which can be

expected is prohibited.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.08, continued)

June, 2022 (Revised) 18

(v) Defaming competitors by falsely imputing to them dishonorable conduct, inability to

perform contracts, questionable credit standing or other false representations or falsely

disparaging products, selling prices, values, credit terms, policies or services of

competitors.

(5) Routine Optometric Service. An optometric service may be considered routine for and if it has

the following characteristics:

(a) It is performed frequently in the optometrist’s practice.

(b) It is usually provided at a set fee to substantially all patients receiving the service.

(d) It includes all professionally recognized components within generally accepted

standards.

(6) Advertising Records and Responsibility.

(a) Each licensee who is a principal partner, or officer of a firm or entity identified in any

advertisement, is jointly and severally responsible for the form and content of any

advertisement. This provision shall also include any licensed professional employees

acting as an agent of such firm or entity.

(b) Any and all advertisements are presumed to have been approved by the licensee

named therein.

other form of advertisement shall be retained by the licensee for a period of two (2)

years from the last date of broadcast or publication and be made available for review

upon request by the Board or its designee.

(d) At the time any type of advertisement is placed the licensee must possess and rely

upon information which, when produced, would substantiate the truthfulness or any

assertion, omission or representation of material fact set forth in the advertisement or

public communication.

(7) Required Disclosures. The advertising of prices or discounts from such prices of eyeglasses,

spectacles, lenses, contact lenses, frames, mountings and prosthetic devices is permitted

under the condition that such advertising includes and specifies the kind, type and quality of

the advertised item and is not in violation of any other advertising rules of the Optometry

Board.

(8) Corporate or Business Names.

(a) Requests for approval of corporate or business names must be submitted on an official

form at the Board administrative office. Prior use of a corporate name in advertising the

name must be submitted to and approved by the Board.

(b) Such requests will be maintained in the administrative office until the next scheduled

Board meeting at which time that will be presented to and reviewed by the Board. If the

Board, in its discretion, decides that the corporate name is appropriate and in

compliance with all statutes and rules, the corporate name may be approved.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.08, continued)

June, 2022 (Revised) 19

Board as directed by the Board. A record of such corporate names will be kept in the

administrative office.

(9) Severability. It is hereby declared that the section, clauses, sentences and parts of these

rules are severable, are not matters of mutual essential inducement, and any of them shall be

exscinded if these rules would otherwise be unconstitutional or ineffective. If any one or more

sections, clauses, sentences or parts shall be adjudged unconstitutional or invalid, such

judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be

confined in its operation to the specific provision or provisions so held unconstitutional or

invalid, and the inapplicability or invalidity of any section, clause, sentence or part in any one

or more instances shall not be taken to affect or prejudice in any way its applicability or

validity in any other instance.

Authority: T.C.A. §§ 4-5-204, 63-8-107, 63-8-107(c), 63-8-112, 63-8-112(1)–(3), and 63-8-115.

Administrative History: Original rule filed May 15, 1981; effective July 22, 1981. Amended by Public

Chapter 969; effective July 1, 1984. Repeal and new rule filed November 30, 1990; effective January 14,

1991. Amendment filed October 29, 1991; effective December 13, 1991. Amendment filed December 20,

2021; effective March 20, 2022.

1045-02-.09 OCULAR AND CONTACT LENS PRESCRIPTIONS AND OFFICE EQUIPMENT.

(1) Optometrists shall comply with all federal statutes and regulations regarding release of

verified contact lens prescriptions. The Board of Optometry shall consider the failure to

comply as constituting unprofessional conduct and shall subject the licensee to disciplinary

action pursuant to T.C.A. § 63-8-120.

(2) A contact lens prescription shall expire one (1) year after the date on which the prescription

was issued, unless the optometrist who issued the prescription specifies an earlier expiration

date based solely on the optometrist’s professional judgment regarding the ocular health of

the patient.

(3) All therapeutic prescriptions written by a Tennessee optometrist certified to practice

therapeutics must include:

(a) Tennessee license number;

(b) “T” designation preceding license number, i.e. OD-T000;

(4) Each optometrist shall utilize the necessary instrumentation to practice optometry within the

scope of licensure in order that they may properly diagnose and/or treat conditions of the

human eye and adnexa.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-8-112, 63-8-112(1), 63-8-113(c), 63-8-113(d), 63-8-120, 63-8-

120(2), and 63-8-120(12). Administrative History: Original rule filed May 15, 1981; effective July 22,

1981. Repeal and new rule filed November 30, 1990; effective January 14, 1991. Amendment filed

October 29, 1991; effective December 13, 1991. Amendment filed October 18, 2004; effective January 1,

2005. Amendment filed July 10, 2006; effective September 23, 2006.

1045-02-.10 DISCIPLINARY ACTIONS, CIVIL PENALTIES, DECLARATORY ORDERS, SCREENING

PANELS, ASSESSMENT OF COSTS, AND SUBPOENAS.

(1) Upon a finding by the Board that a licensee has violated any provision of the Tennessee

Optometric Act (T.C.A. §§ 63-8-101, et seq.) or the rules promulgated pursuant thereto, the

Board may impose any of the following actions separately or in any combination which is

deemed appropriate to the offense:

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 20

(a) Private Censor – This is a written action issued to a licensee for minor or near

infractions. It is informal and advisory in nature and does not constitute a formal

disciplinary action.

(b) Public Censure or Reprimand – This is written action issued to a licensee for one time

and less severe violations. It is a formal disciplinary action.

scrutiny for a fixed period of time. This action may be combined with conditions which

must be met before probation will be lifted and/or which restrict the licensee’s activities

during the probationary period.

(d) Licensure Suspension – This is a formal disciplinary action which suspends a

licensee’s right to practice optometry for a fixed period of time. It contemplates the

reentry of the licensee into practice under the originally issued license.

(e) Licensure Revocation – This is the most severe form of disciplinary action which

removes a licensee from the practice of optometry. If revoked, it relegates the violator

to the status he or she possessed prior to application for licensure. However, the Board

may in its discretion allow the reinstatement of a revoked license upon conditions and

after a period of time it deems appropriate. No petition for reinstatement and no new

application for licensure from a person whose license was revoked shall be considered

prior to the expiration of at least one (1) year unless otherwise stated in the Board’s

revocation Order.

(f) Conditions – Any action deemed appropriate by the Board required of a disciplined

licensee during any period of probation or suspension or the reinstatement of a

revoked license.

(g) Civil penalty – A monetary disciplinary action assessed by the Board pursuant to

paragraph (4) of this rule.

(h) Once ordered, probation, suspension, revocation, assessment of a civil penalty, or any

other condition of any type of disciplinary action may not be lifted unless and until the

licensee petitions, pursuant to paragraph (2) of this rule, and appears before the Board

after the period of initial probation, suspension, revocation, or other conditioning has

run and all conditions placed on the probation, suspension, revocation, have been met,

and after any civil penalties assessed have been paid.

(2) Order of Compliance – This procedure is a necessary adjunct to previously issued

disciplinary orders and is available only when a petitioner has completely complied with the

provisions of a previously issued disciplinary order, including an unlicensed practice civil

penalty order, and wishes or is required to obtain an order reflecting that compliance.

(a) The Board will entertain petitions for an Order of Compliance as a supplement to a

previously issued order upon strict compliance with the procedures set forth in

subparagraph (b) in only the following three (3) circumstances:

1. When the petitioner can prove compliance with all the terms of the previously

issued order and is seeking to have an order issued reflecting that compliance;

2. When the petitioner can prove compliance with all the terms of the previously

issued order and is seeking to have an order issued lifting a previously ordered

suspension or probation; or

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 21

3. When the petitioner can prove compliance with all the terms of the previously

issued order and is seeking to have an order issued reinstating a license

previously revoked.

(b) Procedures

1. The petitioner shall submit a Petition for Order of Compliance, as contained in

subparagraph (c), to the Board’s Administrative Office that shall contain all of the

following:

(i) A copy of the previously issued order; and

(ii) A statement of which provision of subparagraph (a) the petitioner is relying

upon as a basis for the requested order; and

(iii) A copy of all documents that prove compliance with all the terms or

conditions of the previously issued order. If proof of compliance requires

testimony of an individual(s), including that of the petitioner, the petitioner

must submit signed statements from every individual the petitioner intends

to rely upon attesting, under oath, to the compliance. The Board’s

consultant and administrative staff, in their discretion, may require such

signed statements to be notarized. No documentation or testimony other

than that submitted will be considered in making an initial determination on,

or a final order in response to, the petition.

