TITLE 9. HEALTH SERVICES

Historical Note

Adopted effective January 28, 1987 (Supp. 87-1). Amended effective September 14, 1990 (Supp. 90-3). Amended effective October 19, 1993 (Supp. 93-4). Amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-102. Release of Protected Health Information

A person in possession of protected health information, as defined in 45 C.F.R. 160.103, shall release the protected health information to the Department or a local health agency upon request if the protected health information is requested for the purpose of detecting, preventing, or controlling disease, injury, or disability.

Historical Note

Adopted effective May 2, 1991 (Supp. 91-2). Former Section R9-6-102 renumbered to R9-6-105, new Section R9-6-102 renumbered from R9-6-106 and amended effective October 19, 1993 (Supp. 93-4). Amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Former R9-6-102 renumbered to R9-6-201; new R9-6-102 made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-103. Renumbered

Historical Note

Renumbered from R9-6-107 and amended effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Section renumbered to R9-6-301 by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-104. Repealed

Historical Note

Renumbered from R9-6-108 and amended effective October 19, 1993 (Supp. 93-4). Section repealed by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2).

R9-6-105. Renumbered

Historical Note

Adopted effective January 20, 1992 (Supp. 92-1). Former Section R9-6-105 renumbered to R9-6-107, new Section R9-6-105 renumbered from R9-6-102 and amended effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Section renumbered to R9-6-501 by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-106. Renumbered

Historical Note

Amended effective June 4, 1980 (Supp. 80-3). Former Section R9-6-112 renumbered and amended as Section R9-6-106 effective January 28, 1987 (Supp. 87-1). Former Section R9-6-106 renumbered to R9-6-102, new Section R9-6-106 adopted effective October 19, 1993 (Supp. 93-4). Section renumbered to R9-6-601 by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

Historical Note

New Exhibit made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-107. Repealed

Historical Note

Adopted effective September 14, 1990 (Supp. 90-3). Former Section R9-6-107 renumbered to R9-6-103, new Section R9-6-107 renumbered from R9-6-105 and amended effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Amended by final rulemaking at 5 A.A.R. 496, effective January 19, 1999 (Supp. 99-1). Section repealed by final rulemaking at 8 A.A.R. 4274, effective September 16, 2002 (Supp. 02-3).

R9-6-108. Renumbered

Historical Note

Adopted as an emergency effective January 12, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-1). Emergency expired. Readopted without change as an emergency effective May 9, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-2). Amended and readopted as an emergency effective August 8, 1988 pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-3). Emergency expired. Readopted as an emergency and Paragraph (9) corrected effective November 16, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Adopted without change as a permanent rule effective May 22, 1989 (Supp. 89-2). Renumbered to R9-6-104 effective October 19, 1993 (Supp. 93-4).

R9-6-109. Reserved

R9-6-110. Reserved

R9-6-111. Repealed

Historical Note

Corrected Departmental reference in subsection (C) (Supp. 76-5). Amended effective June 4, 1980 (Supp. 80-3. Repealed effective January 28, 1987 (Supp. 87-1).

R9-6-112. Renumbered

Historical Note

Amended effective June 4, 1980 (Supp. 80-3). Former Section R9-6-112 renumbered and amended as Section R9-6-106 effective January 28, 1987 (Supp. 87-1).

R9-6-113. Repealed

Historical Note

Former Section R9-6-113 repealed, new Section R9-6-113 adopted effective June 4, 1980 (Supp. 80-3). Amended paragraph 4, effective January 31, 1983 (Supp. 83-1). Repealed effective January 28, 1987 (Supp. 87-1).

R9-6-114. Repealed

Historical Note

Corrected Departmental reference in subsections (B) and (C) (Supp. 76-5). Former Section R9-6-114 repealed, new Section R9-6-114 adopted effective June 4, 1980 (Supp. 80-3). Repealed effective January 28, 1987 (Supp. 87-1).

ARTICLE 2. COMMUNICABLE DISEASE AND INFESTATION REPORTING

R9-6-201. Definitions

In this Article, unless otherwise specified:

1. "Clinical laboratory" has the same meaning as in A.R.S. § 36-451.

2. "Drug" has the same meaning as in A.R.S. § 32-1901.

3. "Epidemiologic curve" means a graphic display of the number of cases over time.

