Where Nurse Registries Get Into Trouble: Control, Compliance, and Communicable Disease Screenings

How Control Over Health Screenings Can Jeopardize Independent Contractor Status

Nurse registries operate under a very specific regulatory framework. You are not the employer. You are not the care provider. You are a referral service connecting independent caregivers with clients. That distinction is everything. And one of the most common ways registries unintentionally blur that line is through communicable disease screening processes.

The Legal Requirement: What the State Actually Says

Florida law requires that:

• Each caregiver must provide a health statement
• The statement must come from a licensed healthcare professional
• It must confirm the caregiver is "free from communicable disease"

Equally important — what the law does not require:

• The registry does not have to create the form
• The registry does not have to administer the screening
• The registry does not have to control how the caregiver obtains it

The responsibility is placed on the independent contractor to furnish compliant documentation. For what the requirement actually says and where it comes from, see what "free from communicable disease" actually means.

FAB 2018-4: Why Control Matters

Under Field Assistance Bulletin (FAB) 2018-4, the Department of Labor highlights control as a central factor in determining independent contractor status. Control is not limited to caregiving tasks. It includes:

• How requirements are completed
• What process must be followed
• Where the worker must go
• What tools or forms must be used

When a registry begins influencing these areas, it starts to look less like a referral source — and more like an employer.

Where Nurse Registries Get Into Trouble

Many registries, with good intentions, attempt to simplify compliance by building internal systems. This often includes:

• Creating their own communicable disease screening forms
• Requiring caregivers to use those forms
• Directing caregivers to specific providers
• Managing or administering the screening process internally

On the surface, this feels helpful. From a regulatory standpoint, it introduces risk.

The Control Problem

When a registry creates and controls the screening process, it may be interpreted as:

• Dictating how a caregiver satisfies a legal requirement
• Limiting the caregiver's independence in choosing providers
• Structuring compliance in a way that resembles employer oversight

This is the type of "manner and means" control that FAB 2018-4 addresses. Even if the intent is administrative efficiency, what matters is how it looks in practice. Whether any particular registry's practices cross that line is a question for that registry and its own counsel. This article describes a concern worth examining, not a legal conclusion about your operation.

Why We Built It This Way

This is not theoretical.

Abby Services, a Florida-licensed nurse registry, ran this screening internally for years. The registry was not trying to control anything. But it did provide the screening, and it did supply a prepopulated form — and either could be misread as directing how a caregiver satisfied a requirement. In an evaluation of whether a caregiver is an independent contractor or an employee, appearances carry weight.

Rather than defend the distinction, the registry removed the question. The screening moved out of the registry entirely, and caregivers now obtain their own documentation independently.

There is a second reason. An internal screening program, however well run, tends to drift toward clinical service delivery — which is outside the traditional role of a nurse registry, and outside what a registry license contemplates.

MyHealthForm.com is what that screening became once it was moved out. It is a separate business from Abby Services, though both were founded by the same Registered Nurse. No registry is required to use it, and registries remain free to accept qualifying documentation from any appropriate healthcare professional.

The Compliance-Safe Approach: Stay Neutral

The safest model is simple and defensible:

Verify compliance. Do not control how compliance is achieved.

That means:

• Accept valid documentation that meets the statute
• Avoid designing or requiring specific forms
• Allow caregivers to independently obtain their health statements

This preserves the integrity of the independent contractor relationship.

Where MyHealthForm.com Fits In

This is the problem MyHealthForm.com was built to solve — by moving the screening out of the registry entirely. Instead of a registry creating internal forms, managing screenings, and assuming the associated liability, the caregiver obtains their own documentation through an independent platform:

• A screening adapted from two published instruments — the Wisconsin Department of Health Services Communicable Disease / Tuberculosis Screening Questionnaire and the Mount Sinai Health System Infectious Diseases Screening Tool
• Symptom, exposure, and risk-factor review
• Review by a Florida-licensed Registered Nurse under a written protocol established and signed by a licensed physician
• A health statement that meets the documentation requirement

Worth emphasizing: the screening declines as well as issues. When a response identifies a symptom, an exposure, or another concern, no statement is issued and the caregiver is directed to an appropriate healthcare provider for evaluation. A screening that cleared everyone would be worth nothing to a registry — and would not survive a surveyor asking how determinations are made. How screenings are reviewed →

Why This Strengthens Independent Contractor Compliance

A neutral third-party option reinforces:

• The caregiver's independence
• The registry's role as a referral service
• A clear boundary between administration and control

And it should go without saying: no registry is required to use this service. Registries remain free to accept qualifying documentation from any appropriate healthcare professional. Referring caregivers to one option among several is not the same as directing them to it — and that distinction is the entire point of this article.

The Bottom Line

Policies and procedures show regulators that you understand the rules. Operations show them how you actually apply them. If your registry is creating internal screening tools, controlling how caregivers complete requirements, or managing compliance processes on their behalf, it may be worth reassessing with your counsel. Because under FAB 2018-4, control — no matter how well-intentioned — can shift the entire classification analysis.

Final Thought

The goal is not just to meet the requirement. It is to meet it in a way that protects your model. And sometimes the most compliant move a nurse registry can make is simple: Step back — and let independent contractors remain independent.