2. The Board authorizes its consultant and administrative staff to make an initial

determination on the petition and take one of the following actions:

(i) Certify compliance and have the matter scheduled for presentation to the

Board as an uncontested matter; or

(ii) Deny the petition, after consultation with legal staff, if compliance with all of

the provisions of the previous order is not proven and notify the petitioner

of what provisions remain to be fulfilled and/or what proof of compliance

was either not sufficient or not submitted.

3. If the petition is presented to the Board the petitioner may not submit any

additional documentation or testimony other than that contained in the petition as

originally submitted.

4. If the Board finds that the petitioner has complied with all the terms of the

previous order an Order of Compliance shall be issued.

5. If the petition is denied either initially by staff or after presentation to the Board

and the petitioner believes compliance with the order has been sufficiently

proven the petitioner may, as authorized by law, file a petition for a declaratory

order pursuant to the provisions of T.C.A. § 4-5-223 and Rule 1200-10-01-.11.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 22

Petition for Order of Compliance

Board of Optometry

Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents, as substantiated by the attached documentation,

that all provisions of the attached disciplinary order have been complied with and I am

respectfully requesting: (circle one)

1. An order issued reflecting that compliance; or

2. An order issued reflecting that compliance and lifting a previously ordered

suspension or probation; or

3. An order issued reflecting that compliance and reinstating a license previously

revoked.

Note – You must enclose all documents necessary to prove your request including a

copy of the original order. If any of the proof you are relying upon to show compliance

is the testimony of any individual, including yourself, you must enclose signed

statements from every individual you intend to rely upon attesting, under oath, to the

compliance. The Board’s consultant and administrative staff, in their discretion, may

require such signed statements to be notarized. No documentation or testimony other

than that submitted will be considered in making an initial determination on, or a final

order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature

(3) Order Modifications – This procedure is not intended to allow anyone under a previously

issued disciplinary order, including an unlicensed practice civil penalty order, to modify any

findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is

also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than

the one(s) previously ordered. All such provisions of Board orders were subject to

reconsideration and appeal under the provisions of the Uniform Administrative Procedures

Act (T.C.A. §§ 4-5-301, et seq.). This procedure is not available as a substitute for

reconsideration and/or appeal and is only available after all reconsideration and appeal rights

have been either exhausted or not timely pursued. It is also not available for those who have

accepted and been issued a reprimand.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 23

(a) The Board will entertain petitions for modification of the disciplinary portion of

previously issued orders upon strict compliance with the procedures set forth in

subparagraph (b) only when the petitioner can prove that compliance with any one or

more of the conditions or terms of the discipline previously ordered is impossible. For

purposes of this rule the term “impossible” does not mean that compliance is

inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures

1. The petitioner shall submit a written and signed Petition for Order Modification on

the form contained in subparagraph (c) to the Board’s Administrative Office that

shall contain all of the following:

(i) A copy of the previously issued order; and

(ii) A statement of why the petitioner believes it is impossible to comply with

the order as issued; and

(iii) A copy of all documents that proves that compliance is impossible. If proof

of impossibility of compliance requires testimony of an individual(s),

including that of the petitioner, the petitioner must submit signed and

notarized statements from every individual the petitioner intends to rely

upon attesting, under oath, to the reasons why compliance is impossible.

No documentation or testimony other than that submitted will be

considered in making an initial determination on, or a final order in

response to, the petition.

2. The Board authorizes its consultant and administrative staff to make an initial

determination on the petition and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of

General Counsel for presentation to the Board as an uncontested matter;

(ii) Deny the petition, after consultation with legal staff, if impossibility of

compliance with the provisions of the previous order is not proven and

notify the petitioner of what proof of impossibility of compliance was either

not sufficient or not submitted.

3. If the petition is presented to the Board the petitioner may not submit any

additional documentation or testimony other than that contained in the petition as

originally submitted.

4. If the petition is granted a new order shall be issued reflecting the modifications

authorized by the Board that it deemed appropriate and necessary in relation to

the violations found in the previous order.

5. If the petition is denied either initially by staff or after presentation to the Board

and the petitioner believes impossibility of compliance with the order has been

sufficiently proven the petitioner may, as authorized by law, file a petition for a

declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and Rule 1200-

10-01-.11.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 24

Petition for Order Modification

Board of Optometry

Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents that for the following reasons, as substantiated

by the attached documentation, the identified provisions of the attached disciplinary

order are impossible for me to comply with:

Note – You must enclose all documents necessary to prove your request including a

copy of the original order. If any of the proof you are relying upon to show impossibility

is the testimony of any individual, including yourself, you must enclose signed and

notarized statements from every individual you intend to rely upon attesting, under

oath, to the reasons why compliance is impossible. No documentation or testimony

other than that submitted will be considered in making an initial determination on, or a

final order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature

(4) Civil Penalties.

(a) Purpose – The purpose of this rule is to set out a schedule designating the minimum

and maximum civil penalties which may be assessed pursuant to Public Chapter 389,

Acts of 1989.

(b) Schedule of Civil Penalties

1. A Type A Civil Penalty may be imposed whenever the Board finds a person who

is required to be licensed, certified, permitted, or authorized by the Board, guilty

of a willful and knowing violation of the Practice Act, or regulations pursuant

thereto, to such an extent that there is, or is likely to be, an imminent, substantial

threat to the health, safety and welfare of an individual patient or the public. For

purposes of this section, willfully and knowingly practicing as an optometrist

without a permit, license, certification, or other authorization from the Board is

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 25

one of the violations of the Optometry Practice Act for which a Type A Civil

Penalty is assessable.

2. A Type B Civil Penalty may be imposed whenever the Board finds the person

required to be licensed, certified, permitted, or authorized by the Board is guilty

of a violation of the Optometry Practice Act or regulations pursuant thereto in

such manner as to impact directly on the care of patients or the public.

3. A Type C Civil Penalty may be imposed whenever the Board finds the person

required to be licensed, certified, permitted, or authorized by the Board is guilty

of a violation of the Optometry Practice Act or regulations promulgated thereto,

which are neither directly detrimental to the patients or public, nor directly impact

their care, but have only an indirect relationship to patient care or the public.

1. Type A Civil Penalties shall be assessed in the amount of not less than $500 nor

more than $1000.

2. Type B Civil Penalties may be assessed in the amount of not less than $100 and

not more than $500.

3. Type C Civil Penalties may be assessed in the amount of not less than $50 and

not more than $100.

(d) Procedures for Assessing Civil Penalties

1. The Division of Health Related Boards may initiate a civil penalty assessment by

filing a Memorandum of Assessment of Civil Penalty. The Division shall state in

the memorandum the facts and law upon which it relies in alleging a violation, the

proposed amount of the civil penalty and the basis for such penalty. The Division

may incorporate the Memorandum of Assessment of Civil Penalty with a Notice

of Charges which may be issued attendant thereto.

2. Civil Penalties may also be initiated and assessed by the Board during

consideration of any Notice of Charges. In addition, the Board may, upon good

cause shown, assess a type and amount of civil penalty which was not

recommended by the Division.

3. In assessing the civil penalties pursuant to these rules the Board may consider

the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to

the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of non-

compliance; and,

(v) The interest of the public.

4. All proceedings for the assessment of civil penalties shall be governed by the

contested case provisions of Title 4, Chapter 5, Tennessee Code Annotated.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 26

(5) Declaratory Orders – The Board adopts, as if fully set out herein, Rule 1200-10-01-.11, of the

Division of Health Related Boards and as it may from time to time be amended, as its rule

governing the declaratory order process. All declaratory order petitions involving statutes,

rules or orders within the jurisdiction of the Board shall be addressed by the Board pursuant

to that rule and not by the Division. Declaratory Order Petition forms can be obtained from

the Board’s administrative office.

(6) Screening Panels – The Board adopts, as if fully set out herein, Rule 1200-10-01-.13, of the

Division of Health Related Boards and as it may from time to time be amended, as its rule

governing the screening panel process.

(7) Assessment of costs in disciplinary proceedings shall be as set forth in T.C.A. §§ 63-1-144

and 63-8-120.

(8) Subpoenas

(a) Purpose – Although this rule applies to persons and entities other than optometrists, it

is the Board’s intent as to optometrists that they be free to comprehensively treat and

document treatment of their patients without fear that the treatment or its

documentation will be unduly subjected to scrutiny outside the profession.