4. "Normally sterile site" means an anatomic location, or tissue or body fluid from an anatomic location, in which microorganisms are not found in the absence of disease and includes:

a. The lower respiratory tract;

b. Blood;

c. Bone marrow;

d. Cerebrospinal fluid;

e. Pleural fluid;

f. Peritoneal fluid;

g. Synovial fluid;

h. Pericardial fluid;

i. Urine;

j. A closed abscess; or

k. Another anatomic location other than the skin, upper respiratory tract, middle ear, vaginal tract, or gastrointestinal tract.

5. "Pharmacist" has the same meaning as in A.R.S. § 32-1901.

6. "Point of contact" means an individual through whom the Department or a local health agency can obtain information upon request.

7. "Whole blood" means human blood from which plasma, erythrocytes, leukocytes, and thrombocytes have not been separated.

Historical Note

Former Section R9-6-211 renumbered and amended and subsection (C) renumbered from R9-6-212 and amended effective May 2, 1991 (Supp. 91-2). Former Section R9-6-201 renumbered to R9-6-501, new Section R9-6-201 renumbered from R9-6-601, repealed, and a new Section R9-6-201 adopted effective October 19, 1993 (Supp. 93-4). Former R9-6-201 repealed; new R9-6-201 renumbered from R9-6-102 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-202. Reporting Requirements for a Health Care Provider or an Administrator of a Health Care Institution or Correctional Facility

A. A health care provider who diagnoses, treats, or detects a case or suspect case of a communicable disease listed in Table 1 or detects an occurrence listed in Table 1 shall, either personally or through a representative, submit a report to the local health agency within the time limitation in Table 1 and as specified in subsection (C), (D), or (E).

B. An administrator of a health care institution or correctional facility in which a case or suspect case of a communicable disease listed in Table 1 is diagnosed, treated, or detected or an occurrence listed in Table 1 is detected shall, either personally or through a representative, submit a report to the local health agency within the time limitation in Table 1 and as specified in subsection (C), (D), or (E).

C. Except as described in subsections (D) and (E), for each case, suspect case, or occurrence for which a report is required by subsection (A) or (B) and Table 1, a health care provider or an administrator of a health care institution or correctional facility shall submit a report that includes:

1. The following information about the case or suspect case:

a. Name;

b. Residential and mailing addresses;

c. Whether the individual resides on or off an Indian reservation and, if on, the name of the reservation;

d. Telephone number;

e. Date of birth;

f. Race and ethnicity;

g. If Native American, tribal affiliation, if known;

h. Gender;

i. If known, whether the individual is pregnant;

j. Occupation;

k. If known, whether the individual is attending a school or a child care establishment and, if so, the name of the school or child care establishment; and

l. For a case or suspect case who is a child requiring parental consent for treatment, the name, residential address, and telephone number of the child's parent or guardian, if known;

2. The following information about the disease:

a. The name of the disease;

b. The date of onset of symptoms;

c. The date of diagnosis;

d. The date of specimen collection;

e. Each type of specimen collected;

f. Each type of laboratory test completed;

g. The date of laboratory confirmation; and

h. A description of the laboratory test results, including quantitative values if available;

3. If reporting a case or suspect case of chancroid, gonorrhea, syphilis, or genital Chlamydia infection, a description of the treatment prescribed, if any, including:

a. The name of each drug prescribed,

b. The dosage prescribed for each drug, and

c. The date of prescription for each drug; and

4. The name, address, and telephone number of the individual making the report.

D. For each unexplained death with a history of fever, a health care provider or an administrator of a health care institution or correctional facility shall submit a report that includes:

1. The following information about the deceased individual:

a. Name;

b. Residential address;

c. Telephone number; and

d. If known, medical history;

2. A description of the clinical course of the illness that resulted in death;

3. A list of the laboratory tests completed on the deceased individual and, if available, the laboratory test results, including quantitative values;

4. The suspected cause or causes of death;

5. If known, the status of the autopsy;

6. The name, residential address, and telephone number of a family member of the deceased individual who can serve as a point of contact; and

7. The name, address, and telephone number of the individual making the report.

E. For each outbreak for which a report is required by subsection (A) or (B) and Table 1, a health care provider or an administrator of a health care institution or correctional facility shall submit a report that includes:

1. A description of the signs and symptoms;

2. If possible, a diagnosis and identification of suspected sources;

3. The number of known cases and suspect cases;

4. A description of the setting of the outbreak; and

5. The name, address, and telephone number of the individual making the report.

F. A health care provider who orders an HIV-related test on an infant who was perinatally exposed to HIV to determine whether the infant is infected with HIV or an administrator of a health care institution in which an HIV-related test is ordered on an infant who was perinatally exposed to HIV to determine whether the infant is infected with HIV shall, either personally or through a representative, report the following to the Department within five working days after receiving the results of the HIV-related test:

1. The name of the infant;

2. The name of the infant's mother;

3. The infant's date of birth;

4. The type of HIV-related test ordered;

5. The date of the HIV-related test;

6. The results of the HIV-related test; and

7. The ordering health care provider's name, address, and telephone number.

G. Except as provided in Table 1, a health care provider or an administrator of a health care institution or correctional facility shall, either personally or through a representative, submit a report required under this Section:

1. By telephone;

2. In a document sent by fax, delivery service, or mail; or

3. Through an electronic reporting system authorized by the Department.

Historical Note

Renumbered from R9-6-213 and amended effective May 2, 1991 (Supp. 91-2). Former Section R9-6-202 renumbered to R9-6-502, new Section R9-6-202 renumbered from R9-6-602 and amended effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Amended by final rulemaking at 8 A.A.R. 4467, effective December 1, 2002 (Supp. 02-4). Amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

Table 1. Reporting Requirements for a Health Care Provider or an Administrator of a Health Care Institution or
Correctional Facility

Historical Note

New Table made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-203. Reporting Requirements for an Administrator of a School, Child Care Establishment, or Shelter

A. An administrator of a school, child care establishment, or shelter shall, either personally or through a representative, report a case, suspect case, or outbreak listed in Table 2 to the local health agency within the time limitation and as specified in Table 2 and subsection (B).

B. An administrator of a school, child care establishment, or shelter shall submit a report by telephone that includes:

1. The name and address of the school, child care establishment, or shelter;

2. The number of individuals with the disease, infestation, or symptoms;

3. The date and time that the disease or infestation was detected or that the symptoms began;

4. The number of rooms, grades, or classes affected and the name of each;

5. The following information about each affected individual:

a. Name;

b. Date of birth or age;

c. Residential address and telephone number; and

d. Whether the individual is a staff member, a student, a child in care, or a resident;

6. The number of individuals attending or residing at the school, child care establishment, or shelter; and

7. The name, address, and telephone number of the individual making the report.

Historical Note

Renumbered from R9-6-214 and amended effective May 2, 1991 (Supp. 91-2). Former Section R9-6-203 renumbered to R9-6-503, new Section R9-6-202 adopted effective October 19, 1993 (Supp. 93-4). Former R9-6-203 renumbered to R9-6-206; new R9-6-203 made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

Table 2. Reporting Requirements for an Administrator of a School, Child Care Establishment, or Shelter

Historical Note

New Table made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-204. Clinical Laboratory Director Reporting Requirements

A. A director of a clinical laboratory that obtains a test result described in Table 3 or that receives a specimen for detection of an infectious agent or toxin listed in Table 3 shall, either personally or through a representative, submit a report and, if applicable, an isolate to the Department within the time limitation and as specified in Table 3 and subsection (B) or (C).

B. Except as provided in Table 3, for each test result for which a report is required by subsection (A) and Table 3, a clinical laboratory director shall submit a report that includes:

1. Unless the test result is from anonymous HIV testing as described in R9-6-339, the name and, if available, the address and telephone number of the subject;

2. Unless the test result is from anonymous HIV testing as described in R9-6-339, the date of birth of the subject;

3. The laboratory identification number;

4. The specimen type;

5. The date of collection of the specimen;

6. The type of test completed on the specimen;

7. The test result, including quantitative values if available; and

8. The ordering health care provider's name and telephone number.

C. For each specimen for which an immediate report is required by subsection (A) and Table 3, a clinical laboratory director shall submit a report that includes:

1. The name and, if available, the address and telephone number of the subject;

2. The date of birth of the subject;

3. The laboratory identification number;

4. The specimen type;

5. The date of collection of the specimen;

6. The type of test ordered on the specimen; and

7. The ordering health care provider's name and telephone number.

D. A clinical laboratory director shall submit a report by telephone; in a document sent by fax, delivery service, or mail; or through an electronic reporting system authorized by the Department. Except as provided in Table 3, each report shall contain the information required under subsection (B) or (C).

