DEPARTMENT OF COMMUNITY HEALTH

                           BUREAU OF EPIDEMIOLOGY

             DIVISION OF ENVIRONMENTAL AND OCCUPATIONAL EPIDEMIOLOGY

                   HEAVY METAL AND PESTICIDE ANALYSIS REPORTING


(By authority conferred on the director of the department of community health 
by sections 5111 and 2226(d) of 1978 PA 368, section 8 of 1978  PA  312,  and 
Executive  Reorganization  Order  Nos.  1996-1  and  1997-4,  MCL   333.5111, 
333.2226(d), 325.78, 330.3101, and 333.26324)


R 325.61   Definitions.
  Rule 1. (1) As used in these rules:
  (a) "Heavy metal analysis report form" means the  form  used   to    report 
the required reportable information for blood and  urine  that    has    been 
analyzed for arsenic, cadmium, or mercury.
  (b) "Pesticide poisoning report form" means  the  form  used   to    report 
the required  reportable  information  for  blood  that  has  been   analyzed 
for acetylcholinesterase or pseudocholinesterase.
  (c) "Pesticide" means any substance or mixture  of   substances   including 
inert ingredients and adjuvants used to  prevent,  destroy,   mitigate,    or 
repel  any pest. Pesticides include, but are not limited  to,   insecticides, 
herbicides, fungicides, rodenticides, repellents, fumigants,  wood  treatment 
products, and disinfectants.
  (d) "Department" means the Michigan department of community health.
  (e) "Physician/provider" means a person who is licensed under  Article   15 
of the public health code MCL 333.16101 to 333.18838 who   provides    health 
care services and who is authorized to request the analysis  of   blood   and 
urine specimens.

  History: 2005 AACS.


R 325.62   Reportable information.
  Rule 2. (1) Reportable information is specifically  related  to  blood  and 
urine samples submitted to clinical laboratories for analysis.
  (2) Upon initiating a  request  for   analysis   of    arsenic,    cadmium, 
mercury,    acetylcholinesterase,      or      pseudocholinesterase,      the 
physician/provider  ordering  the  analysis   shall   complete   the   client 
information (section  I)  and the physician/provider information (section II) 
of  a  heavy  metal  analysis report form or pesticide poisoning report  form 
designated by the  department.
Or, the physician/provider shall complete a similar  form  that  ensures  the 
inclusion of the  same  required  data  and  provide  all  of  the  following 
information:
  (a) All of the following information with respect to the individual tested:
  (i) Name.
  (ii) Sex, if available.
  (iii) Race, if available.
  (iv) Ethnic group, if available.
  (v) Birthdate or age.
  (vi) Address.
  (vii) Telephone number.
  (viii) If the individual is a minor, then the name of a parent or guardian.
  (ix) If the individual is an adult, then the name and address of  his    or 
her employer, if available.
  (b) The date the sample was collected.
  (3) The heavy metal  analysis  report   form   or    pesticide    poisoning 
analysis report form, or a document with the same data, shall  be   submitted 
with  the sample for analysis to a  clinical  laboratory  that  performs  the 
analysis.
  (4) Upon receipt of the blood  or  urine   sample   for    analysis,    the 
clinical laboratory shall  complete  the  laboratory   information   (section 
III)  and provide  all  of  the  information   required   and/or   submitted
 by   the physician/provider along with all of the following:
  (a) The name, address, and phone number of the laboratory.
  (b) The date of analysis.
  (c) The results of the analysis. All values, normal and   abnormal,   shall 
be reported. For arsenic, blood levels  shall  be  reported   in   micrograms 
per milliliter (µg/ml) and urine levels  in  micrograms  per  liter  (µg/L).
For cadmium, blood levels shall be reported as micrograms  per  liter  (µg/L)
 of whole blood and urine tests shall be  reported  as  micrograms  per  gram
 of creatinine (µg/gram creatinine) or  micrograms   per   liter   (µg/L).
Mercury shall be reported as nanograms per milliliter of  blood  (ng/ml)  and 
micrograms per liter (µg/L) of urine. Acetylcholinesterase shall be  reported
 as  units per gram of hemoglobin (U/g hemoglobin),  and    the    laboratory 
normal   range  shall  be  included.  Pseudocholinesterase  levels  shall  be 
reported as units per liter (U/L) of plasma, and the laboratory normal  range
 shall  be  included.
Alternate units will be accepted for reporting purposes, as approved  by  the 
department.

  History: 2005 AACS.


R 325.63   Reporting responsibilities.
  Rule 3. (1) All clinical laboratories  doing  business  in    this    state 
that analyze   blood   or   urine   samples     for     arsenic,     cadmium, 
mercury,  acetylcholinesterase,  or  pseudocholinesterase  shall  report  all 
results to the department  of  community  health,  bureau  of  epidemiology,
 division   of occupational and environmental epidemiology,  3423  N.  Martin 
Luther  King  Jr.
Blvd., Lansing, MI 48909. Reports shall be made within 5 working  days  after 
test completion.
  (2) Nothing in this rule shall be construed  to  relieve    a    laboratory 
from reporting results of a blood or urine  analysis  for  arsenic,  cadmium, 
mercury, acetylcholinesterase, or  pseudocholinesterase  to   the   physician 
or  other health care provider who ordered the test or to any other entity as
 required by state, federal, or  local  statutes  or  regulations    or    in 
accordance  with accepted standard of  practice,  except  that  reporting  in 
compliance with  this rule satisfies the reporting requirements  of  1978  PA 
368, MCL 333.1101.

