60-Day Pre-Suit Notice of Potential Health Care Liability Claim - Tennessee (T.C.A. § 29-26-121)

60-DAY PRE-SUIT NOTICE OF POTENTIAL HEALTH CARE LIABILITY CLAIM

(Pursuant to T.C.A. § 29-26-121)

TABLE OF CONTENTS

1. Header / Sender Block
2. Recipient Block
3. Re Line
4. Salutation and Statutory Reference
5. Notice Content Required by § 29-26-121(a)(2)
6. Statement of Potential Claim
7. HIPAA-Compliant Medical Authorization
8. Records Request Under § 29-26-121(d)
9. Effect on Statutes of Limitations and Repose
10. Preservation Demand and Tolling Acknowledgment
11. Method of Service
12. Closing and Signature
13. Attachments
14. Affidavit of Party Giving Notice
15. Tennessee Practice Notes
16. Sources and References

1. HEADER / SENDER BLOCK

[LAW FIRM LETTERHEAD]

[ATTORNEY NAME], BPR No. [####]

[FIRM NAME]

[STREET ADDRESS]

[CITY], Tennessee [ZIP]**

Telephone: [NUMBER]

Email: [EMAIL]

Date: [__/__/____]

2. RECIPIENT BLOCK

[PROVIDER NAME, M.D. / D.O. / R.N. / HOSPITAL / PRACTICE GROUP]

[CURRENT PRACTICE OR BUSINESS ADDRESS]

[CITY, STATE, ZIP]

(Sent VIA U.S. CERTIFIED MAIL — RETURN RECEIPT REQUESTED, ARTICLE NO. [____________], with separate copy by [hand delivery / overnight courier with delivery confirmation].)

3. RE LINE

Re: Pre-Suit Notice of Potential Health Care Liability Claim Pursuant to T.C.A. § 29-26-121

Patient: [PATIENT NAME]

Date of Birth: [__/__/____]

Date(s) of Treatment at Issue: [__/__/____] through [__/__/____]

Medical Record Number(s): [________________]

4. SALUTATION AND STATUTORY REFERENCE

To the addressee:

This letter constitutes formal pre-suit notice under T.C.A. § 29-26-121 of a potential health care liability claim against you arising out of the care and treatment of [PATIENT NAME] identified above. The undersigned is counsel for the claimant identified in Section 5 below. This notice is served at least sixty (60) days before the contemplated filing of a complaint, in compliance with T.C.A. § 29-26-121(a)(1).

5. NOTICE CONTENT REQUIRED BY § 29-26-121(a)(2)

5.1. (A) Name, address, and relationship of claimant authorizing the notice (T.C.A. § 29-26-121(a)(2)(A)).

• Claimant: [CLAIMANT FULL LEGAL NAME]
• Address: [CLAIMANT STREET ADDRESS, CITY, STATE, ZIP]
• Relationship to patient: ☐ patient/self ☐ spouse ☐ parent / next friend of minor ☐ adult child ☐ personal representative of the estate of decedent ☐ guardian / conservator ☐ other: [DESCRIBE]

5.2. (B) Name and address of the attorney sending the notice (T.C.A. § 29-26-121(a)(2)(B)).

• Attorney: [ATTORNEY NAME], BPR No. [####]
• Firm: [FIRM NAME]
• Address: [STREET, CITY, STATE, ZIP]
• Telephone: [NUMBER]
• Email: [EMAIL]

5.3. (C) Date(s) of alleged act or omission (T.C.A. § 29-26-121(a)(2)(C)).

The alleged act(s) or omission(s) giving rise to the potential claim occurred on or about [__/__/____] and continued through [__/__/____].

5.4. (D) List of all health care providers receiving notice arising from this incident (T.C.A. § 29-26-121(a)(2)(D)).

The following providers are receiving pre-suit notice in connection with the same incident:

5.5. (E) HIPAA-compliant medical authorization (T.C.A. § 29-26-121(a)(2)(E)).

A HIPAA-compliant medical authorization permitting you to obtain complete medical records of [PATIENT NAME] from every other provider listed in Section 5.4 is enclosed as Attachment 1 and is fully executed by the patient or the patient's authorized representative.

6. STATEMENT OF POTENTIAL CLAIM

6.1. The potential claim arises from the care and treatment of [PATIENT NAME] at [FACILITY / OFFICE], [CITY], Tennessee, between [__/__/____] and [__/__/____].

6.2. The factual basis for the potential claim, in summary, is as follows:

• [Briefly describe the alleged negligence — e.g., failure to diagnose acute myocardial infarction in light of presenting chest pain on [DATE]; surgical injury during [PROCEDURE] on [DATE]; medication error involving [DRUG] on [DATE]; retained foreign object discovered on [DATE]; failure to obtain informed consent for [PROCEDURE] performed on [DATE]; premature discharge on [DATE].]
• [State the resulting injury or harm, including hospitalizations, additional procedures, permanent injury, or death.]