Historical Note

Adopted effective October 19, 1993 (Supp. 93-4). Former R9-6-204 renumbered to R9-6-302; new R9-6-204 made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

Table 3. Clinical Laboratory Director Reporting Requirements

Historical Note

New Table made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-205. Reporting Requirements for a Pharmacist or an Administrator of a Pharmacy

A. A pharmacist who fills an individual's initial prescription for two or more of the drugs listed in subsection (B) or an administrator of a pharmacy in which an individual's initial prescription for two or more of the drugs listed in subsection (B) is filled shall, either personally or through a representative, submit a report that complies with subsection (C) to the Department within five working days after the prescription is filled.

B. Any combination of two or more of the following drugs when initially prescribed for an individual triggers the reporting requirement of subsection (A):

1. Isoniazid,

2. Streptomycin,

3. Any rifamycin,

4. Pyrazinamide, or

5. Ethambutol.

C. A pharmacist or an administrator of a pharmacy shall submit a report required under subsection (A) by telephone; in a document sent by fax, delivery service, or mail; or through an electronic reporting system authorized by the Department and shall include in the report:

1. The following information about the individual for whom the drugs are prescribed:

a. Name,

b. Address,

c. Telephone number, and

d. Date of birth; and

2. The following information about the prescription:

a. The name of the drugs prescribed,

b. The date of prescription, and

c. The name and telephone number of the prescribing health care provider.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-206. Local Health Agency Responsibilities Regarding Communicable Disease Reports

A. The Department shall supply each local health agency with a form to be used by a health care provider or an administrator of a health care institution or correctional facility when making a written report required under R9-6-202(A) or (B) and Table 1. The form shall contain space to provide the information required under R9-6-202(C). A local health agency shall distribute copies of the form as needed to health care providers and administrators of health care institutions and correctional facilities.

B. For each reported case or suspect case of unexplained death with a history of fever, the local health agency for the jurisdiction in which the death occurred shall:

1. Within one working day after receiving a report, submit to the Department:

a. The following information about the deceased individual:

i. Name;

ii. Residential address;

iii. Date of birth;

iv. Race and ethnicity;

v. Whether the individual resided on or off a reservation and, if on, the name of the reservation;

vi. Gender;

vii. Whether the individual was pregnant and, if so, the outcome of the pregnancy; and

viii. Occupation;

b. The approximate date and time of death;

c. A description of the setting where the death occurred and of the circumstances leading up to the time of death;

d. The name, residential address, and telephone number of a family member of the deceased individual who can serve as a point of contact; and

e. The name, address, and telephone number of the individual making the report; and

2. Within 30 days after receiving the report, submit to the Department a written report of the epidemiologic investigation required under Article 3, including:

a. The name and date of birth of the deceased individual;

b. The date of any specimen collection;

c. Identification of each type of specimen collected;

d. Identification of each type of laboratory test completed;

e. A description of the laboratory test results, including quantitative results if available;

f. If an autopsy was completed, the autopsy results;

g. A hypothesis or conclusion as to the cause of death; and

h. Specific recommendations for preventing future deaths, if applicable.

C. Within 10 working days after completing an epidemiologic investigation of a case as required under Article 3, if Article 3 does not require a local health agency to complete a disease-specific form, a local health agency shall submit to the Department a written report of the epidemiologic investigation, including:

1. A communicable disease report containing the information described in R9-6-202(C),

2. A description of all laboratory test results contributing to the diagnosis,

3. A classification of the case according to the case definition,

4. A description of the case's outcome,

5. A description of the case's specific risk factors for the disease or a hypothesis of how the case acquired the infection that resulted in the disease, and

6. A description of how the local health agency provided or arranged for the case to receive education about the nature of the disease and how to prevent transmission or limit disease progression.

D. A local health agency shall forward to the Department each original report received by the local health agency, including any report of disease in a nonresident of the jurisdiction who is or has been diagnosed or treated in the jurisdiction, within five working days after receipt and shall specify the current status for each report, as follows:

1. Case confirmed and epidemiologic investigation not required,

2. Case confirmed and report from epidemiologic investigation attached,

3. Case under investigation, or

4. No action taken.

E. Within 30 days after completing an epidemiologic investigation of an outbreak as required under this Chapter, a local health agency shall submit to the Department a written summary of the investigation, including:

1. A description of the outbreak location;

2. The date and time that the local health agency was notified of the outbreak;

3. A description of how the local health agency verified the outbreak;

4. The number of individuals reported to be ill during the outbreak;

5. The number of individuals estimated to be at risk for illness as a result of the outbreak;

6. The specific case definition used;

7. A summary profile of the signs and symptoms;

8. An epidemiologic curve;

9. A copy of the laboratory evidence collected, including all laboratory test results;

10. Hypotheses of how the outbreak occurred;

11. A description of the control measures used and the dates they were implemented;

12. The conclusions drawn based upon the results of the investigation;

13. Specific recommendations for preventing future outbreaks; and

14. The name, address, and telephone number of the individual making the report.

F. A local health agency shall immediately notify the Department when the local health agency receives a report or reports indicating an outbreak or suspect outbreak. The notification shall include:

1. The location of the outbreak or suspect outbreak;

2. If known, the number of cases and suspect cases;

3. The date that the outbreak was reported or dates that cases suggestive of an outbreak were reported;

4. The setting of the outbreak or suspect outbreak;

5. The name of the disease suspected or known to be the subject of the outbreak or suspect outbreak; and

6. The name and telephone number of an individual at the local health agency who can serve as a point of contact regarding the outbreak or suspect outbreak.

Historical Note

Section renumbered from R9-6-203 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-207. Federal or Tribal Entity Reporting

A. To the extent permitted by law, a federal or tribal entity shall comply with the reporting requirements in this Article as follows:

1. If the federal or tribal entity is participating in the diagnosis or treatment of an individual, the federal or tribal entity shall comply with the reporting requirements for a health care provider;

2. If the federal or tribal entity is operating a facility that provides health care services, the federal or tribal entity shall comply with the reporting requirements for an administrator of a health care institution;

3. If the federal or tribal entity is operating a correctional facility, the federal or tribal entity shall comply with the reporting requirements for an administrator of a correctional facility;

4. If the federal or tribal entity is operating a clinical laboratory, the federal or tribal entity shall comply with the reporting requirements for a clinical laboratory director;

5. If the federal or tribal entity is operating a facility that provides pharmacy services, the federal or tribal entity shall comply with the reporting requirements for an administrator of a pharmacy;

6. If the federal or tribal entity is operating a facility that provides child care services, the federal or tribal entity shall comply with the reporting requirements for an administrator of a child care establishment; and

7. If the federal or tribal entity is operating a facility that offers instruction to students in a grade level from kindergarten through grade 12, a college or university, a "private vocational program" as defined in A.R.S. § 32-3001, or an institution that grants a "degree" as defined in A.R.S. § 32-3001, the federal or tribal entity shall comply with the reporting requirements for an administrator of a school.

B. For the purposes of this Section, "federal or tribal entity" means a person operating within this state, whether on federal or tribal land or otherwise, under the authority of an agency or other administrative subdivision of the federal government or a tribal nation and who is:

1. Licensed as a doctor of allopathic, naturopathic, osteopathic, or homeopathic medicine under the laws of this or another state;

2. Licensed as a physician assistant under the laws of this or another state;

3. Licensed as a registered nurse practitioner under the laws of this or another state;

4. Licensed as a dentist under the laws of this or another state;

5. Operating a facility that provides health care services;

6. Operating a correctional facility;

7. Operating a clinical laboratory;

8. Operating a facility that provides pharmacy services;

9. Operating a facility that provides child care services; or

10. Operating a facility that offers instruction to students in a grade level from kindergarten through grade 12, a college or university, a "private vocational program" as defined in A.R.S. § 32-3001, or an institution that grants a "degree" as defined in A.R.S. § 32-3001.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-208. Reserved

R9-6-209. Reserved

R9-6-210. Reserved

R9-6-211. Renumbered

Historical Note

Renumbered to R9-6-201 effective May 2, 1991 (Supp. 91-2).

R9-6-212. Renumbered

Historical Note

Renumbered to R9-6-201(C) effective May 2, 1991 (Supp. 91-2).

R9-6-213. Renumbered

Historical Note

Renumbered to R9-6-202 effective May 2, 1991 (Supp. 91-2).

R9-6-214. Renumbered

Historical Note

Renumbered to R9-6-203 effective May 2, 1991 (Supp. 91-2).

ARTICLE 3. CONTROL MEASURES FOR COMMUNICABLE DISEASES
AND INFESTATIONS

R9-6-301. Definitions

In this Article, unless otherwise specified:

1. "Blood bank" means a facility where human whole blood or a blood component is collected, prepared, tested, processed, or stored, or from which human whole blood or a blood component is distributed.

2. "Blood center" means a mobile or stationary facility that procures human whole blood or a blood component that is transported to a blood bank.

