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(1) The total funds to be allocated to the county based on population as specified in 1465(a)(1).
(2) The total funds to be allocated to the county based on budgeted allowable expenditures, revenues, and net costs as specified in 1465(a)(2).
(3) The total funds to be allocated to an Eligible Contract County solely for public health services as specified in 1465(a)(3).
(4) The total funds to be allocated to the City of Berkeley as specified in 1465 (a)(5).
(5) The total funds to be allocated to the San Joaquin Local Health District solely for public health services as specified in 1465(a)(6).
(6) The net costs of local jurisdiction funds for health services that must be incurred by the local jurisdiction in order to receive the total allocation specified in 1465(a).
(7) The sharing ratio of State funds as specified in (2), (3), (4) and (5) to the local jurisdiction funds as specified in (6). The sharing ratios shall not exceed those specified in 1465(h), as applicable.
(8) An assurance by the local jurisdiction that it agrees to expend local jurisdiction funds for net county costs for county health services in the amounts specified in 1465(c), (d), (e), and (f), as applicable.
(9) An assurance by the local jurisdiction that the health services provided by the Agreement will be in general accordance with the local jurisdiction's Multi-Year Plan and Budget or Update.
(10) An assurance by the local jurisdiction that monies provided by the State under the terms of this Agreement will be used to finance health services as described in the Multi-Year Plan and Budget or Update and for no other purpose.
(11) An assurance by the local jurisdiction that sufficient records, files and documentation will be maintained for State review concerning program activity and expenditures made under this Agreement and will be accessible for a period of at least four years from the expiration of this Agreement, or in the event of a State audit, until the audit has been resolved.
(12) An assurance by the local jurisdiction that access will be provided during normal working hours to authorize representatives of the Department and of other State agencies to all records, files, and documentation related to the Agreement.
(13) An assurance by the local jurisdiction that reports will be provided as required by the Department.
(b) The Agreement shall also include provisions pertaining to medically indigent services funds received pursuant to 1466. The provisions shall include but not be limited to:
(1) The total funds to be allocated to the county based on the allocation specified in 1466.
(2) The net costs for health services that must be incurred by the county in order to receive the allocation specified in 1466.
(3) An assurance by the county that it will incur no less in net costs of county funds for county health services in any fiscal year than the amount required to obtain the maximum allocation specified in 1465.
(4) An assurance by the county that funds allocated pursuant to 1466 shall be expended only for health services included in Sections 14132 and 14021 of the Welfare and Institutions Code for persons certified eligible pursuant to Section 17000 of the Welfare and Institutions Code. A county shall not be bound by utilization control provisions which are specified within Sections 14132 and 14021.
(5) An assurance by the county that funds allocated pursuant to 1466 shall not be expended for costs of services specified in county Short-Doyle plans which are in excess of the 125 percent limitation specified in Section 5705.1 of the Welfare and Institutions Code.
(6) The total funds to be provided by the State as specified in (a) and in (b)(1) above, under the terms of the Agreement.
(c) The Agreement shall constitute a contractual obligation.
(d) A local jurisdiction that has not submitted a signed Agreement to the Department by the end of a current fiscal year shall be subject to recoupment of any funds disbursed pursuant to (b)(1).
(e) A local jurisdiction that does not conform with any or all of the terms of the Agreement may be subject to recoupment of funds disbursed to that local jurisdiction.
Note: Authority cited: Section 16712, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16704 and 16706, Welfare and Institutions Code.
s 1473. Disbursement.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Section 16803, Welfare and Institutions Code.
s 1475. Reports.
(a) For Fiscal Year 1979-80 and annually thereafter, each local jurisdiction shall submit to the Department a report of estimated actual expenditures, revenues, and net county costs for services provided in accordance with the Multi-Year Plan and Budget or Update.
(1) The report shall be submitted in a form and in accordance with procedures specified by the Department.
(2) The report shall be due on November 15 in the year following the fiscal year for which data s being reported.
(b) For Fiscal Year 1979-80 and annually thereafter, each local jurisdiction shall submit to the Department a report of actual expenditures, revenues and net county costs for services provided in accordance with the Multi-Year Plan and Budget or Update.
(1) The report shall be submitted in accordance with the format and procedures as specified by the Department.
(2) The report shall be due on November 15 in the second year following the fiscal year for which data is being reported.
(c) Beginning on November 15, 1981, and annually thereafter each local jurisdiction shall prepare and submit to the Department a report describing health services provided by the local jurisdiction pursuant to Part 5 (commencing with Section 17000) of Division 9 of the Welfare and Institutions Code.
(1) The report shall be submitted in accordance with the procedures and timetable as established by the Department.
(2) The report shall include but not be limited to information covering the following:
(A) Eligibility standards
(B) Services provided
(C) Resources utilized
(D) Fees collected
(E) Target population size
(F) Costs
(d) The Director shall withhold part or all payment of County Health Services Funds to a local jurisdiction, unless the reports specified in (a) through (c) have been received by the Department.
Note: Authority cited: Section 16712, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16706 and 16716, Welfare and Institutions Code.
s 1477. Recoupment.
