Immoral, unprofessional, unethical, or dishonorable conduct shall include, but not be limited to, the following:

1. (1) Conduct designed to, or likely to, deceive, or harm the public.
2. (2) Being a party to or aiding and abetting the violation of these regulations or the laws of the State of Tennessee regulating the practice of chiropractic.
3. (3) The intentional or negligent use of any false, fraudulent or forged statement, writing or document, or the use of any fraudulent, deceitful, dishonest, or immoral practice in connection with any of the licensing requirements of T.C.A. §§ 63-4-101, et seq.
4. (4) Advertising or promoting, waiving, abrogating, or rebating the deductible and/or co-payment amounts of any insurance policy by forgiving any or all of any patient’s obligations for payment, unless the insurer is notified in writing of the fact of such waiver. Advertising or promoting the same must include the notice to the insurer and the record must include proof of the actual notice. If the patient is unable, due to circumstances, to pay for their services and no advertising or promotion is given to the patient, the provider may excuse any portion of fees to ensure that the patient may receive the necessary procedure.

5. (5) Social Media Standards

   1. (a) The term social media refers to all internet and mobile technologies and practices that are used to share content, opinions, experiences and perspectives online. Examples of social media platforms include, but are not limited to: Webpages, Instagram, Facebook, Twitter (X), YouTube, LinkedIn, and blogging sites.
   2. (b) Social media may present opportunities to enhance patient care, education about chiropractic, intra- and inter-professional communication and collaboration, and opportunities for continuing education and professional development.

   3. (c) A licensee is expected to comply with all existing legal, regulatory and professional obligations when engaging in the use of social media, including all relevant legislation, regulation, standards of practice, policies and guidelines. The following guidelines identify some of those obligations as they relate to the use of social media. A licensee must:

      1. 1. Uphold and comply with all legal and professional obligations to maintain privacy and confidentiality of patients in accordance with the Health Insurance Portability and Accountability Act (HIPAA). A licensee may not divulge information through social media that identifies a patient by name or through a combination of other identifying information.
      2. 2. Any communication between a licensee and patient, such as providing information, must be done through secure private messaging only. A licensee must have a clear understanding of the privacy settings available in any use of social media, and apply their use accordingly. While patients or licensees of the public may make themselves publicly known through posting, a licensee must not breach the privacy or confidentiality of a patient in any context.
      3. 3. Not provide any clinical advice, communicate a diagnosis and/or guarantee results to a patient or the public through social media. However, a licensee may provide general health information related to the chiropractic scope of practice for educational or informational purposes.
      4. 4. Regularly review Tennessee chiropractic scope of practice both in statute and rule. A licensee must be aware of the risks of using social media for professional reasons, such as the public incorrectly applying information found online to their personal health situation. Whenever a licensee uses his professional designation or provides health related information, that licensee is viewed as acting in a professional capacity. A licensee must exercise caution when posting health related information, so that it is clearly used for education or informational purposes, and must not be used as clinical advice.
      5. 5. Exercise caution when posting health related information and links to journal articles or academic information to ensure he is not infringing on any copyrighted material.
      6. 6. Maintain appropriate professional boundaries, and avoid posting information, comments or images that may be perceived as disgraceful, dishonorable or unprofessional. A licensee is not to post any information to social media that may be perceived as harassment, bullying, or inflammatory in nature. A licensee is further encouraged to have separate personal and professional social media pages.
      7. 7. Comply with relevant scope of practice, professional ethics and advertising provisions under Tenn. Comp. R. & Regs. sections 0260-02-.02, 0260-02-.13, 0260-02-.20 respectively.
      8. 8. A licensee must consider his legal, professional and regulatory obligations and exercise good judgment and caution before posting material to social media.
6. (6) Grossly excessive use of examinations of a patient or a pattern of clearly excessive use of examinations of patients when patients are charged for this service or reimbursement of the examination(s) is requested from a third party. The conduct mentioned herein is presumed to have occurred when there is no documented, substantiated, finding(s) or condition(s) of the patient(s) which warrant(s) the use of examination(s) for a chiropractic diagnosis.
7. (7) Grossly excessive use of care and treatment of a patient or a pattern of clearly excessive use of care and treatment of patients when patients are charged for this service or reimbursement of payment for the care and treatment is requested from a third party. The conduct mentioned herein is presumed to have occurred when there is no documented, substantiated finding(s) or condition(s) of the patient(s) based on a chiropractic diagnosis which warrant(s) the treatment(s) and care performed.

8. (8) A chiropractic physician shall not overutilize or otherwise improperly use ionizing radiation. In order to avoid overutilization of ionizing radiation, a chiropractic physician shall observe the following guidelines:

   1. (a) Routine radiography of any patient shall not be performed without due regard for clinical need;
   2. (b) Subsequent radiographic evaluation of the patient shall not be undertaken without significant observable clinical indication, as determined by the treating chiropractic physician.

9. (9) Sexual Misconduct

   1. (a) Licensees shall not engage in sexual harassment. Sexual harassment is sexual solicitation, physical advances or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the licensee’s activities or roles as a licensee and that either is unwelcome, offensive, or creates a hostile workplace environment and the licensee knows or is told this, or is sufficiently severe or intense to be abusive to a reasonable person in the context. Sexual harassment can consist of a single intense or severe act or of multiple persistent or pervasive acts.
   2. (b) Licensees shall not engage in sexual relationships with current patients, employees, or co-workers because such relationships are likely to impair judgment or be exploitative.
   3. (c) Licensees shall not accept as patients persons with whom they have engaged in sexual intimacies.
   4. (d) Licensees shall not engage in sexual intimacies with a former patient for at least six (6) months after cessation or termination of professional services.
   5. (e) Licensees must respect a patient’s dignity at all times and should provide appropriate gowns and private facilities for dressing, undressing, and examination. A licensee should not be present in the room when a patient is dressing or undressing.
   6. (f) Licensees may have a chaperone present during examination for the protection of both the patient and the licensee. A licensee should refuse to examine sensitive parts of the patient’s body without a chaperone present.
10. (10) Unlicensed Assistants - Licensees shall not allow staff personnel to perform procedures or services in the clinic for which the personnel do not hold the license or certification required for such performance. This includes those services for which certification as a chiropractic therapy assistant or a chiropractic x-ray technologist is required. Violators will be subject to a civil penalty of up to one thousand dollars ($1000.00) per month for each employee found to be practicing without a license. Failure to pay any assessed civil penalty may result in additional disciplinary action.

Authority: T.C.A. §§ 63-4-106, 63-4-114, 63-4-119, 63-4-120, 63-4-121, 63-4-122, and 63-4-123. Administrative History: Original rule filed December 28, 1995; effective March 12, 1996. Amendment filed February 12, 1996; effective April 27, 1996. Amendment filed April 14, 2003; effective June 2003. Amendments filed February 17, 2017; effective May 18, 2017. Amendments filed February 19, 2025; effective May 20, 2025.