3. "Close contact" means an individual who has spent a sufficient amount of time with and who has been within a sufficient proximity to a case to have sustained significant exposure to an infectious agent.

4. "Concurrent disinfection" means the application of measures to disinfect inanimate objects or surfaces after the discharge of body fluids from the body of an infected individual or after the contamination of articles with body fluids.

5. "Contact precautions" means, in addition to Standard precautions, placement of a case in a private room or a cohort room and use of a gown and gloves when in the proximity of the case.

6. "Contaminated" means to have come in contact with a disease-causing agent or toxin.

7. "Counseling and testing site" means a health facility offering clients HIV counseling and HIV-related testing that meets the standards established in Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Revised Guidelines for HIV Counseling, Testing, and Referral (November 2001), published in Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Pub. No. RR-19, 50 Morbidity and Mortality Weekly Report (November 9, 2001), incorporated by reference, on file with the Department and the Office of the Secretary of State, and available at http://www.cdc.gov/mmwr/ or ftp://ftp.cdc.gov/pub/Publications/mmwr/ or from Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333. This incorporation by reference contains no future editions or amendments.

8. "Disinfection" means killing or inactivating communicable-disease-causing agents on inanimate objects by directly applied chemical or physical means.

9. "Disinfestation" means any physical, biological, or chemical process to reduce or eliminate undesired arthropod or rodent populations.

10. "Droplet precautions" means, in addition to Standard precautions, placement of a case in a private room or cohort room and use of a mask when working within three feet of the case.

11. "Follow-up" means the practice of investigating and monitoring cases, carriers, contacts, or suspect cases to detect, treat, or prevent disease.

12. "Identified individual" means an individual named by a case as an individual who may have been exposed through sexual contact with the case and for whom a case provides information that enables the local health agency to locate the individual.

13. "Incapacitated adult" means an individual older than 18 years of age for whom a guardian has been appointed by a court of competent jurisdiction.

14. "Midwife" has the same meaning as in A.R.S. § 36-751.

15. "Pediculocide" means a shampoo or cream rinse manufactured and labeled for controlling head lice.

16. "Person in charge" means the individual present at a food establishment who is responsible for the food establishment's operation at the time in question.

17. "Plasma center" means a facility where the process of plasmapheresis or another form of apheresis is conducted.

18. "Pupil" means a student attending a school, as defined in A.R.S. § 15-101.

19. "School district personnel" means individuals who work for a "school district," as defined by A.R.S. § 15-101, whether within a classroom or other setting and whether as employees, contractors, or volunteers.

20. "Sexual contact" means vaginal intercourse, anal intercourse, fellatio, or cunnilingus.

21. "State health officer" means the Director of the Department or the Director's designee.

Historical Note

Adopted effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Former R9-6-301 repealed; new R9-6-301 renumbered from R9-6-103 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-302. Local Health Agency Control Measures

A local health agency shall:

1. Review each report received under Article 2 for completeness and accuracy;

2. Confirm each diagnosis;

3. Conduct epidemiologic and other investigations required by this Chapter;

4. Facilitate notification of known contacts;

5. Conduct surveillance;

6. Determine trends;

7. Implement control measures, quarantines, isolations, and exclusions as required by the Arizona Revised Statutes and this Chapter; and

8. Disseminate surveillance information to health care providers.

Historical Note

Renumbered from R9-6-702 and amended effective October 19, 1993 (Supp. 93-4). Former R9-6-302 renumbered to R9-6-304; new R9-6-302 renumbered from R9-6-204 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-303. Food Establishment Control Measures

The person in charge of a food establishment shall ensure compliance with all food handler exclusion requirements in this Article or ordered by a local health agency.

Historical Note

Renumbered from R9-6-703 and amended effective October 19, 1993 (Supp. 93-4). Former R9-6-303 renumbered to R9-6-305; new R9-6-303 made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-304. Amebiasis

A. Case control measures:

1. A local health agency shall exclude an amebiasis case from working as a food handler, caring for children in or attending a child care establishment, or caring for patients or residents in a health care institution until treatment with an amebicide is completed and two successive fecal examinations negative for amoebae are obtained from specimens collected at least 24 hours apart.

2. A local health agency shall conduct an epidemiologic investigation of each reported amebiasis case or suspect case.

B. Contact control measures: A local health agency shall exclude each amebiasis contact with symptoms of amebiasis from working as a food handler until two successive fecal examinations negative for amoebae are obtained from specimens collected at least 24 hours apart.