Consequently, balancing that intent against the interest of the public and patients to be

protected against substandard care and activities requires that persons seeking to

subpoena such information and/or materials must comply with the substance and

procedures of these rules.

It is the intent of the Board that the subpoena power outlined herein shall be strictly

proscribed. Such power shall not be used by the Division or Board investigators to seek

other incriminating evidence against optometrists when the Division or Board does not

have a complaint or basis to pursue such an investigation. Thus, unless the Division or

its investigators have previously considered, discovered, or otherwise received a

complaint from either the public or a governmental entity, then no subpoena as

contemplated herein shall issue.

(b) Definitions – As used in this chapter of rules the following words shall have the

meanings ascribed to them:

1. Probable Cause

(i) For Investigative Subpoenas – shall mean that probable cause, as defined

by case law at the time of request for subpoena issuance is made, exists

that a violation of the Optometry Practice Act or rules promulgated

pursuant thereto has occurred or is occurring and that it is more probable

than not that the person(s), or items to be subpoenaed possess or contain

evidence which is more probable than not relevant to the conduct

constituting the violation.

(ii) The utilization of the probable cause evidentiary burden in proceedings

pursuant to this rule shall not in any way, nor should it be construed in any

way to establish a more restrictive burden of proof than the existing

preponderance of the evidence in any civil disciplinary action which may

involve the person(s) or items that are the subject of the subpoena.

2. Presiding Officer – For Investigative Subpoenas shall mean any elected officer of

the Board, or any duly appointed or elected chairperson of any panel of the

Board.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 27

1. Investigative Subpoenas

(i) Investigative Subpoenas are available only for issuance to the authorized

representatives of the Tennessee Department of Health, its investigators

and its legal staff.

(ii) An applicant for such a subpoena must either orally or in writing notify the

Board’s Unit Director of the intention to seek issuance of a subpoena. That

notification must include the following:

(I) The time frame in which issuance is required so the matter can be

timely scheduled; and

(II) A particular description of the material or documents sought, which

must relate directly to an ongoing investigation or contested case,

and shall, in the instance of documentary materials, be limited to the

records of the patient or patients whose complaint, complaints, or

records are being considered by the Division or Board.

I. In no event shall such subpoena be broadly drafted to provide

investigative access to optometry records of other patients

who are not referenced in a complaint received from an

individual or governmental entity, or who have not otherwise

sought relief, review, or Board consideration of any

optometrist’s conduct, act, or omission; and

II. If the subpoena relates to the prescribing practices of a

licensee, then it shall be directed solely to the records of the

patient(s) who received the pharmaceutical agents and whom

the Board of Pharmacy or issuing pharmacy(ies) has so

identified as recipients; and

(III) Whether the proceedings for the issuance is to be conducted by

physical appearance or electronic means; and

(IV) The name and address of the person for whom the subpoena is

being sought, or who has possession of the items being

subpoenaed.

(iii) The Board’s Unit Director shall cause to have the following done:

(I) In as timely a manner as possible arrange for either an elected

officer of the Board, or any duly appointed or elected chairperson of

any panel of the Board, to preside and determine if issuing the

subpoena should be recommended to the full Board; and

(II) Establish a date, time and place for the proceedings to be conducted

and notify the presiding officer, the applicant and the court reporter;

and

(III) Maintain a complete record of the proceedings including an audio

tape in such a manner as to:

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 28

I. Preserve a verbatim record of the proceeding; and

II. Prevent the person presiding over the proceedings and/or

signing the subpoena from being allowed to participate in any

manner in any disciplinary action of any kind formal or informal

which may result which involves either the person or the

documents or records for which the subpoena was issued.

(iv) The Proceedings

(I) The applicant shall do the following:

I. Provide for the attendance of all persons whose testimony is to

be relied upon to establish probable cause; and

II. Produce and make part of the record copies of all documents

to be utilized to establish probable cause; and

III. Obtain, complete and provide to the presiding officer a

subpoena which specifies the following:

A. The name and address of the person for whom the

subpoena is being sought or who has possession of the

items being subpoenaed; and

B. The location of the materials, documents or reports for

which production pursuant to the subpoena is sought if

that location is known; and

C. A brief, general description of any items to be produced

pursuant to the subpoena; and

D. The date, time and place for compliance with the

subpoena.

IV. Provide the presiding officer testimony and/or documentary

evidence, which in good faith, the applicant believes is

sufficient to establish that probable cause exists for issuance

of the subpoena as well as sufficient proof that all other

reasonably available alternative means of securing the

materials, documents or items have been unsuccessful.

(v) The Presiding Officer shall do the following:

(I) Be selected only after assuring the Board’s Unit Director that he or

she has no prior knowledge of or any direct or indirect interest in or

relationship with the person(s) being subpoenaed and/or the

licensee who is the subject of the investigation; and

(II) Commence the proceedings and swear all necessary witnesses; and

(III) Hear and maintain the confidentiality, if any, of the evidence

presented at the proceedings and present to the full Board only that

evidence necessary for an informed decision; and

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.10, continued)

June, 2022 (Revised) 29

(IV) Control the manner and extent of inquiry during the proceedings and

be allowed to question any witness who testifies; and

(V) Determine based solely on the evidence presented in the

proceedings whether probable cause exists and if so, make such

recommendation to the full Board; and

(VI) Not participate in any way in any other proceeding whether formal or

informal, which involves the matters, items or person(s) which are

the subject of the subpoena. This does not preclude the presiding

officer from presiding at further proceedings for issuance of

subpoenas in the matter.

(vi) The Board shall do the following:

(I) By a vote of two-thirds (2/3) of the Board members issue the

subpoena for the person(s) or items specifically found to be relevant

to the inquiry, or quash or modify an existing subpoena by a majority

vote; and

(II) Sign the subpoena as ordered to be issued, quashed or modified.

2. Post-Notice of Charges Subpoenas – If the subpoena is sought for a contested

case being heard with an Administrative Law Judge from the Secretary of State’s

office presiding, this definition shall not apply and all such post-notice of charges

subpoenas should be obtained from the office of the Administrative Procedures

Division of the Office of the Secretary of State pursuant to the Uniform

Administrative Procedures Act and rules promulgated pursuant thereto.

(d) Subpoena Forms

1. All subpoenas shall be issued on forms approved by the Board.

2. The subpoena forms may be obtained by contacting the Board’s Administrative

Office.

(e) Subpoena Service – Any method of service of subpoenas authorized by the Tennessee

Rules of Civil Procedure or the rules of the Tennessee Department of State,

Administrative Procedures Division may be utilized to serve subpoenas pursuant to this

rule.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-217, 4-5-223, 4-5-224, 4-5-225, 63-1-122, 63-1-134, 63-1-

138, 63-8-112, 63-8-120, 63-8-121, and 63-8-123. Administrative History: Original rule filed January 29,

1990; effective March 15, 1990. Repeal and new rule filed November 30, 1990; effective January 14,

1991. Amendment filed October 11, 1999; effective December 25, 1999. Amendment filed February 10,

2000; effective April 25, 2000. Amendment filed December 18, 2000; effective March 3, 2001.

Amendment filed August 13, 2004; effective October 27, 2004. Amendment filed July 10, 2006; effective

September 23, 2006.

1045-02-.11 SCOPE OF PRACTICE. The scope of the practice of optometry in Tennessee is

specifically defined but includes many aspects which if not particularly regulated could lead to serious

ramifications for the consuming public. This rule is to designate specific areas in the practice of optometry

for regulation, the violation of which may result in disciplinary action pursuant to T.C.A. §§ 63-8-120(a)(2),

63-8-120(9) and 63-8-120(10).

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.11, continued)

June, 2022 (Revised) 30

(1) Practice of Optometry - For the safety and welfare of the citizens of the State of Tennessee,

the practice of optometry is defined to be the science and art of examining, diagnosing,

treating, and managing conditions of the visual system, conditions and pathology related to

the human eye and related structures, for the purpose of protecting, enhancing, and

maintaining visual performance and the integrity of the human eye and related structures.