6.3. The claimant alleges that the care provided fell below the recognized standard of acceptable professional practice in [community / specialty] in violation of T.C.A. § 29-26-115.

7. HIPAA-COMPLIANT MEDICAL AUTHORIZATION

(See Attachment 1.)

The enclosed authorization:

• ☐ identifies [PATIENT NAME], DOB [__/__/____];
• ☐ specifies the records to be released (all medical records including without limitation office notes, hospital records, imaging, laboratory, pathology, billing records, and electronic health record audit trails);
• ☐ identifies each provider in Section 5.4 as both a permitted source and a permitted recipient;
• ☐ states the purpose: "investigation and prosecution of a potential health care liability claim";
• ☐ states an expiration date of [__/__/____] (typically 12 months from execution, or upon completion of the investigation/litigation);
• ☐ contains the patient's (or representative's) signature and date;
• ☐ contains the right-to-revoke, redisclosure, and treatment-conditioning notices required by 45 C.F.R. § 164.508(c)(2).

8. RECORDS REQUEST UNDER § 29-26-121(d)

8.1. Pursuant to T.C.A. § 29-26-121(d)(1), the claimant requests complete copies of all medical records relating to the care and treatment of [PATIENT NAME] from [__/__/____] through [__/__/____], including without limitation:

• ☐ Outpatient chart, progress notes, and physician orders
• ☐ Hospital records: admission, history & physical, daily progress notes, nursing notes, vital sign flow sheets, medication administration records
• ☐ Operative reports, anesthesia records, recovery-room notes
• ☐ Diagnostic imaging studies (films, DICOM data, radiology reports)
• ☐ Laboratory and pathology reports
• ☐ Discharge summaries, transfer notes, and consultations
• ☐ Billing records, CPT/ICD coding, and itemized statements
• ☐ EHR audit trail / metadata (access log, edit/amendment history)
• ☐ Telephone notes, secure messaging, and correspondence

8.2. Pursuant to T.C.A. § 29-26-121(d)(2), the records must be produced within thirty (30) days of receipt of this notice. Failure to produce timely may extend Plaintiff's deadline to file a Certificate of Good Faith and may be used as evidence of bad faith.

8.3. The reasonable cost of copying may be charged in accordance with T.C.A. § 63-2-102.

9. EFFECT ON STATUTES OF LIMITATIONS AND REPOSE

9.1. Service of this notice upon you operates to extend the applicable statutes of limitations and statutes of repose by one hundred twenty (120) days from the date of expiration, pursuant to T.C.A. § 29-26-121(c).

9.2. The original one-year statute of limitations under T.C.A. § 29-26-116 / § 28-3-104 expires on [__/__/____]. With the 120-day extension, the deadline to file is [__/__/____].

9.3. The three-year statute of repose under T.C.A. § 29-26-116(a)(3) expires on [__/__/____].

9.4. Nothing in this notice waives any tolling, accrual, or discovery-rule arguments otherwise available at law.

10. PRESERVATION DEMAND AND TOLLING ACKNOWLEDGMENT

10.1. Litigation hold. You are hereby placed on notice to preserve all paper and electronic records, communications, imaging, and audit trails related to the care of [PATIENT NAME]. Spoliation may give rise to an adverse inference and sanctions.

10.2. Insurance notice. Please immediately forward this notice to your professional-liability carrier and risk-management department.

10.3. No waiver. Sending this notice is not a waiver of any right, remedy, claim, or cause of action.

11. METHOD OF SERVICE

This notice has been served upon you in the following manner pursuant to T.C.A. § 29-26-121(a)(3) and (a)(4):

☐ Personal delivery to the provider on [__/__/____] at [ADDRESS], accepted by [NAME / TITLE OF RECIPIENT].

☐ Personal delivery to an identified individual whose job function includes receptionist duties for deliveries on [__/__/____] at [ADDRESS], accepted by [NAME / TITLE].

☐ United States Certified Mail, return receipt requested, postage prepaid, on [__/__/____], Article Number [____________], addressed to the provider's current practice or business address as reflected in the records of the Tennessee Department of Health.

☐ Commercial overnight delivery service (FedEx / UPS) with documented delivery confirmation on [__/__/____], tracking [____________], in accordance with Arden v. Kozawa, 466 S.W.3d 758 (Tenn. 2015).

12. CLOSING AND SIGNATURE

If you have insurance coverage that may apply to the potential claim, please tender this notice immediately. Counsel is available to discuss the matter, including potential pre-suit resolution, before the 60-day notice period expires.

Respectfully,

[________________________________]

[ATTORNEY NAME], BPR No. [####]

Counsel for [CLAIMANT NAME]

Encl: as listed below.

13. ATTACHMENTS

• Attachment 1 — HIPAA-Compliant Medical Authorization (45 C.F.R. § 164.508)
• Attachment 2 — List of Providers Receiving Notice (matches Section 5.4)
• Attachment 3 — Records Request Cover (T.C.A. § 29-26-121(d))

14. AFFIDAVIT OF PARTY GIVING NOTICE

(Retain in the file; will be attached to the future complaint as exhibit pursuant to T.C.A. § 29-26-121(b).)

