N.H. Code Admin. R. He-P 810.03 – Definitions

(a) “Abuse” means any one of the following:
1. (1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;
2. (2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and
3. (3) “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without their informed consent.
(b) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.
(c) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.
(d) “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151, He-P 810, or other licensing rules.
(e) “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.
(f) “Admission” means the point in time when a patient has been accepted by a licensee for the provision of services and is physically present in the licensed facility.
(g) “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. This term includes “living wills” and “durable powers of attorney for health care”, in accordance with RSA 137-J or a “surrogate decision maker” in accordance with RSA 137-J:35.
(h) “Advanced practice registered nurse” means an individual licensed by the New Hampshire board of nursing in accordance with RSA 326-B:18 and be certified by a board-recognized national certifying body in the specialty for which the nurse was educated.
(i) “Advanced practice registered nurse-certified nurse midwife (APRN-CNM)” means an individual licensed by the New Hampshire board of nursing in accordance with RSA 326-B:11 and certified by the American Certified Nurse Midwife Certification Council.
(j) “Adverse medication reaction” means harm caused by a medication at normal doses.
(k) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, and captive or affiliated insurance companies.
(l) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate identified under RSA 137-J:35-37.
(m) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a birthing center pursuant to RSA 151.
(n) “Area of noncompliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 810, or other federal and state requirements.
(o) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach their highest practicable level of physical, mental, and psychosocial functioning.
(p) “Birthing center” means a facility that is not located in a licensed acute care hospital, and which provides prenatal care through postnatal care, and which instructs and assists women in natural childbirth.
(q) “Care plan” means a documented guide developed by a licensed or certified practitioner, in consultation with the patient, guardian, personal representative, or agent , as a result of the assessment process for the provision of care and services to a patient.
(r) “Certified midwife” means a “certified midwife” as defined in Mid 301.01(b).
(s) “Certified nurse-midwife” means a “certified nurse-midwife” as defined in Mid 301.01(c).
(t) “Change of ownership” means the transfers of a controlling interest in an established birthing center to any individual, agency, partnership, corporation, governmental entity, association, or other legal entity.
(u) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.
(v) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or their designee.
(w) “Contracted employee” means a temporary employee working under the direct supervision of the birthing center, but employed by an outside agency.
(x) “Controlling interest” means greater than 50% ownership interest.
(y) “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR § 485.606.
(z) “Days” means calendar days unless otherwise specified in the rule.
(aa) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator their ability to complete the required task in a way that reflects the minimum standard to a certificate of completion of course material or a post-test to the training provided.
(ab) “Department” means the New Hampshire department of health and human services.
(ac) “Direct care” means hands on care or services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.
(ad) “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a patient including but not limited to medical, nursing, psychological, or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.
(ae) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified areas of non-compliance.
(af) “Discharge” means moving a patient from a licensed facility or entity to a non-licensed facility or entity.
(ag) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, in the event of an actual or imminent cardiac or respiratory arrest, that chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term includes “do not attempt resuscitation order (DNAR order)”.
(ah) “Emergency” means an unexpected occurrence or set of circumstances that require immediate, remedial attention.
(ai) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.
(aj) “Employee” means anyone employed by the birthing center and for whom the birthing center has direct supervisory authority.
(ak) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 810.
(al) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures.”
(am) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.
(an) “Facility” means “facility” as defined in RSA 151:19, II.
(ao) “Good cause” means any circumstances beyond a person’s control, that the department considers to be circumstances that prevents that person from taking some required action, including:
1. (1) A death in the person’s immediate family;
2. (2) Personal injury or serious illness of the person or an immediate family member; or
3. (3) Another compelling reason or justification.
(ap) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the patient’s health care and personal needs.
(aq) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a).
(ar) “Independent contractor” means an individual or business entity providing service to the licensee or its patients but not employed by the licensee.
(as) “Infectious waste” means those items specified by Env-Sw 103.28.
(at) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.
(au) “Informed consent” means the decision by a person or their guardian, personal representative, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the person, guardian, personal representative, agent, or surrogate decision maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.
(av) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 810, or to respond to allegations of non-compliance with RSA 151 or He-P 810.
(aw) “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.
(ax) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 810, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and license number.
(ay) “Licensed or certified practitioner” means a:
1. (1) Medical doctor;
2. (2) Physician’s assistant;
3. (3) Advanced practice registered nurse (APRN);
4. (4) Licensed advanced practice registered nurse-certified nurse midwife (APRN-CNM);
5. (5) Doctor of osteopathy;
6. (6) Doctor of naturopathic medicine with certification in natural childbirth; or
7. (7) Certified midwife.