(a) For Fiscal Year 1979-80 and annually thereafter, the Department shall review the report specified in 1475(a), which shall serve as the initial basis for the recovery of funds not expended in accordance with the Agreement described in 1469.
(1) The Department:
(A) Shall determine whether or not the county has reported only net costs specifically allowed pursuant to Department guidelines and regulations.
(B) May disallow reported costs that are inaccurate or are not allowable costs for county health services or for health services provided to persons eligible pursuant to Section 17000 of the Welfare and Institutions Code.
(2) The Department shall notify the local jurisdiction in writing of its determinations and allowances made pursuant to (1).
(3) Notification shall be sent to the local jurisdiction's governing body, Auditor-Controller, Administrative Officer, and the Health Agency Director, Health Officer, and Hospital Administrator, as applicable.
(4) The notification for the fiscal year shall list:
(A) Aggregate net county costs specified in the Agreement.
(B) Estimated actual net county costs as reported pursuant to 1475(a).
(C) The difference between the two amounts.
(5) If the estimated actual net county costs are less than the aggregate net county costs specified in the Agreement, the notification shall declare the Department's intent to do one or a combination of the following in order to recoup the State portion of the funds specified in (4)(C):
(A) Adjust subsequent payments to the local jurisdiction from the County Health Services Fund.
(B) Negotiate a repayment plan for the local jurisdiction.
(C) Withhold the appropriate amount from other State funds payable to the local jurisdiction.
(b) For Fiscal Year 1979-80 and annually thereafter, the Department shall review the report specified in 1475(b) which shall serve as the final basis for recoupment of funds not expended in accordance with the Agreement described in 1469, unless the report is modified by actual audit findings officially adopted by the State.
(1) The Department:
(A) Shall determine whether or not the local jurisdiction has reported only net costs specifically allowed pursuant to Department guidelines and regulations.
(B) May disallow reported costs that are inaccurate or are not allowable after verifying the information with the local jurisdiction and notifying them of the proposed disallowance.
(2) The Department shall notify the local jurisdiction in writing of its determinations and disallowances made pursuant to (1) and of any difference between the actual net county costs reported pursuant to 1475(b) and the estimated actual net county costs reported pursuant to 1475(a).
(3) Notification shall be sent to the local jurisdiction's governing body, Auditor-Controller, Administrative Officer, and the Health Agency Director, Health Officer, and Hospital Administrator, as applicable.
(4) The notification for the fiscal year shall list the:
(A) Actual net county costs as reported pursuant to 1475(b).
(B) Estimated actual net county costs as reported pursuant to 1475(a).
(C) Difference between the two amounts.
(5) If the actual net county costs are less than the estimated actual net county costs the notification shall declare the Department's intent to do one or a combination of the following in order to recoup the State portion of the funds specified in (4)(c):
(A) Adjust subsequent payments to the local jurisdiction from the County Health Services Fund.
(B) Negotiate a repayment plan for the local jurisdiction.
(C) Withhold the appropriate amount from other State funds payable to the local jurisdiction.
(c) The governing body of the local jurisdiction shall have twenty-one (21) working days, following receipt of notification pursuant to (a)(2) or (b)(2) to appeal the Department's decision. The appeal shall be in accordance with the format and procedures specified by the Department.
(d) The Department may adjust the monthly payments made to a county pursuant to an Agreement as specified in 1469(b) if the county fails to expend such funds as specified in the Agreement.
(e) The Department shall recover any unexpended funds disbursed to county as specified in 1473(b) for medically indigent services in accordance with the procedures specified in the Agreement.
(f) The Department shall recover any funds not expended pursuant to 1469(b) in accordance with the procedures specified in the Agreement.
Note: Authority cited: Section 16712, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Section 16706, Welfare and Institutions Code.
s 1481. Special Needs and Priorities.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Section 16707, Welfare and Institutions Code.
s 1485. Purpose.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16705 and 16705.5, Welfare and Institutions Code.
s 1486. Conditions.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16705 and 16705.5, Welfare and Institutions Code.
s 1487. Scheduling.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16705 and 16705.5, Welfare and Institutions Code.
s 1489. Notification.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16705 and 16705.5, Welfare and Institutions Code.
s 1491. Conduct.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16705 and 16705.5, Welfare and Institutions Code.
s 1493. Findings.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Section 16705, Welfare and Institutions Code.
s 1495. Transmittal.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16705 and 16705.5, Welfare and Institutions Code.
s 1497. Determinations.
Note: Authority cited: Section 16812, Welfare and Institutions Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16705 and 16705.5, Welfare and Institutions Code.
s 1498. County Medical Services Program.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Section 16709, Welfare and Institutions Code.
s 1498.1. Declaration of Intent to Contract.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16703 and 16709, Welfare and Institutions Code.
s 1498.2. Small County Advisory Committee.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Section 16709, Welfare and Institutions Code.
s 1498.3. Contract.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16704 and 16709, Welfare and Institutions Code.
s 1498.4. Eligibility.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 159, Section 87(c). Reference: Sections 16703, 16706 and 16709, Welfare and Institutions Code.
s 1498.5. Benefits.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Section 16709, Welfare and Institutions Code.
s 1498.6. Administration.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16709 and 16717, Welfare and Institutions Code.
s 1498.7. Fiscal.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16703 and 16709, Welfare and Institutions Code.
s 1498.8. Liabilities.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Section 16709, Welfare and Institutions Code.
s 1498.9. Reporting.