  History: 2005 AACS.


R 325.64   Electronic communications.
  Rule 4. (1) A clinical laboratory may submit the  data  required    in    R 
325.62 electronically to the department.
  (2) For  electronic  reporting,  upon  mutual   agreement    between    the 
reporting laboratory and the department, the reporting shall   utilize    the 
data  format specifications provided by the department.

  History: 2005 AACS.


R 325.65   Investigation and quality assurance.
  Rule 5. (1) The department, upon  receiving  a  report  under   R    325.63 
may investigate to determine the accuracy of  the  report,  patient's  source
 of exposure, and adverse health effects resulting from the exposure.
  (2) Requests  for  individual  medical  and  epidemiologic  information  to 
validate  the  completeness  and  accuracy  of  reporting  are   specifically 
authorized.
  (3) The copies of  the  medical  records  shall  not  be  recopied  by  the 
department and shall be kept in a locked file cabinet when not in use.
  (4) Reports may be released to other state, local, or   federal    agencies 
for those agencies to administer and enforce  provisions  of  laws  or  rules
 to protect individuals from exposure to  hazardous  levels    of    arsenic, 
mercury, cadmium, or pesticides.  Confidential information may be released to
 another governmental agency only after execution of a   signed   interagency 
agreement assuring that the other agency will abide  by  the  confidentiality 
requirements of R 325.66.
  (5) Nothing in this rule shall be construed to relieve  or   preempt    any 
other entities from investigating hazards associated with  these   substances 
under state, federal, or local statutes or regulations.

  History: 2005 AACS.


R 325.66   Confidentiality of reports.
  Rule 6. (1) Reports submitted to the department  under  R  325.63  are  not 
public records and are exempt from disclosure  pursuant  to  the  freedom  of 
information act, 1976 PA 442, MCL 15.243, section 13(1)(d).
  (2) The department shall maintain the confidentiality of all  reports    of 
all tests submitted to the department  and  shall  not  release  reports   or 
any information that may be used  to  directly  link  the  information  to  a 
particular individual, unless the department  has  received  written  consent
 from  the individual, or from the individual's  parent  or  legal  guardian, 
requesting the release of information.
  (3)  Medical  and  epidemiological  information  that  is  released  to   a 
legislative body shall not contain information that  identifies  a   specific 
individual.
Aggregate epidemiological information concerning the public  health  that  is 
released to the public for informational  purposes  only  shall  not  contain 
information that identifies a specific individual.

  History: 2005 AACS.


R 325.67   Heavy metal analysis report form.
  Rule 7. The heavy metal analysis report form reads as follows:
 
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
HEAVY METAL ANALYSIS REPORT
DATA/INFORMATION REQUIRED BY ADMINISTRATIVE RULE R 325.62

I. CLIENT INFORMATION

Last name 				First name 				M.I.

Sex     (M/F)     	Race     (White/Black/Asian/Pacific      Islander/American 
Indian/Alaskan/mixed)


Ethnicity (Hispanic Y/N)	Birth date or age	Phone number


Street address 		    	City			State/Zip Code/County


Name of parent or guardian if individual is a minor

Employer name (if adult)


Employer street address 	 	 City		State/Zip Code


II. PHYSICIAN/PROVIDER INFORMATION

(	)
Provider last name 			First name 	Phone number


Provider street address 	 	 City 		State/Zip Code


III. LABORATORY INFORMATION

(	)
Name of testing laboratory				Phone number


Laboratory street address		 City 	  	State/Zip Code


Date sample taken			Date sample analyzed


Results

Sample		Arsenic		Cadmium			Mercury

Blood		µg/ml		µg/L			ng/ml

Urine		µg/L		µg/gram creatinine	µg/L
OR
µg/L

MDCH - Bureau of Epidemiology, Division  of  Occupational  and  Environmental 
Epidemiology 3423 N. M.L. King, Jr. Blvd., Lansing, MI  48909  o  Fax  Number 
(517) 335-9775 o Phone number (517) 335-8350

  History: 2005 AACS.


R 325.68   Pesticide poisoning analysis report form.
Rule 8. The pesticide poisoning report form reads as follows:

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
PESTICIDE POISONING REPORT
DATA/INFORMATION REQUIRED BY ADMINISTRATIVE RULE R 325.62

I. CLIENT INFORMATION

Last name 				First name 		M.I.

Sex     (M/F)     	Race     (White/Black/Asian/Pacific      Islander/American 
Indian/Alaskan/mixed)

(	)
Ethnicity (Hispanic Y/N)	Birth date 		Phone number

Street address 		    	City 			State/Zip Code/County

Name and address of parent or guardian if individual is a minor

Employer

Employer street address	    	City 		  	State/Zip Code/County

II. PHYSICIAN/PROVIDER INFORMATION

(	)
Provider last name 			First name 	Phone number

Name of medical facility of requesting physician/provider

Facility street address 	City 			State/Zip Code

III. LABORATORY INFORMATION

(	)
Name of testing laboratory				Phone number

Laboratory street address	City 			State/Zip Code

Date sample taken			Date sample analyzed

Results

Test					Laboratory normal range
Acetylcholinesterase 		  U/g hemoglobin	  - 	     U/g hemoglobin

Pseudocholinesterase		  U/L			  - 	     U/L


MDCH - Bureau of Epidemiology, Division  of  Occupational  and  Environmental 
Epidemiology 3423 N. M.L. King, Jr. Blvd., Lansing, MI  48909  o  Fax  Number 
(517) 335-9775 o Phone number (517) 335-8350

  History: 2005 AACS.