(1) The purpose of this chapter is to provide critical information to public health authorities to aid them in protecting and improving the public's health through prevention and control of infectious and noninfectious conditions. Public health authorities use the information gathered under this chapter to take appropriate action including, but not limited to:

(a) Treating ill persons;

(b) Providing preventive therapies for individuals who came into contact with infectious agents;

(c) Investigating and halting outbreaks;

(d) Removing harmful health exposures from the environment;

(e) Assessing broader health-related patterns, including historical trends, geographic clustering, and risk factors; and

(f) Redirecting program activities and developing policies based on broader health-related patterns.

(2) This chapter establishes notification requirements and standards for conditions that pose a threat to public health consistent with the purpose as established in this section.

The definitions, abbreviations, and acronyms in this section apply throughout this chapter unless the context clearly requires otherwise:

(1) "Animal case" means an animal, alive or dead, with a diagnosis or suspected diagnosis of a notifiable condition in Table Agriculture-1 of WAC 246-101-805 made by a veterinarian licensed under chapter 18.92 RCW, veterinary medical facility licensed under chapter 18.92 RCW, or veterinary laboratory as defined under chapter 16.70 RCW based on clinical criteria, or laboratory criteria, or both.

(2) "Animal case report" means the data and other supporting information submitted by the Washington state department of agriculture to the department under WAC 246-101-810 for an individual animal with a notifiable condition.

(3) "Associated death" means a death resulting directly or indirectly from a case of the specified condition, with no period of complete recovery between the onset of the condition and death.

(4) "Blood lead level" means a measurement of lead content in whole blood.

(5) "Board" means the Washington state board of health.

(6) "Business day" means any day that the department is open for business.

(7) "Carrier" means a person harboring a specific infectious agent without developing symptoms and serving as a potential source of infection to others.

(8) "Case" means a person, alive or dead, with a diagnosis or suspected diagnosis of a condition made by a health care provider, health care facility, or laboratory based on clinical criteria, or laboratory criteria, or both, such as the Centers for Disease Control and Prevention, National Notifiable Diseases Surveillance System, Council of State and Territorial Epidemiologists case definitions.

(9) "Case report" means the data and other supporting information submitted by a health care provider or health care facility to public health authorities under WAC 246-101-115 for an individual patient with a notifiable condition.

(10) "Communicable disease" means an infectious disease that can be transmitted from a person, animal, or object to a person by direct or indirect means including, but not limited to, transmission through an intermediate host or vector, food, water, or air.

(11) "Condition" means an infectious or noninfectious condition as these terms are defined in this chapter.

(12) "Department" or "DOH" means the Washington state department of health.

(13) "Health care-associated infection" means a localized or systemic condition that results from adverse reaction to the presence of an infectious agent or its toxins and that was not present or incubating at the time of admission to the health care facility.

(14) "Health care facility" means:

(a) Assisted living facilities licensed under chapter 18.20 RCW;

(b) Birthing centers licensed under chapter 18.46 RCW;

(c) Nursing homes licensed under chapter 18.51 RCW;

(d) Hospitals licensed under chapter 70.41 RCW;

(e) Adult family homes licensed under chapter 70.128 RCW;

(f) Ambulatory surgical facilities licensed under chapter 70.230 RCW;

(g) Private establishments licensed under chapter 71.12 RCW;

(h) Enhanced service facilities licensed under chapter 70.97 RCW;

(i) Clinics, or other settings where one or more health care providers practice; and

(j) In reference to a sexually transmitted infection, other settings as defined in chapter 70.24 RCW.

(15) "Health care provider" means any person having direct or supervisory responsibility for the delivery of health care whose scope of practice allows for diagnosis and treatment of notifiable conditions and who is:

(a) Licensed or certified in this state under Title 18 RCW; or

(b) Military personnel providing health care within the state regardless of licensure.

(16) "Immediately" means without delay, twenty-four hours a day, seven days a week.

(a) For health care providers and health care facilities, immediately means at the time a case is identified;

(b) For laboratories, immediately means upon receiving a presumptive or final test result; or

(c) For state agencies and local health jurisdictions, immediately means upon receiving notification of a case.

(17) "Infection control measures" means the management of an infected person, or of a person suspected to be infected, and others in a manner to prevent transmission of the infectious agent. Infection control measures include, but are not limited to, isolation and quarantine.

(18) "Infectious condition" means a disease caused by a pathogenic organism such as bacteria, virus, fungus, parasite, or infectious agent, and includes communicable disease and zoonotic disease.

(19) "Influenza, novel" or "influenza virus, novel" means a human infection with an influenza A virus subtype that is different from currently circulating human influenza subtypes. Novel subtypes include, but are not limited to, H2, H5, H7, and H9 subtypes.

(20) "Institutional review board" has the same meaning as defined in RCW 70.02.010.

(21) "Investigation report" means the data and other supporting information submitted by a local health jurisdiction to the department under WAC 246-101-513(2) for an individual patient with a notifiable condition.