Note: Authority cited: Section 10725, Welfare and Institutions Code; Section 100275, Health and Safety Code; and Statutes of 1982, Chapter 1594, Section 87(c). Reference: Sections 16709 and 16716, Welfare and Institutions Code.
s 1500. Indian.
"Indian" means any person who is:
(a) Identified as an Indian on the rolls maintained by the Bureau of Indian Affairs,
(b) Identified as an Indian on the rolls maintained by an Indian tribe, band, or other organized group of Indians, in any state,
(c) A descendant in the first or second degree of any person identified at any time on a roll referred to in subsection (a) or (b),
(d) Declared to be a member of a tribe or a descendant in the first or second degree of a member of a tribe by the tribal council of his or her tribe, or
(e) A descendant in any degree from a member of a tribe which has been declared to be terminated by the United States government. However, any person qualifying under this subsection must be at least one quarter Indian blood.
Note: Authority cited: Sections 102 and 208, Health and Safety Code. Reference: Sections 429.30, 429.31 and 429.32, Article 14, Chapter 2, Part 1, Division 1, Health and Safety Code.
s 1501. Indian Tribe.
"Indian Tribe" means any Indian tribe, band, nation or other organized group or community, which is determined to be eligible for the special programs and services provided by the United States or State of California, to Indians because of their status as Indians.
s 1502. Existing Indian Health Programs.
"Existing Indian Health Programs" means any program which provided, as of September 8, 1975, direct health services as defined in Section 1503 under the supervision of a licensed physician and surgeon, dentist, optometrist, or nurse.
s 1503. Direct Health Services.
"Direct Health Services" means one or more of the following services provided under the supervision of a licensed provider of health services acting within the scope of his or her license:
(a) Primary health care consisting of diagnostic, treatment and health maintenance services.
(b) Outreach, education, referral, follow-up services and assistance to the individual in obtaining services from other agencies to which he is entitled (health advocacy).
(c) Specialized health services as listed below:
(1) Screening and disease detection services.
(2) Alcohol and drug abuse detoxification services.
(3) Dental health services.
(4) Services leading to the prevention of vision and hearing loss and the restoration of vision and hearing.
(5) Family planning services.
(6) Maternal and child health services.
(7) Medical care of chronic conditions.
s 1504. Licensed Provider of Health Services.
"Licensed Provider of Health Services" for the purposes of Section 1503 means:
(a) A provider practicing in California licensed by the appropriate healing arts board.
(b) An individual employed by the Federal government in the practice of the healing arts on tribal lands.
s 1505. Department.
"Department" means the State Department of Health Services.
Note: Authority cited: Sections 208 and 1182.2(d), Health and Safety Code. Reference: Section 1182.2, Health and Safety Code.
s 1506. Director.
"Director" means the Director of the State Department of Health Services.
Note: Authority cited: Sections 208 and 1182.2(d), Health and Safety Code. Reference: Section 1182.2, Health and Safety Code.
s 1507. Indian Medicine and Traditional Health Practices.
"Indian Medicine and Traditional Health Practices" means traditional practices of Indian medicine which are native to an Indian community, which are accepted by that Indian community as handed down through the generations and which can be established through the collective knowledge of the elders of that Indian community.
Note: Authority cited: Sections 208 and 1182.2(d), Health and Safety Code. Reference: Section 1182.2, Health and Safety Code.
s 1520. Indian Health Policy Panel.
An Indian Health Policy Panel established by the Director shall advise the Director regarding policy for Indian health.
s 1521. Panel Membership.
Panel membership shall consist of four representatives of the California Rural Indian Health Board, four representatives of the California Urban Indian Health Council, and two individuals appointed by the Director. The representatives of the California Urban Indian Health Council and the California Rural Indian Health Board shall be appointed by the Council and the Board.
s 1530. Financial Assistance to Indian Health Programs.
Monies available under Chapter 606, Statutes of 1975, and any funds available to carry out provisions of Article 14 (commencing with Section 429.30) of Chapter 2 of Part 1 of Division 1 of the Health and Safety Code shall be allotted for the following purposes:
(a) Direct health services as defined under Section 1503 of these regulations.
(b) Technical assistance by individuals experienced in the delivery of health services including, but not limited to, health professionals, economists, sociologists, accountants, legal advisors, midwives (to the extent otherwise permitted by law), and other experts in Indian medicine and traditional health practices. Technical assistance may be provided by State staff, by consultants under contract with the State, or through contracts with local public and voluntary health organizations or existing Indian health programs.
(c) Training for health workers in Indian programs provided in the following manner:
(1) On the job training using workers in the program or individuals from other projects or agencies as instructors.