(a) The practice of optometry includes:

1. The measurement of the vision system and muscular anomalies, by employment

of any means approved by the United States Food and Drug Administration or

related agency, including the use or furnishing of any self-testing device, the use

of any computerized or automatic refracting device, including applications

designed to be used on a computer or video conferencing via an Internet device

either in-person or in remote locations. The practice of optometry also includes

prescribing ophthalmic correction to remedy or relieve defects of vision

performance or muscular anomalies by means including but not limited to

spectacle eyeglasses, contact lenses for orthotic, prosthetic, therapeutic, or

cosmetic purposes, prisms, devices, and the employment of vision therapy or

orthoptics for the aid thereof, and low vision rehabilitation.

2. Examining, diagnosing, treating, and managing conditions rational to the health

and preservation of the human eye and related structures by employment of any

means approved by the United States Food and Drug Administration or related

agency, including the use or prescription of any self-testing, self-administered

treatment or drug delivery devices, the use of any computerized or automatic

devices, including applications designed to be used on a computer or video

conferencing via an Internet device either in-person or in remote locations.

3. The administration of pharmaceutical agents, performing or ordering of

procedures and laboratory tests, primary eye care procedures, and ophthalmic

surgery except for procedures and devices as defined in T.C.A. § 63-8-

102(12)(E)(ii).

4. Examining, diagnosing, treating, and managing must be by an optometrist within

the scope of his or her education, training, and experience and in accordance

with T.C.A. §§ 63-8-101, et seq., the ethics of the profession and applicable law.

The practice of optometry is defined by diagnostic devices, pharmaceuticals,

treatment devices, primary eye care procedures, and ophthalmic surgery unless

specifically excluded by the Tennessee Board of Optometry, pursuant to rules

promulgated under the Administrative Procedures Act.

5. Nothing in this rule shall be construed as allowing any agency, board, or other

entity of this state other than the Tennessee Board of Optometry to determine

what constitutes the practice of optometry.

(b) Specific Exclusions - The following ophthalmic surgery procedures are excluded from

the practice of optometry, except for the preoperative and postoperative care related to

these procedures and other items as defined in T.C.A. § 63-8-102(12)(E)(ii):

1. Retina laser procedures; and

2. Laser or non-laser procedures into the vitreous chamber of the eye to treat any

retinal or macular disease.

3. Surgery related to the removal of the eye from a living human being;

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.11, continued)

June, 2022 (Revised) 31

4. Administration of general anesthesia or ophthalmic surgery performed with

general anesthesia;

5. Surgery requiring full thickness excision of the cornea or sclera – for penetrating

keratoplasty or corneal transplant;

6. Surgery requiring incision of the iris and ciliary body;

7. Surgery requiring incision of the retina;

8. Surgical extraction of the crystalline lens;

9. Surgical placement of intraocular implants;

10. Incisional or excisional surgery of the extraocular muscles;

11. Surgery of the eyelid for incisional cosmetic or mechanical repair of

blepharochalasis;

12. Surgery of the bony orbit, including orbital implants;

13. Incisional or excisional surgery of the lacrimal system; and

14. Surgery of the conjunctiva including pterygium surgery or full thickness

conjunctivoplasty with graft or flap.

(2) Co-Management.

(a) Definitions

1. Co-Management – The cooperative and active participation in the delivery of

services and treatment to patients between optometrists and other health care

providers.

2. Consultation – The deliberations between optometrists and other health care

providers with respect to the diagnosis or treatment of any particular patient.

(b) Intent – It is the intent of this rule to promote the cooperation of optometrists and other

health care providers, when appropriate for total patient care, and cooperation in the

delivery of that care within the scope of their respective professional practices. This

rule provides the framework within which optometrists may work when co-managing a

patient’s care.

may include both consultation and active participation.

1. The decision to receive co-managed health care rests solely with the patient.

However, the decision should be made during consultation between the patient

and all appropriate health care providers who may be involved in the co-

management of care for that patient.

2. An optometrist may provide follow-up care within the scope of optometric practice

for a patient’s medical or surgical eye problem.

3. If post-operative care of a patient is requested, the optometrist should provide a

report to the surgeon of all treatment and services rendered.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.11, continued)

June, 2022 (Revised) 32

(d) Records

1. Optometrist’s Office – Any consultation, treatment, services or care provided for

a co-managed patient in an optometrist’s private office not shared by the co-

managing health care provider, must be fully and completely documented in the

optometrist’s records for that patient.

2. In the case of a patient who is receiving services and/or treatment from more

than one (1) health care provider in a health care facility where only one (1)

comprehensive set of records is kept, an optometrist, if called upon to provide

services or treatment, must sign that record and include the treatment or service

provided each time the patient receives such services or treatment. The

optometrist must also request the other health care providers to sign the record

and include the treatment or services provided each time the patient receives

such services or treatment.

(3) Universal Precautions for the Prevention of HIV Transmission – The Board adopts, as if fully

set out herein, rules 1200-14-03-.01 through 1200-14-03-.03 inclusive, of the Department of

Health and as they may from time to time be amended, as its rule governing the process for

implementing universal precautions for the prevention of HIV transmission for health care

workers under its jurisdiction.

(4) Administration, Sale, Dispensing and Prescribing of Drugs, Including Controlled Substances.

(a) Optometrists licensed within this State shall be subject to discipline for administering,

dispensing, selling, prescribing, or otherwise distributing any drug or controlled

substance to any person which is:

1. Not in the course of professional practice, or not in good faith to relieve pain and

suffering, or not in good faith to diagnose and treat conditions or diseases of the

eye or eyelid; or

2. In violation of any law of this state or of the United States.

(5) Orthoptics and Vision Therapy – Any person other than a doctor of medicine or an

osteopathic physician who examines, diagnoses, manages and treats conditions or diseases

of the eye or eyelid is considered to be practicing optometry in accordance with T.C.A. § 63-

8-102(12). This includes managing a patient through vision therapy, visual training, visual

rehabilitation, orthoptics or eye exercises. “Orthoptic training” means any ocular exercise for

the correction or relief of abnormal muscles or functions of the eyes in accordance with

T.C.A. § 63-8-102(11). A person who hold him/herself out as being able to remedy or relieve

defects of vision or muscular anomalies or other abnormal conditions of the eyes by

engaging in orthoptic training or by adjusting, fitting or adapting lenses or prisms to remedy or

relieve defects of vision or muscular anomalies is engaged in the practice of optometry, as

defined in Tennessee Code Annotated § 63-8-102(12).

(6) Eye Examination Requirements – All eye examinations performed by licensees shall include

the professionally recognized components listed in subpart (3)(a)2.(i) of Rule 1045-02-.08 for

spectacles and in subpart (3)(a)2.(ii) of Rule 1045-02-.08 for contact lenses.

(7) Use of Titles – Any person who possesses a valid, unsuspended and unrevoked license

issued by the Board has the right to use the titles “Optometrist,” “Doctor of Optometry,”

“Optometric Physician,” or “O.D.” and to practice optometry, as defined in T.C.A. §§ 63-8-

102. Violation of this rule or T.C.A. §§ 63-8-113 and 63-8-120 regarding use of titles shall

constitute unprofessional conduct and subject the licensee to disciplinary action.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.11, continued)

June, 2022 (Revised) 33

Authority: T.C.A. §§ 63-1-146, 63-8-102, 63-8-112, 63-8-113, and 63-8-120. Administrative History:

Original rule filed September 18, 1991; effective November 2, 1991. Amendment filed October 29, 1991;

effective December 13, 1991. Amendment filed June 9, 1994; effective August 23, 1994. Amendment

filed August 2, 1995; effective October 16, 1995. Amendment to rule filed December 11, 1998; effective

February 23, 1999. Amendment filed January 4, 2002; effective March 20, 2002. Amendment filed

October 18, 2004; effective January 1, 2005. Amendment filed July 10, 2006; effective September 23,

2006. Amendments filed March 23, 2022; effective June 21, 2022.

1045-02-.12 PRIMARY EYE CARE PROCEDURES. For the purpose of 1993 Public Acts Chapter 295,

the performance of primary eye care procedures rational to the treatment of conditions or diseases of the

eye or eyelid is determined by the board to be those procedures that could be performed in the

optometrist’s office or other health care facilities. Laser surgery and radial keratotomy are excluded

Authority: T.C.A. §§ 63-8-102 and 63-8-112 and Public Chapter 295, Acts of 1993. Administrative

History: Original rule filed February 14, 1993; effective April 30, 1994. Amendments filed March 23,

2022; effective June 21, 2022.

1045-02-.13 OPTOMETRIC PROFESSIONAL CORPORATIONS AND OPTOMETRIC

PROFESSIONAL LIMITED LIABILITY COMPANIES.

