DEPARTMENT OF COMMUNITY HEALTH

                         BUREAU OF EPIDEMIOLOGY

                     DIVISION OF ENVIRONMENTAL HEALTH

          REPORTING OF NON-SUICIDAL, NON-MEDICINAL CHEMICAL POISONINGS


(By authority conferred on the community public  health  agency  by  sections 
5111 and 2226 of PA 368 of 1978, as amended, section 8 of PA 312 of 1978, and 
Executive Reorganization Order  No.1996-1,MCL   333.5111,   MCL 333.2226, MCL 
325.78, MCL 333.2233, MCL 333.2221, and MCL 330.3101.)



R 325.71   Definitions.
 Rule 1. (1) As used in these rules:
  (a) "Chemical" means any substance or mixture  of  substances  composed  of 
chemical elements or obtained by a chemical process.
  (b) "Chemical poison" means a substance which, when  ingested,  inhaled  or 
absorbed, injected into, or developed  within  the  body,  causes  damage  to 
structure or disturbance of function in the body.
"Chemical poison" includes asphyxiant gases.
  (c) "Chemical poisoning report form" means the  form  used  to  report  the 
required reportable information for individuals with a chemical poisoning.
  (d) "Department" means the Michigan department of community health.
  (e) "Health facility" means any facility or agency licensed  under  article 
17 of the public health code, MCL 333.20101 to 333.22260 that provides health 
care services. "Health facility" includes a  hospital,  clinical  laboratory, 
surgical outpatient facility, health maintenance organization, nursing  home, 
home for the aged, county medical care  facility,  ambulance  operation,  and 
hospice.
  (f)  "Local health department" means a public health department established 
under the provisions of article 24 of the public health code, MCL 333.2401 to 
333.2498, to protect the public health and prevent disease within a  specific 
geographic area.
  (g) "Non-medicinal" means substances that  are  not  classified  as  drugs, 
medicines, or biologicals.
  (h)  "Non-suicidal" means  not  associated  with  an  intention  to  commit 
self-harm, including suicide.
  (i)"Health professional" means a person licensed under article  15  of  the 
public health  code, MCL 333.16101 to  333.18838,  in  medicine,  osteopathic 
medicine, as a physician's assistant, or nurse practitioner.
  (j) "Poisoning" means a morbid condition, including death,  produced  by  a 
poison.
  (k) "Protected health information" means any individually identified health 
information, whether oral or recorded in any form or medium that  is  created 
or received by a health care provider, health plan, public health  authority, 
employer, life insurer, school or university, or health  care  clearinghouse; 
and, relates to the past, present, or future physical  or  mental  health  or 
condition of an individual; the provision of health care to an individual; or 
the past, present, or future payment for the provision of health care  to  an 
individual.
  (l)   "Public  health  investigation"  means  the  collection  of  medical, 
epidemiologic, exposure, and other information to determine the magnitude and 
cause of illness or injury, which is used to determine appropriate actions to 
prevent or mitigate additional illness or injury.

  History: 2007 AACS; 2009 MR 14, Eff. July 16, 2009.


R 325.72 Reportable information.
  Rule 2. (1) Reportable information is specifically related to patients with 
known or suspected non-suicidal, non-medicinal chemical poisonings.
  (2) Clinical laboratory evidence of  overexposure  to  a  chemical  poison, 
defined as a laboratory test result outside of  that  laboratory's  reference 
range, shall be considered evidence of known or suspected chemical poisoning.
 (3) The health professional or health facility shall  submit  its  report  a 
format  that  ensures  the  inclusion  of  the   information   listed   under 
subdivisions (a) to (e) of this subrule as applicable.
  (a) All of the following information, with respect to the patient, shall be 
provided:
  (i) Last and first name and middle initial.
  (ii) Sex.
  (iii) Race, if available.
  (iv) Ethnic group, if available.
  (v) Birth date or age.
  (vi) Residential address.
  (vii) Telephone number.
  (viii) If the individual is a minor, the name of a parent or guardian.
  (ix) If the individual is an adult, the name and  address  of  his  or  her 
employer, if available.
  (b) If the reporting entity is a health care provider  or  health  facility 
other than a clinical laboratory, the following diagnostic information  shall 
be provided, in addition to information specified in R 325.72 (3)(a):
  (i) The date of diagnosis.
  (ii) The diagnosis, including diagnostic code, if available.
  (iii) Brief narrative of the poisoning event, including date, location, and 
type of chemical poison involved, and any other information considered by the 
health professional/health facility to be related to health of the public.
  (iv) Brief narrative of the patient signs and symptoms, clinical  findings, 
results of diagnostic tests, and clinical outcome.
  (c) If the  reporting  entity  is  a  clinical  laboratory,  the  following 
information shall be provided in  addition  to  information  specified  in  R 
325.72 (3)(a):
  (i) Name of the clinical test performed.
  (ii) Test result including units of measurement.
  (iii) Laboratory reference range including units of measurement.
  (iv) Date laboratory test was ordered.
  (d) Name, address,  telephone,  and  other  contact  information  shall  be 
provided for the reporting health professional. If the reporting entity is  a 
health facility, contact  information  for  the  diagnosing/treating/ordering 
physician shall be provided.
  (e) Name, address, telephone and other contact information for  the  health 
facility shall be provided if the reporting entity is the facility.