(2) Short term training sponsored by an educational facility not to exceed two weeks duration at any one time or one day per week over a three-month period.
(3) Tuition for the course work required by a staff member for the A.A., B.A. degree or advanced degree.
(d) Studies concerning the health needs, resources and practices of California Indians. Special emphasis shall be placed on the area of Indian medicine and traditional health practices.
s 1531. Allocation of Financial Assistance to Indian Health Programs.
(a) Funds shall be allocated for health services which are supplemental to those available from the Federal or State government. State funds available for the purposes of the Indian Health Service Program (Article 14 (commencing with Section 429.30) of Chapter 2 of Part 1 of Division 1 of the Health and Safety Code) shall not duplicate or replace any commitment made by the Federal government.
(b) No funds shall be provided from those appropriated for the purposes of the Indian Health Service Program for types of services for which Indians are eligible under other programs and for which other funds are available, including but not limited to the following types of services:
(1) Family planning.
(2) Supplemental Feeding for Women, Infants and Children (WIC).
(3) Alcoholism or substance abuse services.
(4) Hospitalization other than for emergency services, if an individual is eligible for medical care under Title XVIII or XIX of the Federal Social Security Act, under the Workmen's Compensation Statutes of California, from the Veteran's Administration or other similar programs or when a public health service hospital is accessible or if an individual has private health insurance.
(5) Maternal and Child Health.
(6) Crippled Childrens Services.
(7) Community Mental Health Services Program (Short-Doyle).
(8) Developmental Disability Program (Regional Centers).
s 1532. Allocation Formula.
(a) In the determination of the allocation of State funds the following factors shall be considered:
(1) Need as demonstrated by:
(A) The number of individuals to be served.
(B) The availability of other resources in the service area.
(C) The accessibility of resources in the service area.
(D) Higher costs of providing health services in the areas served.
(2) The ability of the proposed program to meet that need, as determined by:
(A) Adequate personal services.
(B) Sufficient operating expenses.
(3) Compliance with statewide plan for Indian health services and existing priorities for services.
(4) Compliance with local Indian health plan.
(5) The demonstrated ability of the Indian health program to carry out the proposed services.
s 1533. Reimbursement for Service.
(a) The programs shall maximize utilization of reimbursement from third-party payors.
(b) Where an Indian is eligible for health benefits from third-party payors and the service is provided by an existing Indian health program, the revenue collected from third-party payors shall be used to increase the services offered by the program.
s 1534. To Qualify for Funding.
(a) To qualify for funding an existing Indian health program shall be administered by a nonprofit corporation organized under the laws of this State or by an Indian tribe as defined in Section 1501. The board of directors or trustees of such corporation shall be composed of a majority of Indians as defined in Section 1500.
Note: Authority cited: Sections 208 and 1182.2(d), Health and Safety Code. Reference: Sections 1182 and 1182.2, Health and Safety Code.
s 1535. Criteria for Reimbursement of Direct Services.
(a) Salaries, travel expenses, and per diem rates for employees of existing Indian health programs shall be no greater than the rate set for State employees in like circumstances. Exceptions shall be granted only when no provider of services is available to the program at the rate set for State employees.
(b) Rates for reimbursement of services provided on a fee-for-service basis shall be no greater than the prevailing rates in the community in which the provider of services offers services.
s 1540. Confidentiality of Information.
(a) All patient files and information maintained or possessed by an existing Indian health program shall be treated as privileged communication, shall be held confidential, and shall not be divulged without the written consent of the individual or his personal representative, (or the parent or guardian, in the case of a minor), except as may be necessary to provide emergency services to the individual, to file a claim for benefits on behalf of the individual, or as required by the Department to administer this program. Information may be disclosed in summary, statistical, or other form which does not identify the particular individual.
(b) Services shall be provided in a manner that respects the privacy and dignity of the individual.
s 1541. Informed Consent.
(a) No individual shall be denied benefits available under the Indian Health Service Program for failure to accept any form of offered treatment. In the case of any medical treatment offered or given to an individual under the Indian Health Services Program, a signed consent form shall be obtained indicating that the individual has been informed of all known risks, benefits, and alternatives to the proposed treatment. This requirement may be waived in the case of emergencies. In the case of minors, the consent form shall be signed by the parent or guardian.
s 2000. Joint Regulations for Handicapped Children.
CROSS-REFERENCE: See Title 2, Division 9, Chapter 1, Articles 1-9, Sections 60000-60610, not consecutive.
<<(Chapter Originally Printed 8-15-45)>>
s 2500. Reporting to the Local Health Authority.
(a) The following definitions shall govern the interpretation of this Subchapter.
(1) 'CDC' means the Centers for Disease Control and Prevention, United States Department of Health and Human Services.
(2) 'CSTE' means the Council of State and Territorial Epidemiologists.
(3) 'MMWR' means the Morbidity and Mortality Weekly Report.