(az) “Licensed premises” means the physical location that the department has approved for the birthing center to conduct operations in accordance with its license. It can include the private home of the licensed or certified practitioner, but it does not include the private residence of a patient receiving services from the birthing center licensed under the authority of RSA 151.
(ba) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151and He-P 810.
(bb) “Licensing classification” means the specific category of services authorized by a license.
(bc) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.
(bd) “Material adverse impact” means "material adverse impact" as defined in RSA 151:4-a, I (b).
(be) “Medical director” means a New Hampshire licensed physician in accordance with RSA 329, doctor of naturopathic medicine with certification in natural childbirth, or an APRN-CNM who is responsible for overseeing the quality of medical care and services at the birthing center.
(bf) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.
(bg) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a patient’s refusal.
(bh) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.
(bi) “Neglect” means an act or omission that results or could result in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a patient.
(bj) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.
(bk) “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.
(bl) “Over-the-counter medication” means non-prescription medication.
(bm) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a licensed birthing center.
(bn) “Patient” means any person admitted to or any way receiving care, services, or both from a birthing center licensed in accordance with RSA 151 and He-P 810.
(bo) “Patient record” means a separate file maintained for each person receiving care and services by the licensee, which includes all documentation required by RSA 151 and He-P 810 and all documentation as required by other applicable federal and state requirements.
(bp) “Patient rights” means “patient rights” as defined in RSA 151:19, VI namely, “those rights established under RSA 151:21 or RSA 151:21-b, as applicable”.
(bq) “Performance-based design” means an engineering approach to fire protection design and construction based on:
1. (1) Established fire safety goals and objectives;
2. (2) Deterministic and probabilistic analysis of fire scenarios; and
3. (3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.
(br) “Personal representative” means “patient’s personal representative” as defined in RSA 151:19, V namely, “a person other than the licensee of, an employee of, or a person having direct or indirect ownership interest in a facility, who is designated in writing by a patient or patient’s legal guardian for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights”.
(bs) “Personnel” means an individual who is employed by, a volunteer of, or an independent contractor of the birthing center who provides direct care or services to a patient(s).
(bt) “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.
(bu) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.
(bv) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.
(bw) “Point of care devices” means testing involving a system of devices used to obtain medical, diagnostic results, including but not limited to:
1. (1) A lancing or finger stick device to obtain a blood specimen;
2. (2) A test strip or reagents to apply a specimen for testing; or
3. (3) A meter or monitor to calculate and show the results, including but not limited to:
  1. a. Blood glucose meters, also called “glucometers”;
  2. b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or
  3. c. A cholesterol meter.
(bx) “Pro re nata (PRN) medication” means medication taken as circumstances might require in accordance with the licensed practitioner’s orders.
(by) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.
(bz) “Professional staff” means staff who are licensed, registered, or certified by the state to provide health care services.
(ca) “Protective care” means the provision of patient monitoring services, including but not limited to:
1. (1) Knowledge of patient whereabouts; and
2. (2) Minimizing the likelihood of accident or injury.
(cb) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, including but not limited to nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.
(cc) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.
(cd) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures that do not result in a reconfiguration of the building spaces within.
(ce) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.
(cf) “Reportable incident” means an occurrence of any of the following while the patient is either in the birthing center or in the care of birthing center personnel:
1. (1) The unanticipated death of a patient;
2. (2) The unexplained absence of a patient from the licensed premises who is determined to be a danger to themselves or others;
3. (3) Circumstances that resulted in the notification or involvement of law enforcement or safety officials;
4. (4) Medication errors;
5. (5) Drug diversion; and
6. (6) An injury that requires examination or treatment by a licensed practitioner.
(cg) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services.
(ch) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient.
(ci) “Service area” means “service area” as defined in RSA 151:4-a, I (c).
(cj) “State building code” means “state building code” as defined in RSA 155-A:1, IV.
(ck) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5.
(cl) “State monitoring” means the placement of individuals by the department at a birthing center to monitor the operation and conditions of the facility.
(cm) “Transfer” means “transfer” as defined in RSA 151:19, VII namely, “movement of a patient from one facility to another facility when the legal responsibility for the care of the patient changes from the transferring to the receiving facility. Transfer shall not include the temporary movement of a patient from a facility to a hospital or other location for emergency medical treatment, as long as the facility is in compliance with RSA 151:25. In the event a facility refuses to readmit a patient in accordance with RSA 151:25 following a therapeutic leave, a transfer shall be deemed to have occurred when the decision not to readmit is made. Transfer shall not include movement of a client from a home care to an institutional setting or the shifting of service provision from one home health care provider to another”.
(cn) “Underwriters Laboratories (UL) Listed” means that the global safety certification company UL has confirmed that the product is safe for use.
(co) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

Source. #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99 New. #8957, eff 7-27-07, EXPIRED: 7-27-15 New. #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34