(1) Optometric Professional Corporations (OPC) – Except as provided in this rule Optometric

Professional Corporations shall be governed by the provisions of Tennessee Code

Annotated, Title 48, Chapter 101, Part 6.

(a) Filings – An OPC need not file its Charter or its Annual Statement of Qualifications with

the Board.

(b) Ownership of Stock – With the exception of the health care professional combinations

specifically enumerated in Tennessee Code Annotated, § 48-101-610 only the

following may form and own shares of stock in a foreign or domestic OPC doing

business in Tennessee:

1. Optometrists licensed pursuant to Tennessee Code Annotated Title 63, Chapter

8 or licensed in another state; and/or

2. A foreign or domestic general partnership, OPC or OPLLC in which all partners,

shareholders, members or holders of financial rights are either:

(i) Optometrists licensed pursuant to Tennessee Code Annotated, Title 63,

Chapter 8 to practice optometry in Tennessee or optometrists licensed by

other states, or composed of entities which are directly or indirectly owned

by such licensed optometrists; and/or

(ii) Professionals authorized by Tennessee Code Annotated §§ 48-101-610,

48-248-401, or 48-249-1109 to either own shares of stock in an OPC or be

a member or holder of financial rights in an OPLLC; and/or

(iii) A combination of professionals authorized by subparts (i) and (ii).

1. All, except the following officers, must be persons who are eligible to form or own

shares of stock in an optometric professional corporation as limited by T.C.A. §

48-101-610(d) and subparagraph (1)(b) of this rule:

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.13, continued)

June, 2022 (Revised) 34

(i) Secretary;

(ii) Assistant Secretary;

(iii) Treasurer; and

(iv) Assistant Treasurer.

2. With respect to members of the Board of Directors, only persons who are eligible

to form or own shares of stock in an optometric professional corporation as

limited by T.C.A. § 48-101-610(d) and subparagraph (1)(b) of this rule shall be

directors of an OPC.

(d) Practice Limitations

1. Engaging in, or allowing another optometrist incorporator, shareholder, officer, or

director, while acting on behalf of the OPC, to engage in, optometric practice in

any area of practice or specialty beyond that which is specifically set forth in the

charter may be a violation of Tennessee Code Annotated, § 63-8-120(2).

2. Nothing in these rules shall be construed as prohibiting any health care

professional licensed pursuant to Tennessee Code Annotated, Title 63 from

being an employee of or a contractor to an OPC.

3. Nothing in these rules shall be construed as prohibiting an OPC from electing to

incorporate for the purposes of rendering professional services within two (2) or

more professions or for any lawful business authorized by the Tennessee

Business Corporations Act so long as those purposes do not interfere with the

exercise of independent optometric judgment by the optometrist incorporators,

directors, officers, shareholders, employees or contractors of the OPC who are

practicing optometry as defined by Tennessee Code Annotated, § 63-8-102(12).

4. Nothing in these rules shall be construed as prohibiting an optometrist from

owning shares of stock in any type of professional corporation other than an

OPC so long as such ownership interests do not interfere with the exercise of

independent optometric judgment by the optometrist while practicing optometry

as defined by Tennessee Code Annotated, § 63-8-102(12).

(2) Optometric Professional Limited Liability Companies (OPLLC) – Except as provided in this

rule Optometric Professional Limited Liability Companies shall be governed by either the

provisions of Tennessee Code Annotated, Title 48, Chapters 248 or 249.

(a) Filings – Articles filed with the Secretary of State shall be deemed to be filed with the

Board and no Annual Statement of Qualifications need be filed with the Board.

(b) Membership – With the exception of the health care professional combinations

specifically enumerated in Tennessee Code Annotated, §§ 48-248-401 or 48-249-1109

only the following may be members or holders of financial rights of a foreign or

domestic OPLLC doing business in Tennessee:

1. Optometrists licensed pursuant to Tennessee Code Annotated Title 63, Chapter

8 or licensed in other states; and/or

2. A foreign or domestic general partnership, OPC or OPLLC in which all partners,

shareholders, members or holders of financial rights are either:

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.13, continued)

June, 2022 (Revised) 35

(i) Optometrists licensed pursuant to Tennessee Code Annotated Title 63,

Chapter 8 to practice optometry in Tennessee or optometrists licensed by

other states or composed of entities which are directly or indirectly owned

by such licensed optometrists; and/or

(ii) Professionals authorized by Tennessee Code Annotated, §§ 48-101-610,

48-248-401, or 48-249-1109 to either own shares of stock in an OPC or be

a member or holder of financial rights in an OPLLC; and/or

(iii) A combination of professionals authorized by subparts (i) and (ii).

1. All, except the following managers, must be persons who are eligible to form or

become members or holders of financial rights of an optometric professional

limited liability company as limited by T.C.A. § 48-248-401 and subparagraph

(2)(b) of this rule:

(i) Secretary

(ii) Treasurer

2. Only persons who are eligible to form or become members or holders of financial

rights of an optometric professional limited liability company as limited by T.C.A.

§ 48-248-401 and subparagraph (2)(b) of this rule shall be allowed to serve as a

director, or serve on the Board of Governors of an OPLLC.

(d) Practice Limitations

1. Engaging in, or allowing another optometrist member, officer, manager, director,

or governor, while acting on behalf of the OPLLC, to engage in, optometric

practice in any area of practice or specialty beyond that which is specifically set

forth in the articles of organization may be a violation of Tennessee Code

Annotated, § 63-8-120(2).

2. Nothing in these rules shall be construed as prohibiting any health care

professional licensed pursuant to Tennessee Code Annotated, Title 63 from

being an employee of or a contractor to an OPLLC.

3. Nothing in these rules shall be construed as prohibiting an OPLLC from electing

to form for the purposes of rendering professional services within two (2) or more

professions or for any lawful business authorized by the Tennessee Limited

Liability Company Act or the Tennessee Revised Limited Liability Company Act

so long as those purposes do not interfere with the exercise of independent

optometric judgment by the optometrist members or holders of financial rights,

governors, officers, managers, employees or contractors of the OPLLC who are

practicing optometry as defined by Tennessee Code Annotated, § 63-8-102(12).

4. Nothing in these rules shall be construed as prohibiting an optometrist from being

a member of any type of professional limited liability company other than an

OPLLC so long as such membership interests do not interfere with the exercise

of independent optometric judgment by the optometrist while practicing

optometry as defined by Tennessee Code Annotated, § 63-8-102(12).

5. All OPLLCs formed in Tennessee pursuant to Tennessee Code Annotated, §§

48-248-104 or 48-249-1104, to provide services only in states other than

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.13, continued)

June, 2022 (Revised) 36

Tennessee shall annually file with the Board a notarized statement that they are

not providing services in Tennessee.

(3) Dissolution – The procedure that the Board shall follow to notify the attorney general that an

OPC or a OPLLC has violated or is violating any provision of Title 48, Chapters 101, 248 or

249, shall be as follows but shall not terminate or interfere with the Secretary of State’s

authority regarding dissolution pursuant to Tennessee Code Annotated, §§ 48-101-624, 48-

248-409, or 48-249-1122.

(a) Service of a written notice of violation by the Board on the registered agent of the OPC

and/or OPLLC or the Secretary of State if a violation of the provisions of Tennessee

Code Annotated, Title 48, Chapters 101, 248 or 249 occurs.

(b) The notice of violation shall state with reasonable specificity the nature of the alleged

violation(s).

days after service of the notice of violation, correct each alleged violation or show to

the Board’s satisfaction that the alleged violation(s) did not occur.

(d) The notice of violation shall state that, if the Board finds that the OPC and/or OPLLC is

in violation, the attorney general will be notified and judicial dissolution proceedings

may be instituted pursuant to Tennessee Code Annotated, Title 48.

(e) The notice of violation shall state that proceedings pursuant to this section shall not be

conducted in accordance with the contested case provisions of the Uniform

Administrative Procedures Act, compiled in Title 4, Chapter 5 but that the OPC and/or

OPLLC, through its agent(s), shall appear before the Board at the time, date, and place

as set by the Board and show cause why the Board should not notify the attorney

general and reporter that the organization is in violation of the Act or these rules. The

Board shall enter an order that states with reasonable particularity the facts describing

each violation and the statutory or rule reference of each violation. These proceedings

shall constitute the conduct of administrative rather than disciplinary business.