STATE OF TENNESSEE

COUNTY OF [_____________]

I, [ATTORNEY NAME], being first duly sworn, depose and state:

1. I am over 18 years of age and have personal knowledge of the facts stated herein.
2. On [__/__/____], I caused to be served the foregoing Pre-Suit Notice of Potential Health Care Liability Claim, with attachments, on each provider listed in Section 5.4 above, by the method indicated for that provider in Section 11 (or as set forth in the corresponding provider notice).
3. The notice complied with T.C.A. § 29-26-121(a)(2) by including (A) the claimant's name, address, and relationship to the patient; (B) my name and address; (C) the date of the alleged act/omission; (D) the list of all providers receiving notice; and (E) a HIPAA-compliant medical authorization.
4. Documentation of service (return receipts, certified-mail receipts, overnight tracking, or affidavits of personal delivery) is attached hereto.

Further affiant sayeth not.

[________________________________]

[ATTORNEY NAME]

Sworn to and subscribed before me this [____] day of [_______________], 20[____].

[________________________________]

Notary Public

(My Commission Expires: [_______________])

15. TENNESSEE PRACTICE NOTES

• Jurisdictional, not procedural. § 29-26-121's notice requirement is a condition precedent to suit. Myers v. AMISUB (SFH), Inc., 382 S.W.3d 300 (Tenn. 2012). Filing without compliant notice is fatal.
• Strict compliance presumed. Stevens v. Hickman, 418 S.W.3d 547 (Tenn. 2013) requires strict compliance with the HIPAA authorization core elements; substantial compliance is excused only on a showing of no prejudice.
• No-prejudice safety valve. Runions v. Jackson-Madison Cnty. Gen. Hosp. Dist., 549 S.W.3d 77 (Tenn. 2018) recognizes substantial compliance where the defendant suffered no prejudice from the deficiency. Do not rely on this as a primary strategy.
• Out-of-state mailing. Arden v. Kozawa, 466 S.W.3d 758 (Tenn. 2015) approves commercial-carrier service with delivery confirmation.
• Each defendant. Notice must be served on each provider that will be a named defendant. A single notice covering multiple defendants is impermissible unless properly addressed and served on each.
• Address verification. Use the Tennessee Department of Health licensure search and the Tennessee Secretary of State business search to confirm current practice addresses and registered agents before service.
• 120-day extension. Calendar the extended SOL the day notice is served; do not rely on the original SOL.
• GTLA caveat. For governmental hospitals, T.C.A. § 29-20-305(b) imposes a 12-month SOL and other GTLA limits in addition to HCLA. Notice still required.
• Wrongful death. § 29-26-121 applies; notice may be sent by the personal representative or other party authorized under § 20-5-106.
• Fast-track counties. Davidson, Shelby, Knox, and Hamilton counties may impose case-management orders that compress discovery — file the complaint promptly after the 60th day to maximize pre-trial preparation time.
• Confidentiality of HIPAA authorization. The HIPAA authorization required by § 29-26-121(a)(2)(E) is for INVESTIGATION purposes; it permits each recipient provider to obtain records from other providers. It is NOT a "litigation" authorization to defense counsel; that is governed by Tenn. R. Civ. P. 26 and Alsip v. Johnson City Med. Ctr., 197 S.W.3d 722 (Tenn. 2006).

16. SOURCES AND REFERENCES

• T.C.A. § 29-26-121 — Claim for health care liability; notice; evidence of compliance — https://www.capitol.tn.gov/
• T.C.A. § 29-26-115; § 29-26-116; § 29-26-117; § 29-26-118; § 29-26-122
• 45 C.F.R. § 164.508 — HIPAA core elements for valid authorization
• Myers v. AMISUB (SFH), Inc., 382 S.W.3d 300 (Tenn. 2012)
• Stevens ex rel. Stevens v. Hickman Cmty. Health Care Servs., Inc., 418 S.W.3d 547 (Tenn. 2013)
• Arden v. Kozawa, 466 S.W.3d 758 (Tenn. 2015)
• Runions v. Jackson-Madison Cnty. Gen. Hosp. Dist., 549 S.W.3d 77 (Tenn. 2018)
• Foster v. Chiles, 467 S.W.3d 911 (Tenn. 2015) (extraordinary cause)
• Hinkle v. Kindred Hosp., No. M2010-02499-COA-R3-CV (Tenn. Ct. App. 2012) (record-request mechanics)
• Tennessee Department of Health Licensure Verification — https://apps.tn.gov/hpls-app/search/
• Tennessee Secretary of State Business Search — https://tnbear.tn.gov/

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. Tennessee's 60-day pre-suit notice is jurisdictional. Failure to comply or to use a HIPAA-compliant authorization with all required core elements may result in dismissal of the claim, often with prejudice. An attorney licensed in Tennessee must review and customize this document before service. Verify all provider addresses, statutes of limitation, and current regulatory requirements before use.