  History: 2007 AACS; 2009 MR 14, Eff. July 16, 2009.


R 325.73   Reporting responsibilities.
  Rule 3.  (1)  When requested by the department or local health  department, 
health  professionals  and  health  facilities  shall  provide  reports.  The 
department or local health department shall notify health  professionals  and 
health facilities when reports of 1 or  more  types  of  chemical  poisonings 
shall be submitted.  Both of the following apply:
  (i) Reports shall be made within 5 working days following  request  by  the 
department or local health department.
  (ii) Reports shall be provided  to  the  agency  (department  and/or  local 
health department) that makes the request.
  (2)  Reports may be provided by health professionals and health facilities, 
without departmental or local health department request, when  the  reporting 
entity believes that public health investigation is  needed  to  protect  the 
public.
  (3)  Nothing  in  this  rule  shall  be  construed  to  relieve  a   health 
professional or health  facility  from  reporting  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: 2007 AACS.


R 325.74 Investigation and quality assurance.
  Rule 4. (1) The department or local health  department,  upon  receiving  a 
report under R 325.73, may investigate  to  determine  the  accuracy  of  the 
report, a patient's source of exposure, and adverse health effects  resulting 
from the exposure.
  (2) The department and local public health departments shall collaborate in 
the development of procedures for processing poisoning reports and conducting 
follow-up investigations to ensure efficient, non-duplicative, and  effective 
public health response.
  (3) Requests  for  individual  medical  and  epidemiologic  information  to 
validate  the  completeness  and  accuracy  of  reporting  are   specifically 
authorized.
  (4) Copies of protected health information from  reported  poisoning  cases 
shall be kept in locked file cabinets when not  in  use.  Information  stored 
electronically shall be maintained on a  secure  server  accessible  only  by 
department  or  local  health  department  program  staff  through   password 
protected user accounts.
  (5) 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  chemical  poisons.   Protected  health 
information may be released to other  governmental  agencies  and  bona  fide 
agents of the state that comply with the confidentiality  requirements  of  R 
325.75.
  (6)  Confidential   information   obtained   during   the   public   health 
investigation may be exchanged between the department and  the  local  health 
department with jurisdiction where the chemical poisoning occurred.
  (7) Nothing in this rule shall be construed to relieve or preempt any other 
entities from investigating hazards associated with  chemical  poisons  under 
state, federal, or local statutes or regulations.

  History: 2007 AACS; 2009 MR 14, Eff. July 16, 2009.


R 325.75 Confidentiality of reports.
  Rule 5.  (1)  Reports  submitted  to  the  department  or   local    health 
department under R  325.73  are  not  public  records  and  are  exempt  from 
disclosure pursuant to the freedom of information act, section 13 of 1976  PA 
442, MCL 15.231.
  (2)  The  department  and  local  health  departments  shall  maintain  the 
confidentiality of all reports  and  shall  not  release  reports,  including 
protected health information or any information that may be used to  directly 
link the information to a particular  individual,  except  as  allowed  in  R 
325.74(5), unless the department or  local  health  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, which is released to the  public  for  informational  purposes  only, 
shall not contain information that allows individuals to be identified.

  History: 2007 AACS; 2009 MR 14, Eff. July 16, 2009.