(f) If, after the proceeding the Board finds that an OPC and/or OPLLC did violate any

provision of Title 48, Chapters 101, 248, and/or 249 or these rules, and failed to correct

said violation or demonstrate to the Board’s satisfaction that the violation did not occur,

the Board shall certify to the attorney general and reporter that it has met all

requirements of either Tennessee Code Annotated, §§ 48-101-624(1)–(3) and/or 48-

248-409(1)–(3) and/or 48-249-1122(1)–(3).

(4) Violation of this rule by any optometrist individually or collectively while acting as an OPC or

as an OPLLC may subject the optometrist(s) to disciplinary action pursuant to Tennessee

Code Annotated, §§ 63-8-120(a)(2).

(5) The authority to own shares of stock or be members or holders of financial rights in an OPC

or an OPLLC granted by statute or these rules to professionals not licensed in this state shall

in no way be construed as authorizing the practice of any profession in this state by such

unlicensed professionals.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 48-101-605, 48-101-608, 48-101-610, 48-101-618, 48-101-624,

48-101-628, 48-101-629, 48-101-630, 48-248-104, 48-248-202, 48-248-401, 48-248-404, 48-248-409,

48-248-501, 48-248-601, 48-248-602, 48-248-603, 48-249-101, et seq., 63-8-102, 63-8-112, 63-8-115,

and 63-8-120. Administrative History: Original rule filed June 10, 2004; effective August 24, 2004.

Amendment filed March 22, 2007; effective June 9, 2007.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

June, 2022 (Revised) 37

1045-02-.14 OPTOMETRIC RECORDS.

(1) Purposes – The purposes of these rules are:

(a) To recognize that optometric records are an integral part of the practice of optometry

as defined in T.C.A. § 63-8-102.

(b) To give optometrists, their professional and non-professional staff, and the public

direction about the content, transfer, retention, and destruction of those records.

(2) Conflicts – As to optometric records, these rules should be read in conjunction with the

provisions of T.C.A. § 63-2-101, T.C.A. § 63-2-102 and Rule 1045-02-.11(1)(d), and are not

intended to conflict with those statutes or rules in any way. Those statutes and rules, along

with these rules, govern the subjects that they cover in the absence of other controlling state

or federal statutes or rules to the contrary.

(3) Applicability – These rules regarding optometric records shall apply only to those records, the

information for which was obtained by optometrists or their employees, or those over whom

they exercise supervision, for purposes of services provided in any clinical setting other than

those provided in a hospital as defined by T.C.A. § 68-11-302(4), a hospital emergency room

or hospital outpatient facility.

(4) Optometric Records

(a) Duty to Create and Maintain Optometric Records – As a component of the standard of

care and of minimal competency an optometrist must cause to be created and

maintained an optometric record for every patient for whom he or she, and/or any of his

or her supervisees, performs services or provides professional consultation.

(b) Notice – Anywhere in these rules where notice is required to be given to patients of any

optometrist that notice shall be required to be issued within thirty (30) days of the date

of the event that triggers the notice requirement, and may be accomplished by public

notice or by any other means reasonably designed to inform the patients.

practice of optometry for all patients shall include all information and documentation

listed in T.C.A. § 63-2-101(c)(2) and such additional information that is necessary to

insure that a subsequent reviewing or treating optometrist can both ascertain the basis

for the diagnosis, treatment plan and outcomes, and provide continuity of care for the

patient.

(d) Transfer

1. Records of Optometrists upon Death or Retirement – When an optometrist retires

or dies while in practice, patients seen by the optometrist in his/her office during

the immediately preceding thirty-six (36) months shall be notified by the

optometrist, or his/her authorized representative and urged to find a new

optometrist and be informed that upon authorization, copies of the records will be

sent to the new optometrist.

2. Records of Optometrists upon Departure from a Group – The responsibility for

notifying patients of an optometrist who leaves a group practice whether by

death, retirement, or departure shall be governed by the optometrist’s

employment contract.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.14, continued)

June, 2022 (Revised) 38

(i) Whomever is responsible for that notification must notify patients seen by

the optometrist in his/her office during the immediately preceding thirty-six

(36) months of his/her departure.

(ii) Except where otherwise governed by provisions of the optometrist’s

contract, those patients shall also be notified of the optometrist’s new

address and offered the opportunity to have copies of their medical records

forwarded to the departing optometrist at his or her new practice. Provided

however, a group shall not withhold the records of any patient who has

authorized their transfer to the departing optometrist or any other

optometrist.

(iii) The choice of optometrist in every case should be left to the patient, and

the patient should be informed that upon authorization his/her records will

be sent to the optometrist of the patient’s choice.

3. Sale of an Optometric Practice – An optometrist or the estate of a deceased

optometrist may sell the elements that comprise his/her practice, one of which is

its goodwill, i.e., the opportunity to take over the patients of the seller by

purchasing the optometrist’s records. Therefore, the transfer of records of

patients is subject to the following:

(i) The optometrist (or the estate) must ensure that all optometric records are

transferred to another optometrist or entity that is held to the same

standards of confidentiality as provided in these rules.

(ii) Patients seen by the optometrist in his/her office during the immediately

preceding thirty-six (36) months shall be notified that the optometrist (or the

estate) is transferring the practice to another optometrist or entity who will

retain custody of their records and that at their written request the copies of

their records will be sent to another optometrist or entity of their choice.

(e) Abandonment of Optometric Records – For purposes of this section of the rules death

of an optometrist shall not be considered as abandonment.

1. It shall be a prima facie violation of T.C.A. § 63-8-120(a)2. for an optometrist to

abandon his practice without making provision for the security, or transfer, or

otherwise establish a secure method of patient access to their records.

2. Upon notification that an optometrist in a practice has abandoned his practice

and not made provision for the security, or transfer, or otherwise established a

secure method of patient access to their records, patients should take all

reasonable steps to obtain their optometric records by whatever lawful means

available and should immediately seek the services of another optometrist.

(f) Retention of Optometric Records – Optometric records shall be retained for a period of

not less than ten (10) years from the optometrist’s or his supervisees’ last professional

contact with the patient except for the following:

1. Optometric records for incompetent patients shall be retained indefinitely.

2. Optometric records of minors shall be retained for a period of not less than one

(1) year after the minor reaches the age of majority or ten (10) years from the

date of the optometrist’s or his supervisees’ last professional contact with the

patient, whichever is longer.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.14, continued)

June, 2022 (Revised) 39

3. Notwithstanding the foregoing, no optometric record involving services which are

currently under dispute shall be destroyed until the dispute is resolved.

(g) Destruction of Optometric Records

1. No record shall be singled out for destruction other than in accordance with

established office procedures.

2. Records shall be destroyed only in the ordinary course of business according to

established office operating procedures that are consistent with these rules.

3. Records may be destroyed by burning, shredding, or other effective methods in

keeping with the confidential nature of the records.

4. When records are destroyed, the time, date and circumstances of the destruction

shall be recorded and maintained for future reference. The record of destruction

need not list the individual patient optometric records that were destroyed but

shall be sufficient to identify which group of destroyed records contained a

particular patient’s optometric records.

(5) Violations – Violation of any provision of these rules is grounds for disciplinary action

pursuant to T.C.A. § 63-8-120(a)(2).

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-2-101, 63-2-102, 63-8-112, and 63-8-120. Administrative

History: Original rule filed January 29, 1990; effective March 15, 1990. Repeal filed November 30, 1990;

effective January 14, 1991. Repeal and new rule filed October 18, 2004; effective January 1, 2005.

1045-02-.15 CONSUMER RIGHT-TO-KNOW REQUIREMENTS.

(1) Malpractice Reporting Requirements – The threshold amount below which medical

malpractice judgments, awards or settlements in which payments are awarded to

complaining parties need not be reported pursuant to the “Health Care Consumer Right-To-

Know Act of 1998” shall be ten thousand dollars ($10,000).

(2) Criminal Conviction Reporting Requirements – For purposes of the “Health Care Consumer

Right-To-Know Act of 1998,” the following criminal convictions must be reported:

(a) Conviction of any felony; and

(b) Conviction or adjudication of guilt of any misdemeanor, regardless of its classification,

in which any element of the misdemeanor involves any one or more of the following:

1. Sex.

2. Alcohol or drugs.

3. Physical injury or threat of injury to any person.

4. Abuse or neglect of any minor, spouse or the elderly.

5. Fraud or theft.

the order of expungement signed by the judge must be submitted to the Department

before the conviction will be expunged from any profile.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.15, continued)

June, 2022 (Revised) 40

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-8-115, and 63-51-101, et seq.; and Public Chapter 373 of the

Public Acts of 1999. Administrative History: Original rule filed November 18, 1999; effective January 31,

2000.