(4) 'Case' means (A) a person who has been diagnosed by a health care provider, who is lawfully authorized to diagnose, using clinical judgment or laboratory evidence, to have a particular disease or condition listed in subsection (j); or (B) a person who meets the definition of a case in Section 2564 - Diarrhea of the Newborn, Section 2574 - Food Poisoning, Section 2612 Salmonella Infections (Other than Typhoid Fever), Section 2628 - Typhoid Fever, or Section 2636 - Venereal Disease; or (C) a person who is considered a case of a disease or condition that satisfies the most recent communicable disease surveillance case definitions established by the CDC and published in the Morbidity and Mortality Weekly Report (MMWR) or its supplements; or (D) an animal that has been determined, by a person authorized to do so, to have rabies or plague.
(5) 'Clinical signs' means the objective evidence of disease.
(6) 'Clinical symptoms' means the subjective sensation of disease felt by the patient.
(7) 'Communicable disease' means an illness due to a specific microbiological or parasitic agent or its toxic products which arises through transmission of that agent or its products from an infected person, animal, or inanimate reservoir to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or the inanimate environment.
(8) 'Director' means State Director of Health Services.
(9) 'Drug susceptibility testing' means the process where at least one isolate from a culture of a patient's specimen is subjected to antimicrobial testing to determine if growth is inhibited by drugs commonly used to treat such infections.
(10) 'Epidemiological risk factors' means those attributes, behaviors, exposures, or other factors that alter the probability of disease.
(11) 'Epidemiologically linked case' means a case in which the patient has/has had contact with one or more persons who have/had the disease, and transmission of the agent by the usual modes of transmission is plausible.
(12) 'Foodborne disease' means illness suspected by a health care provider to have resulted from consuming a contaminated food.
(13) 'Foodborne disease outbreak' means an incident in which two or more persons experience a similar illness after ingestion of a common food, and epidemiologic analysis implicates the food as the source of the illness. There are two exceptions: even one case of botulism or chemical poisoning constitutes an outbreak if laboratory studies identify the causative agent in the food.
(14) 'Health care provider' means a physician and surgeon, a veterinarian, a podiatrist, a nurse practitioner, a physician assistant, a registered nurse, a nurse midwife, a school nurse, an infection control practitioner, a medical examiner, a coroner, or a dentist.
(15) 'Health officer' and 'local health officer' as used in this subchapter includes county, city, and district health officers.
(16) 'In attendance' means the existence of the relationship whereby a health care provider renders those services which are authorized by the health care provider's licensure or certification.
(17) 'Infection control practitioner' means any person designated by a hospital, nursing home, clinic, or other health care facility as having responsibilities which include the detection, reporting, control and prevention of infections within the institution.
(18) 'Laboratory findings' means (A) the results of a laboratory examination of any specimen derived from the human body which yields microscopical, cultural, immunological, serological, or other evidence suggestive of a disease or condition made reportable by these regulations; or (B) the results of a laboratory examination of any specimen derived from an animal which yields evidence of rabies or plague.
(19) 'Multidrug-resistant Mycobacterium tuberculosis' means a laboratory culture or subculture of Mycobacterium tuberculosiswhich is determined by antimicrobial susceptibility testing to be resistant to at least isoniazid and rifampin.
(20) 'Outbreak' means the occurrence of cases of a disease (illness) above the expected or baseline level, usually over a given period of time, in a geographic area or facility, or in a specific population group. The number of cases indicating the presence of an outbreak will vary according to the disease agent, size and type of population exposed, previous exposure to the agent, and the time and place of occurrence. Thus, the designation of an outbreak is relative to the usual frequency of the disease in the same facility or community, among the specified population, over a comparable period of time. A single case of a communicable disease long absent from a population or the first invasion by a disease not previously recognized requires immediate reporting and epidemiologic investigation.
(21) 'Personal information' means any information that identifies or describes a person, including, but not limited to, his or her name, social security number, date of birth, physical description, home address, home telephone number, and medical or employment history.
(22) 'Sexually Transmitted Diseases' means Chancroid, Lymphogranuloma Venereum, Granuloma Inguinale, Syphilis, Gonorrhea, Chlamydia, Pelvic Inflammatory Disease, and Nongonococcal Urethritis.
(23) 'Suspected case' means (A) a person whom a health care provider believes, after weighing signs, symptoms, and/or laboratory evidence, to probably have a particular disease or condition listed in subsection (j); or (B) a person who is considered a probable case, or an epidemiologically-linked case, or who has supportive laboratory findings under the most recent communicable disease surveillance case definition established by CDC and published in the Morbidity and Mortality Weekly Report (MMWR) or its supplements; or (C) an animal which has been determined by a veterinarian to exhibit clinical signs or which has laboratory findings suggestive of rabies or plague.
(24) 'Unusual disease' means a rare disease or a newly apparent or emerging disease or syndrome of uncertain etiology which a health care provider has reason to believe could possibly be caused by a transmissible infectious agent or microbial toxin.
(25) 'Water-associated disease' means an illness in which there is evidence to suggest that the illness could possibly have resulted from physical contact with or swallowing water from a microbiologically or chemically contaminated source. Examples of such potentially contaminated water sources are lakes, rivers, streams, irrigation water, wells, public and private drinking water, bottled water, reclaimed water, ocean and bay waters, hot springs, hot tubs, whirlpool spas, and swimming pools. Epidemiologic investigation by public health authorities is required to demonstrate that a suspected water-associated illness was likely to have been waterborne and related to the suspected source.