Historical Note

Renumbered from R9-6-704 and amended effective October 19, 1993 (Supp. 93-4). Former R9-6-304 renumbered to R9-6-306; new R9-6-304 renumbered from R9-6-302 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-305. Anthrax

A. Case control measures: A local health agency shall conduct an epidemiologic investigation of each reported anthrax case or suspect case.

B. Environmental control measures: A local health agency shall provide or arrange for sterilization by dry heating or incineration of objects contaminated by Bacillus anthracis.

Historical Note

Renumbered from R9-6-705 and amended effective October 19, 1993 (Supp. 93-4). Former R9-6-305 renumbered to R9-6-308; new R9-6-305 renumbered from R9-6-303 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-306. Aseptic Meningitis: Viral

Outbreak control measures: A local health agency shall conduct an epidemiologic investigation of each reported outbreak of viral aseptic meningitis.

Historical Note

Renumbered from R9-6-706 and amended effective October 19, 1993 (Supp. 93-4). Former R9-6-306 renumbered to R9-6-309; new R9-6-306 renumbered from R9-6-304 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-307. Basidiobolomycosis

Case control measures: A local health agency shall conduct an epidemiologic investigation of each reported basidiobolomycosis case or suspect case.

Historical Note

Former Section R9-6-115, Paragraph (5), renumbered and amended as R9-6-707 effective January 28, 1987 (Supp. 87-1). Former R9-6-307 renumbered to R9-6-310; new R9-6-307 made by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-308. Botulism

A. Case control measures: A local health agency shall conduct an epidemiologic investigation of each reported botulism case or suspect case. For each botulism case who is an infant, a local health agency shall complete and submit to the Department within 10 working days after completing an epidemiologic investigation:

1. A Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Form CDC 52.73, "Guide to Investigation of Infant Botulism" (September 1987), which is incorporated by reference, on file with the Department, and available from the Centers for Disease Control and Prevention, Division of Bacterial and Mycotic Diseases, 1600 Clifton Rd., NE, Mailstop C-09, Atlanta, GA 30333, including no future editions or amendments; or

2. An electronic equivalent to Form CDC 52.73 provided by the Department.

B. Environmental control measures: An individual in possession of food known to be contaminated by Clostridium botulinum shall boil the contaminated food for 10 minutes and then discard it. An individual in possession of utensils known to be contaminated by Clostridium botulinum shall boil the contaminated utensils for 10 minutes before reuse or disposal.

Historical Note

Adopted effective October 19, 1993 (Supp. 93-4). Amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Former R9-6-308 renumbered to R9-6-311; new R9-6-308 renumbered from R9-6-305 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-309. Brucellosis

Case control measures: A local health agency shall conduct an epidemiologic investigation of each reported brucellosis case or suspect case. For each brucellosis case, a local health agency shall complete and submit to the Department within 10 working days after completing an epidemiologic investigation:

1. A Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Form CDC 4.153, "Brucellosis Case Surveillance Report" (November 1980), which is incorporated by reference, on file with the Department, and available from the Centers for Disease Control and Prevention, Division of Bacterial and Mycotic Diseases, 1600 Clifton Rd., NE, Mailstop C-09, Atlanta, GA 30333, including no future editions or amendments; or

2. An electronic equivalent to Form CDC 4.153 provided by the Department.

Historical Note

Renumbered from R9-6-708 and amended effective October 19, 1993 (Supp. 93-4). Amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Former R9-6-309 renumbered to R9-6-312; new R9-6-309 renumbered from R9-6-306 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-310. Campylobacteriosis

A. Case control measures:

1. A local health agency shall exclude a campylobacteriosis case from working as a food handler, caring for children in or attending a child care establishment, or caring for patients or residents in a health care institution until:

a. One of the following occurs:

i. A culture negative for Campylobacter spp. is obtained from a stool specimen, or

ii. Treatment is maintained for 24 hours; and

b. Diarrhea has resolved.

2. A local health agency shall conduct an epidemiologic investigation of each reported campylobacteriosis case or suspect case. For each campylobacteriosis case, a local health agency shall complete and submit to the Department within 10 working days after completing an epidemiologic investigation Exhibit III-A or an electronic equivalent to Exhibit III-A provided by the Department.

B. Contact control measures: A local health agency shall exclude each campylobacteriosis contact with diarrhea from working as a food handler until a culture negative for Campylobacter spp. is obtained from a stool specimen or diarrhea has resolved.