1045-02-.16 TAMPER-RESISTANT PRESCRIPTIONS.

(1) Purpose.

This rule is designed to implement the law requiring that licensed optometrists have all

written, typed, or computer-generated prescriptions issued on tamper-resistant prescription

paper.

(2) Definitions.

The following definitions are applicable to this rule:

(a) “Drug” shall have the same meaning as set forth in T.C.A. § 63-10-204(16).

(b) “Prescriber” means an individual licensed in Tennessee as a medical doctor, podiatrist,

advanced practice nurse with a certificate of fitness to prescribe, dentist, optometrist,

osteopathic physician, or physician’s assistant.

204(34).

(d) “Tamper-resistant prescription” means a written prescription order with features that

are designed to prevent unauthorized copying, erasure, modification, and use of

counterfeit prescription forms.

(3) Tamper-Resistant Prescription Requirements.

(a) A prescriber shall ensure that all handwritten, typed, or computer-generated

prescription orders are issued on tamper-resistant prescriptions. Tamper-resistant

prescriptions shall contain the following features:

1. Either a void or illegal pantograph or a watermark designed to prevent copying;

2. Either quantity check-off boxes with refill indicators or a uniform, non-white

background color designed to prevent erasure or modification; and

3. Security features and descriptions listed on the prescriptions designed to prevent

use of counterfeit forms.

(4) Security Measures and Recordkeeping.

(a) Each prescriber shall undertake adequate safeguards and security measures to ensure

against loss, improper destruction, theft, or unauthorized use of the tamper-resistant

prescriptions in the prescriber’s possession.

(5) Use of Tamper-Resistant Prescriptions.

(a) Facsimile Prescription Transmission.

1. Prescriptions sent by facsimile transmission are not required to be placed on

tamper-resistant prescription paper.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.16, continued)

June, 2022 (Revised) 41

2. If a prescriber transmits a prescription order to a pharmacy by facsimile

transmission, the prescriber or someone designated by the prescriber shall

document in the patient’s medical record the name of the drug, strength, and

quantity prescribed. The prescriber may, but is not required to, document the

means by which the prescription was transmitted.

(b) Electronic Prescription Transmission.

1. Prescriptions sent by electronic transmission are not required to be placed on

tamper-resistant prescription paper.

2. If a prescriber transmits a prescription order to a pharmacy by electronic

transmission, the prescriber shall document the prescription in the patient’s file

and in accordance with the applicable laws and rules for each of the prescribers’

respective professions as well as applicable federal laws and rules. The

prescriber, may, but is not required to, document the means by which the

prescription was transmitted.

Authority: Chapter 1035 of the Public Acts of 2008 and T.C.A. §§ 53-10-401, 63-8-112, and 63-8-126.

[effective October 1, 2008 for TennCare prescriptions and July 1, 2009 for non-TennCare prescriptions].

Administrative History: Public necessity rule filed June 25, 2009; effective through December 7, 2009.

Public necessity rule filed June 25, 2009 expired; on December 8, 2009, the rule reverted to its prior

status. Emergency rule filed December 21, 2009; effective through June 19, 2010. Original rule filed

March 22, 2010; effective June 20, 2010.

1045-02-.17 MINIMUM DISCIPLINE FOR OPIOID PRESCRIBING.

(1) If the Board or Committee finds that its licensee has prescribed, dispensed, or administered

opioids in a manner that violates the Board’s or Committee’s statutes or rules (for example,

by prescribing in a manner that constitutes gross healthcare liability or a pattern of continued

or repeated health care liability, ignorance, negligence or incompetence), the Board or

Committee shall make a finding that the licensee engaged in a significant deviation or pattern

of deviation from sound medical judgement. For purposes of such a finding, sound medical

judgment is the equivalent to the standard of care as defined in T.C.A. § 63-1-122.

(2) Having made such a finding, the minimum discipline that the Board or Committee assesses

shall include the following:

(a) Reprimand;

(b) Successful completion of a Board or Committee approved intensive continuing

education course or program regarding treatment with opioids;

completion of the required continuing education;

(d) One or more Type A civil penalties;

(e) Proof to the licensee’s Board or Committee that they have notified any physicians,

podiatrists, advanced practice registered nurses, or physician assistants with whom

they collaborate of the discipline; and

(f) Where the licensee is a physician or podiatrist, a restriction against collaborating with

any advanced practice registered nurses or physician assistants for issuing opioids

during the period in which the licensee is restricted from prescribing opioids.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.17, continued)

June, 2022 (Revised) 42

(3) The prescribing Boards and Committee recognize that a higher level of minimum discipline is

required for those licensees who have been disciplined for opioid-related prescribing

violations but continue to violate the standard of care. As set out in paragraph (1) of this rule,

the following findings are synonymous, though the Boards or Committee may have used one

or more sets of language to describe a violation. If a licensee commits an order violation in

which the prior order contains one or more of the following findings, the licensee has

committed an opioid-related order violation for purposes of paragraph (5) of this rule:

(a) That the licensee had prescribed, dispensed, or administered opioids in a manner that

constituted gross healthcare liability or a pattern of continued or repeated health care

liability, ignorance, negligence or incompetence;

(b) That the licensee engaged in a significant deviation or pattern of deviation from sound

medical judgement related to the issuance of opioids;

(d) That the licensee had dispensed, prescribed or administered opioids 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;

(e) That the licensee was unfit or incompetent by reason of negligence, habits or other

cause related to the licensee’s prescribing or issuance of opioids; or

(f) That the licensee violated the rules of the licensing entity with regard to prescribing or

issuance of opioids.

(4) If within one (1) year from the date a licensee’s opioid-prescribing privileges are reinstated,

having been restricted by an opioid-related order, that licensee’s Board or Committee finds

that, during that year the licensee had prescribed, dispensed, or administered opioids in a

manner that violates the Board’s or Committee’s statutes or rules (for example, by

prescribing in a manner that constitutes gross healthcare liability or a pattern of continued or

repeated health care liability, ignorance, negligence or incompetence), the Board or

Committee shall make a finding that the licensee re-engaged in a significant deviation or

pattern of deviation from sound medical judgement such that they are a repeat offender. For

purposes of such a finding, sound medical judgment is the equivalent to the standard of care

as defined in T.C.A. § 63-1-122.

(5) If the licensee commits an opioid-related order violation within one year of the opioid-related

order, or if the licensee is found to be a repeat offender, the minimum discipline that the

Board or Committee assesses shall include the following:

(a) Probation;

(b) Successful completion of a practice monitoring program which shall include at a

minimum:

1. Board or Committee approval of the monitor or monitoring program;

2. Quarterly reports to the Board or Committee which include the practice monitor’s

findings with regard to the licensee’s:

(i) Non-opioid prescribing practices;

(ii) Medical record keeping;

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.17, continued)

June, 2022 (Revised) 43

(iii) Pain management;

(iv) Opioid treatment practices—where the practice monitoring is longer than

the restriction against prescribing opioids; and

(v) Compliance with the practice monitor’s recommendations, including

completion of any additional education recommended by the practice

monitor;

in the initial Board or Committee order, and for no less than one (1) year;

(d) One or more Type A civil penalties totaling at least twice the amount that was assessed

in the initial Board or Committee order;

(e) Proof to the licensee’s Board or Committee that they have notified any physicians,

podiatrists, advanced practice registered nurses, or physician assistants with whom

they collaborate of the discipline; and

(f) Where the licensee is a physician or podiatrist, a restriction against collaborating with

any advanced practice registered nurses or physician assistants during the period in

which the licensee is restricted from prescribing opioids.

(6) Nothing in this rule shall prohibit the Board or Committee from taking action in excess of the

minimum disciplinary action outlined herein. Each case shall be judged independently and

may result in additional discipline including other restrictions or a higher level of discipline,

including revocation, where appropriate. Further, nothing in this rule shall prohibit the Board

or Committee from taking disciplinary action against a licensee based on a finding that the

licensee violated the practice act in manners additional to those outlined in paragraph (1)

above, suggesting a need for a higher level of discipline.