(26) 'Waterborne disease outbreak' means an incident in which two or more persons experienced a similar illness after consumption or use of the same water intended for drinking or after water contact such as by immersion, and epidemiologic investigation by public health authorities implicates the same water as the source of the waterborne illness. There is one exception: a single case of waterborne chemical poisoning constitutes an outbreak if laboratory studies indicate that the source water is contaminated by the chemical.
(b) It shall be the duty of every health care provider, knowing of or in attendance on a case or suspected case of any of the diseases or conditions listed in subsection (j) of this section, to report to the local health officer for the jurisdiction where the patient resides as required in subsection (h) of this section. Where no health care provider is in attendance, any individual having knowledge of a person who is suspected to be suffering from one of the diseases or conditions listed in subsection (j) of this section may make such a report to the local health officer for the jurisdiction where the patient resides.
(c) The administrator of each health facility, clinic or other setting where more than one health care provider may know of a case, a suspected case or an outbreak of disease within the facility shall establish and be responsible for administrative procedures to assure that reports are made to the local health officer.
(d) Each report made pursuant to subsection (b) shall include all of the following information if known:
(1) name of the disease or condition being reported; the date of onset; the date of diagnosis; the name, address, telephone number, occupation, race/ethnic group, Social Security number, sex, age, and date of birth for the case or suspected case; the date of death if death has occurred; and the name, address and telephone number of the person making the report.
(2) If the disease reported pursuant to subsection (b) is hepatitis, a sexually transmitted disease or tuberculosis, then the report shall include the following applicable information, if known: (A) hepatitis information as to the type of hepatitis, type-specific laboratory findings, and sources of exposure, (B) sexually transmitted disease information as to the specific causative agent, syphilis-specific laboratory findings, and any complications of gonorrhea or chlamydia infections, or (C) tuberculosis information on the diagnostic status of the case or suspected case, bacteriologic, radiologic and tuberculin skin test findings, information regarding the risk of transmission of the disease to other persons, and a list of the anti-tuberculosis medications administered to the patient.
(e) Confidential Morbidity Report forms, PM 110 (1/90), are available from the local health department for reporting as required by this section.
(f) Information reported pursuant to this section is acquired in confidence and shall not be disclosed by the local health officer except as authorized by these regulations, as required by state or federal law, or with the written consent of the individual to whom the information pertains or the legal representative of the individual.
(g) Upon the Department of Health Services' request, a local health department shall provide to the Department the information reported pursuant to this section. Absent the individual's written consent, no information that would directly or indirectly identify the case or suspected case as an individual who has applied for or been given services for alcohol or other drug abuse by a federally assisted drug or alcohol abuse treatment program (as defined in federal law at 42 C.F.R. Section 2.11) shall be included.
(h) The urgency of reporting is identified by symbols in the list of diseases and conditions in subsection (j) of this section. Those diseases with a diamond (r) are considered emergencies and shall be reported immediately by telephone. Those diseases and conditions with a cross (+) shall be reported by mailing, telephoning or electronically transmitting a report within one (1) working day of identification of the case or suspected case. Those diseases and conditions not otherwise identified by a diamond or a cross shall be reported by mailing a written report, telephoning, or electronically transmitting a report within seven (7) calendar days of the time of identification.
(i) For foodborne disease, the bullet (w) symbol indicates that, when two (2) or more cases or suspected cases of foodborne disease from separate households are suspected to have the same source of illness, they shall be reported immediately by telephone.
(j) Health care providers shall submit reports for the following diseases or conditions.