Historical Note

Renumbered from R9-6-709 and amended effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Former R9-6-310 renumbered to R9-6-313; new R9-6-310 renumbered from R9-6-307 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-311. Chancroid (Haemophilus ducreyi)

A. Case control measures: A local health agency shall conduct an epidemiologic investigation of each reported chancroid case or suspect case, confirming the stage of the disease.

B. Contact control measures: When a chancroid case has named an identified individual, a local health agency shall:

1. Notify the identified individual of chancroid exposure;

2. Offer or arrange for the identified individual to receive treatment for chancroid; and

3. Counsel the identified individual about the following:

a. The characteristics of chancroid,

b. The syndrome caused by chancroid,

c. Measures to reduce the likelihood of transmitting chancroid to another, and

d. The need to notify individuals with whom the identified individual has had sexual contact within a time period determined based upon the stage of the disease.

Historical Note

Repealed effective May 2, 1991 (Supp. 91-2). New Section R9-6-311 renumbered from R9-6-710 and amended effective October 19, 1993 (Supp. 93-4). Former R9-6-311 renumbered to R9-6-314; new R9-6-311 renumbered from R9-6-308 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-312. Chlamydia Infection, Genital

A. Case control measures: The Department shall review each Chlamydia infection case report for completeness, accuracy, and need for follow-up.

B. Contact control measures: If an individual who may have been exposed to Chlamydia through sexual contact with a Chlamydia infection case seeks treatment for Chlamydia infection from a local health agency, the local health agency shall offer or arrange for treatment.

Historical Note

Adopted effective October 19, 1993 (Supp. 93-4). Former R9-6-312 renumbered to R9-6-315; new R9-6-312 renumbered from R9-6-309 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-313. Cholera

A. Case control measures:

1. A local health agency shall exclude a cholera case from working as a food handler, caring for patients or residents in a health care institution, or caring for children in or attending a child care establishment until two successive cultures negative for Vibrio cholerae are obtained from fecal specimens collected at least 24 hours apart and at least 48 hours after discontinuing antibiotics.

2. A local health agency shall conduct an epidemiologic investigation of each reported cholera case or suspect case. For each cholera case, a local health agency shall complete and submit to the Department within 10 working days after completing an epidemiologic investigation:

a. A Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Form CDC 52.79, "Cholera and Other Vibrio Illness Surveillance Report" (July 2000), which is incorporated by reference, on file with the Department, and available from the Centers for Disease Control and Prevention, Division of Bacterial and Mycotic Diseases, 1600 Clifton Rd., NE, Mailstop C-09, Atlanta, GA 30333, including no future editions or amendments; or

b. An electronic equivalent to Form CDC 52.79 provided by the Department.

B. Contact control measures: A local health agency shall:

1. Provide follow-up for each cholera contact for five days after exposure; and

2. Exclude each cholera contact with symptoms of cholera from working as a food handler, caring for patients or residents in a health care institution, or caring for children in or attending a child care establishment until two successive cultures negative for Vibrio cholerae are obtained from fecal specimens collected at least 24 hours apart.

Historical Note

Renumbered from R9-6-711 and amended effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Former R9-6-313 renumbered to R9-6-316; new R9-6-313 renumbered from R9-6-310 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-314. Coccidioidomycosis (Valley Fever)

Outbreak control measures: A local health agency shall conduct an epidemiologic investigation of each reported outbreak of coccidioidomycosis.

Historical Note

Adopted effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Former R9-6-314 renumbered to R9-6-318; new R9-6-314 renumbered from R9-6-311 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-315. Colorado Tick Fever

Case control measures: A local health agency shall conduct an epidemiologic investigation of each reported Colorado tick fever case or suspect case.

Historical Note

Renumbered from R9-6-712 and amended effective October 19, 1993 (Supp. 93-4). Former R9-6-315 renumbered to R9-6-321; new R9-6-315 renumbered from R9-6-312 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).

R9-6-316. Conjunctivitis: Acute

Case control measures: An administrator of a school or child care establishment, either personally or through a representative, shall exclude an acute conjunctivitis case from attending the school or child care establishment until the symptoms of acute conjunctivitis subside or treatment for acute conjunctivitis is initiated and maintained for 24 hours.

Historical Note

Renumbered from R9-6-713 and amended effective October 19, 1993 (Supp. 93-4). Amended effective April 4, 1997 (Supp. 97-2). Former R9-6-316 repealed; new R9-6-316 renumbered from R9-6-313 and amended by final rulemaking at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).