Authority: T.C.A. § 63-1-162. Administrative History: Emergency rule filed March 29, 2019; effective

through September 25, 2019. Original rule filed May 14, 2019; effective August 12, 2019. Rule was

originally numbered 1045-02-.18 but was renumbered 1045-02-.17 with the deletion of original rule 1045-

02-.17 filed March 23, 2022; effective June 21, 2022.

1045-02-.18 TELEHEALTH IN THE PRACTICE OF OPTOMETRY.

(1) Definitions

(a) Emergency – A situation or condition where failure to provide immediate treatment

poses a threat of loss of sight to a person. For the purposes hereof, routine visual care

shall not be an emergency.

(b) In-person patient encounter – A patient encounter conducted by a provider who is at

the same physical location as the location of the patient.

evaluation, diagnosis, and/or treatment of a patient whether the optometrist is

physically present in the same room, in a remote location within the state, or across

state lines.

(d) Telehealth – The definition of telehealth shall be defined as provided in T.C.A. § 63-1-

155(a)(2).

(2) Establishment of an Optometrist-Patient Relationship

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.18, continued)

June, 2022 (Revised) 44

(a) Optometrist-patient relationship. Pursuant to T.C.A. § 63-1-155(b), an optometrist-

patient relationship with respect to telemedicine or telehealth is created by mutual

consent and mutual communication, except in an emergency, between the patient and

the optometrist. The consent by the patient may be expressed or implied consent;

however, the optometrist-patient relationship is not created simply by the receipt of

patient health information by an optometrist unless a prior optometrist-patient

relationship exists. The duties and obligations created by the relationship do not arise

until the optometrist:

1. Affirmatively undertakes to diagnose or treat the patient; or

2. Affirmatively participates in the diagnosis or treatment.

(b) The optometrist-patient relationship established via telehealth, shall at a minimum,

meet the requirements of T.C.A. § 63-1-155(b).

health services, advice and/or care using telehealth technologies without:

1. Fully verifying, to the extent possible, the requesting patient’s identity;

2. Disclosing the optometrist’s identity and applicable credential(s) to the patient;

and

3. Obtaining appropriate consents from requesting patients after disclosures

regarding the delivery models and treatment methods or limitations, including

any special informed consents regarding the use of telehealth technologies.

(d) An appropriate optometrist-patient relationship has not been established when the

identity of the optometrist is unknown to the patient.

(3) The Appropriate Use of Telehealth Technologies in Optometric Practice

(a) Policy Statement – The Tennessee Board of Optometry has developed these rules to

educate licensees as to the appropriate use of telehealth technologies in the practice of

optometry. The Tennessee Board of Optometry is committed to ensuring patient

access to the convenience and benefits afforded by telehealth technologies, while

promoting the responsible practice of optometry by licensees. These rules shall not be

construed to alter the scope of practice of any optometrist or authorize the delivery of

optometric services in a setting, or in a manner, not otherwise authorized by

Tennessee law.

(b) Licensure

1. An optometrist is a “healthcare services provider” under Tennessee law and shall

be licensed and under the jurisdiction of the Tennessee Board of Optometry

when utilizing telehealth technology to provide services to a patient located in the

State of Tennessee.

2. Optometrists who treat or prescribe through online services sites are practicing

optometry and are under the jurisdiction of the Tennessee Board of Optometry.

Optometrists shall possess appropriate licensure through the Tennessee Board

of Optometry. The optometrists shall abide by the established requirements for

spectacle and contact lens prescription release pursuant to T.C.A. §§ 63-8-101,

et seq.

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.18, continued)

June, 2022 (Revised) 45

1. An optometrist who delivers services through the use of telehealth shall be held

to the same standard of professional practice as a similar optometrist of the

same practice area or specialty that is providing the same healthcare services

through in-person encounters, and nothing in this rule is intended to create any

new standards of care.

(d) Informed Consent

1. Evidence documenting appropriate patient informed consent for the use of

telehealth technologies shall be obtained and maintained. Documentation of

informed consent that is signed and dated, including electronic

acknowledgement or signature of the patient, establishes a presumption of

informed consent. Appropriate informed consent should include the following

terms:

(i) Identification of the patient, the optometrist and the optometrist’s

credentials;

(ii) Types of transmissions permitted using telehealth technologies;

(iii) Necessity of in-person patient encounter. When, for whatever reason, the

telemedicine modality in use for a particular patient encounter is unable to

provide all pertinent clinical information that an optometrist exercising

ordinary skill and care would deem reasonably necessary for the practice

of optometry at an acceptable level of safety and quality in the context of

that particular encounter, then the distant site optometrist shall make this

known to the patient and advise and counsel the patient regarding the

need for the patient to obtain an additional in-person patient encounter

reasonably able to meet the patient’s needs;

(iv) Limitations of telehealth. A provider who uses telehealth technology, before

providing services, shall give each patient notice regarding telehealth

services, including the risks and benefits of being treated via telehealth,

and how to receive follow-up care or assistance in the event of an adverse

reaction to the treatment or in the event of an inability to communicate as a

result of a technological or equipment failure; and

(v) Details on security measures taken with the use of telehealth technologies,

such as encrypting data, password protected screen savers and data files,

or utilizing other reliable authentication techniques, as well as potential

risks to privacy notwithstanding such measures;

(e) Continuity of Care. Patients should be able to seek, with relative ease, follow-up care

or information from the optometrist who conducts an encounter using telemedicine

technologies. Optometrists solely providing services using telehealth technologies with

no existing optometrist-patient relationship prior to the encounter shall make

documentation of the encounter available using telehealth technologies easily available

to the patient, and subject to the patient’s consent and request, any identified care

provider of the patient within a reasonable time frame after the encounter.

(f) Optometric Records. The patient’s optometric record should include, if applicable,

copies of all patient-related electronic communications, including optometrist-patient

communication(s), prescriptions, laboratory and test results, evaluations and

GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02

(Rule 1045-02-.18, continued)

June, 2022 (Revised) 46

consultations, records of past care, and instructions obtained or produced in

connection with the utilization of telehealth technologies. Informed consents obtained in

connection with an encounter involving telehealth technologies should also be filed in

the patient’s examination record. The patient record established during the use of

telehealth technologies shall be accessible and documented for both the optometrist

and the patient, consistent with T.C.A. §§ 63-8-101, et seq.

(g) Privacy and Security of Patient Records and Exchange of Information

1. Optometrists shall meet or exceed applicable federal and state legal

requirements of optometric patient encounters/health information privacy,

including compliance with the Health Insurance Portability and Accountability Act

(HIPAA) and State of Tennessee privacy, confidentiality, security, and optometric

record retention rules.

2. Optometrists shall ensure that sufficient privacy and security measures shall be

in place and documented to assure confidentiality and integrity of patient-

identifiable information.

(h) Prescribing

1. Telehealth technologies, where prescribing medications and ophthalmic

materials may be contemplated, shall require an optometrist to implement

measures to uphold patient safety in the absence of a traditional in-person

patient encounter. Such measures shall guarantee that the identity of the patient

and provider is clearly established and that detailed documentation for the

clinical patient encounter and resulting prescription is both enforced and

independently kept.

2. Prescribing medications, in-person or via telehealth, is at the professional

discretion of the optometrist based on licensure. The indication, appropriateness,

and safety considerations for each telehealth visit prescription shall be evaluated

by the optometrist in accordance with current standards of practice and

consequently carry the same professional accountability as prescriptions

delivered during an in-person patient encounter. However, where such

measures are upheld, and the appropriate clinical consideration is carried out

and documented, optometrists may exercise their judgment and prescribe

medications as part of telehealth encounters.

3. Pursuant to Tenn. Comp. R. & Regs. 1045-02-.09(3), all therapeutic prescriptions

written by a Tennessee optometrist certified to practice therapeutics shall

include:

(i) Tennessee license number; and

(ii) “T” designation preceding license number, i.e. OD-T000.

4. For telehealth ophthalmic prescriptions, the same requirements exist as for fixed

fee in-person services as outlined in Tenn. Comp. R. & Regs. 1045-02-.08(3).

Authority: T.C.A. §§ 63-8-112(1) and 63-1-155. Administrative History: New rule filed December 20,

2021; effective March 20, 2022. Rule was originally numbered 1045-02-.19 but was renumbered 1045-02-

.18 with the deletion of original rule 1045-02-.17 filed March 23, 2022; effective June 21, 2022.