Acquired Immune Deficiency Syndrome (AIDS)
+ Amebiasis
+ Anisakiasis
r Anthrax
+ Babesiosis
r Botulism (Infant, Foodborne, Wound, Other)
r Brucellosis
+ Campylobacteriosis
Chancroid
Chlamydial Infections
r Cholera
r Ciguatera Fish Poisoning
Coccidioidomycosis
+ Colorado Tick Fever
+ Conjunctivitis, Acute Infectious of the Newborn, Specify Etiology
+ Cryptosporidiosis
Cysticercosis
r Dengue
r Diarrhea of the Newborn, Outbreaks
r Diphtheria
r Domoic Acid Poisoning (Amnesic Shellfish Poisoning)
Echinococcosis (Hydatid Disease)
Ehrlichiosis
+ Encephalitis, Specify Etiology: Viral, Bacterial, Fungal, Parasitic
r Escherichia coli O157:H7 Infection
+w Foodborne Disease
Giardiasis
Gonococcal Infections
+ Haemophilus influenzae, Invasive Disease
r Hantavirus Infections
r Hemolytic Uremic Syndrome
Hepatitis, Viral
+ Hepatitis A
Hepatitis B (specify acute case or chronic)
Hepatitis, C (specify acute case or chronic)
Hepatitis D (Delta)
Hepatitis, other, acute
Kawasaki Syndrome (Mucocutaneous Lymph Node Syndrome)
Legionellosis
Leprosy (Hansen Disease)
Leptospirosis
+ Listeriosis
Lyme Disease
+ Lymphocytic Choriomeningitis
+ Malaria
+ Measles (Rubeola)
+ Meningitis, Specify Etiology: Viral, Bacterial, Fungal, Parasitic
r Meningococcal Infections
Mumps
Non-Gonococcal Urethritis (Excluding Laboratory Confirmed Chlamydial Infections
r Paralytic Shellfish Poisoning
Pelvic Inflammatory Disease (PID)
+ Pertussis (Whooping Cough)
r Plague, Human or Animal
+ Poliomyelitis, Paralytic
+ Psittacosis
+ Q Fever
r Rabies, Human or Animal
+ Relapsing Fever
Reye Syndrome
Rheumatic Fever, Acute
Rocky Mountain Spotted Fever
Rubella (German Measles)
Rubella Syndrome, Congenital
+ Salmonellosis (Other than Typhoid Fever)
r Scombroid Fish Polsoning
r Severe Acute Respiratory Infection (SARS)
+ Shigellosis
r Smallpox (Variola)
+ Streptococcal Infections (Outbreaks of Any Type and Individual Cases in Food Handlers and Dairy Workers Only)
+ Swimmer's Itch (Schistosomal Dermatitis)
+ Syphilis
Tetanus
Toxic Shock Syndrome
Toxoplasmosis
+ Trichinosis
+ Tuberculosis
r Tularemia
+ Typhoid Fever, Cases and Carriers
Typhus Fever
r Varicella (deaths only)
+ Vibrio Infections
r Viral Hemorrhagic Fevers (e.g., Crimean-Congo, Ebola, Lassa and Marburg viruses)
+ Water-associated Disease
+ West Nile virus infection
r Yellow Fever
+ Yersiniosis
r OCCURRENCE of ANY UNUSUAL DISEASE
r OUTBREAKS of ANY DISEASE (Including diseases not listed in Section 2500). Specify if institutional and/or open community.
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(r) = to be reported immediately by telephone.
(+) = to be reported by mailing a report, telephoning, or electronically transmitting a report within one (1) working day of identification of the case or suspected case.
(No diamond or cross symbol) = to be reported within seven (7) calendar days by mail, telephone, or electronic report from the time of identification. (w) = when two (2) or more cases or suspected cases of foodborne disease from separate households are suspected to have the same source of illness, they should be reported immediately by telephone.
Note: Authority cited: Sections 100180, 100275 and 120130, Health and Safety Code. Reference: Sections 1603.1, 100180, 100325, 103925, 113150, 113155, 120125, 120130, 120140, 120175, 120245 and 120250, Health and Safety Code; Sections 551, 554 and 555, Business and Professions Code; Section 1798.3, Civil Code; 42 U.S.C. Sections 290ee-3 and 290dd-3; 42 C.F.R. Sections 2.11 and 2.12; Cal. Const., art. 1, Section 1; and Section 1040, Evidence Code.
s 2501. Investigation of a Reported Case, Unusual Disease, or Outbreak of Disease.
(a) Upon receiving a report made pursuant to Section 2500 or 2505, the local health officer shall take whatever steps deemed necessary for the investigation and control of the disease, condition or outbreak reported. If the health officer finds that the nature of the disease and the circumstances of the case, unusual disease, or outbreak warrant such action, the health officer shall make or cause to be made an examination of any person who or animal which has been reported pursuant to Sections 2500 or 2505 in order to verify the diagnosis, or the existence of an unusual disease, or outbreak, make an investigation to determine the source of infection, and take appropriate steps to prevent or control the spread of the disease. Whenever requested to do so by the Department, the health officer shall conduct a special morbidity and mortality study under Health and Safety Code Section 211 for any of the diseases made reportable by these regulations.
(b) If a disease is one in which the local health officer determines identification of the source of infection is important, and the source of infection is believed to be outside the local jurisdiction, the health officer shall notify the Director or the health officer under whose jurisdiction the infection was probably contracted if known. Similar notification shall be given if there are believed to be exposed persons, living outside the jurisdiction of the health officer, who should be quarantined or evaluated for evidence of the disease.
Note: Authority cited: Sections 207, 208 and 3123, Health and Safety Code; and Section 555(b), Business and Professions Code. Reference: Sections 7, 200, 207, 211, 211.5, 304.5, 410, 1603.1, 3051, 3053, 3110, 3122, 3123, 3124, 3125, 3131 and 3132, Health and Safety Code; Sections 551, 554 and 555, Business and Professions Code.
s 2502. Reports by Local Health Officer to State Department of Health Services.
(a) Summary Reports: Each local health officer shall report at least weekly, on the Weekly Morbidity by Place of Report form (DHS 8245 (11/95)) to the Director the number of cases of those diseases, conditions, unusual diseases or outbreaks of disease reported pursuant to Section 2500. Copies of the form are available from the Department's Division of Communicable Disease Control.
(b) Individual Case and Outbreak Reports: For the diseases listed below, the local health officer shall prepare and send to the Department along with the summary report described in (a) above an individual case or outbreak report for each individual case/outbreak of those diseases which the Department has identified as requiring epidemiological analysis reported pursuant to Section 2500. At the discretion of the Director, the required individual case/outbreak report may be either a Confidential Morbidity Report (PM-110 1/90), its electronic equivalent or a hard copy 8.5x11 inch individual case/outbreak report form. The Weekly Morbidity by Place of Report form (DHS 8245 11/95)) indicates which format to use. Each individual case report shall include the following: (1) verification of information reported pursuant to Section 2500; (2) information on the probable source of infection, if known; (3) laboratory or radiologic findings, if any; (4) clinical signs and/or symptoms, if applicable; and (5) any known epidemiological risk factors. The Department or CDC has prepared forms that may be used for many of the diseases requiring individual case reports. Where a form exists, its identification number is listed in parentheses next to the diseases listed below. Copies of these case report forms are available from the Department's Division of Communicable Disease Control. An individual case report is required for the following diseases:
Acquired Immune Deficiency Syndrome (AIDS) (CDC 50.42B)
Anthrax (ACD-152)
Botulism (Infant, Foodborne, Wound, Other) (ACD-153)
Brucellosis (262-101)
Cholera (CDC 52.79)
Cysticercosis (pending)
Diarrhea of the Newborn, Outbreaks (262-504)
Diptheria (262-505)
Escherichia coliO157:H7 Infection (pending)
Foodborne Disease Outbreak (CDC 52.13)
Haemophilus influenzae, Invasive Disease (DHS 8449)
Hantavirus Infections (pending)
Hemolytic Uremic Syndrome (pending)
Hepatitis A (CDC 53.1)
Hepatitis B, acute only (CDC 53.1)
Hepatitis C, acute only (CDC 53.1)
Hepatitis D (Delta), acute only (CDC 53.1)
Hepatitis, any other acute viral type (CDC 53.1)
Kawasaki Syndrome (Mucocutaneous Lymph Node Syndrome) (DHS 8468)
Legionellosis (CDC 52.56)
Leprosy (Hansen Disease) (CDC 52.18)
Leptospirosis (262-102)
Listeriosis (DHS 8296)
Lyme Disease (DHS 8470)
Malaria (CDC 54.1)
Measles (Rubeola) (DHS 8345)
Meningoccal Infections (DHS 8469)
Outbreak of Disease Report (DHS 262-501)
Pelvic Inflammatory Disease (PID)
Pertussis (Whooping Cough) (DHS 8258)
Plague (CDC 56.37)
Poliomyelitis, Paralytic (DHS 8421)
Psittacosis (8023-005)
Q Fever (262-101)
Rabies, Human or Animal (Humans 262-105, Animals PM 102)
Relapsing Fever (262-107)
Reye Syndrome (CDC 55.8)
Rocky Mountain Spotted Fever (CDC 55.1)
Rubella (German Measles) (PM 358; for Congenital Rubella, CDC 71.17)
Severe Acute Respiratory Infection (SARS) (pending)
Smallpox (pending)
Streptococcal Outbreaks and Individual Cases in Food Handlers and Dairy Workers Only
Syphilis (for Congenital Syphilis, CDC 73.126)
Tetanus (CDC 71.15)
Toxic Shock Syndrome (CDC 52.3)
Trichinosis (CDC 54.7)
Tuberculosis (CDC 72.9 A, B, and C)
Tularemia (262-101)
Typhoid Fever, Cases and Carriers (Cases, CDC 52.5; Carriers, CDC 4.383)
Typhus Fever (262-107)
Unusual Disease Report (DHS 262-501)
Varicella, Deaths Only (pending)
VibrioInfections (CDC 52.79)
Viral Hemorrhagic Fevers (pending)
Waterborne Disease Outbreak (CDC 52.12)
West Nile virus infection (pending)
Yellow Fever
(c) Immediate Reports: Cases and suspect cases of anthrax, botulism, brucellosis, cholera, dengue, diarrhea of the newborn (outbreaks), diphtheria, plague, rabies (human only), smallpox (varoila), tularemia, varicella deaths, viral hemorrhagic fevers, yellow fever, occurrence of any unusual diseases, and outbreaks of any disease are to be reported by the local health officer to the Director immediately by telephone.
(d) Upon request of the Department, the local health officer shall submit an individual case report for any disease not listed in subsection (b) above.
(e) During any special morbidity and mortality study requested under Section 2501, the local health officer shall be the Director's agent for purposes of carrying out the powers conferred under Government Code Section 11181.
(f) Confidentiality. Information reported pursuant to this section is acquired in confidence and shall not be disclosed by the local health officer except as authorized by these regulations, as required by state or federal law, or with the written consent of the individual to whom the information pertains or to the legal representative of that individual.
(1) A health officer shall disclose any information, including personal information, contained in an individual case report to state, federal or local public health officials in order to determine the existence of a disease, its likely cause or the measures necessary to stop its spread. (continued)