(22) "Isolation" means the separation of infected or contaminated persons or animals from others to prevent or limit the transmission of the infectious agent or contaminant from those infected or contaminated to those who are susceptible to disease or who may spread the infectious agent or contaminant to others.

(23) "Laboratory" means any facility licensed as a test site or medical test site under chapter 70.42 RCW and chapter 246-338 WAC, including any laboratory that is granted a Clinical Laboratory Improvement Amendment (CLIA)-Waiver.

(24) "Laboratory director" means the person, or person's designee, by whatever title known, having the administrative responsibility for a laboratory.

(25) "Laboratory report" means the data and other supporting information submitted by a laboratory director to public health authorities under WAC 246-101-225 for an individual patient with a notifiable condition.

(26) "Local health jurisdiction" or "LHJ" means a county health department under chapter 70.05 RCW, city-county health department under chapter 70.08 RCW, or health district under chapter 70.46 RCW.

(27) "Local health officer" means the legally qualified physician who has been appointed as the health officer for the local health jurisdiction under chapter 70.05 RCW, or their designee.

(28) "MERS" means Middle East respiratory syndrome.

(29) "Noninfectious condition" means a disease or health concern that may lead to disease caused by nonpathogenic factors.

(30) "Notifiable condition" means a condition identified in Table HC-1 of WAC 246-101-101, Table Lab-1 of WAC 246-101-201, or Table Agriculture-1 of WAC 246-101-805, a case of which requires notification to public health authorities under this chapter; or a condition designated by the local health officer as notifiable within their jurisdiction under WAC 246-101-505 (4)(d). Notifiable condition does not include provisional conditions as defined under WAC 246-101-015.

(31) "Outbreak" means the occurrence of a condition in an area over a given period of time in excess of the expected number of occurrences including, but not limited to, foodborne disease, waterborne disease, and health care-associated infection.

(32) "Outbreak report" means the data and other supporting information about an outbreak that local health jurisdictions submit to the department under WAC 246-101-513(3) following investigation of an outbreak.

(33) "PCR" means polymerase chain reaction.

(34) "Pesticide poisoning" means the disturbance of function, damage to structure, or illness in humans resulting from the inhalation, absorption, ingestion of, or contact with any pesticide.

(35) "Presumptive" means a preliminary test result that has not yet been confirmed as a definitive result.

(36) "Principal health care provider" means the attending health care provider recognized as primarily responsible for diagnosis or treatment of a patient, or in the absence of such, the health care provider initiating diagnostic testing or treatment for the patient.

(37) "Provisional condition" means a condition the department has requested be reported under WAC 246-101-015.

(38) "Public health authorities" includes local health jurisdictions, the department, the department of labor and industries, the department of agriculture, sovereign tribal nations, and tribal epidemiology centers.

(39) "Quarantine" means the limitation of freedom of movement of persons or domestic animals that have been exposed to, or are suspected to have been exposed to, an infectious agent:

(a) For a period of time not longer than the longest usual incubation period of the infectious agent; and

(b) In a way to prevent effective contact with those not exposed.

(40) "Rapid screening test" or "RST" means a U.S. Food and Drug Administration-approved or authorized test that provides same day results and is suitable for obtaining presumptive test results. RST includes point-of-care testing.

(41) "Reference laboratory" means a laboratory licensed inside or outside of Washington state that receives a specimen from another licensed laboratory and performs one or more tests on that specimen.

(42) "School" has the same meaning as in RCW 28A.210.070.

(43) "SARS" means severe acute respiratory syndrome.

(44) "Secretary" means the secretary of the Washington state department of health.

(45) "Secure electronic data transmission" means electronic communication and accounts developed and maintained to prevent unauthorized access, loss, or compromise of sensitive information including, but not limited to, secure file transfer, secure email, secure facsimile, a health information exchange authorized under RCW 41.05.039, and secure electronic disease surveillance system.

(46) "Secure electronic disease surveillance system" means the secure electronic data transmission system maintained by the department and used by local health jurisdictions to submit notifications, investigation reports, and outbreak reports under this chapter.

(47) "Sexually transmitted disease" or "sexually transmitted infection" means a bacterial, viral, fungal, or parasitic disease or condition which is usually transmitted through sexual contact, including:

(a) Acute pelvic inflammatory disease;

(b) Chancroid;

(c) Chlamydia trachomatis infection;

(d) Genital and neonatal Herpes simplex;

(e) Genital human papilloma virus infection;

(f) Gonorrhea;

(g) Granuloma inguinale;

(h) Hepatitis B infection;

(i) Human immunodeficiency virus (HIV) infection;

(j) Lymphogranuloma venereum;

(k) Nongonococcal urethritis (NGU); and

(l) Syphilis.

(48) "Specimen" means material associated or suspected to be associated with a notifiable condition including, but not limited to, isolates, blood, serum, stool, urine, tissue, respiratory secretions, swab, other body fluid, or an environmental sample.

(49) "State health officer" means the person appointed by the secretary under RCW 43.70.020 to serve as statewide health officer, or, in the absence of such appointment, the secretary.

(50) "Veterinarian" means an individual licensed and practicing under provisions of chapter 18.92 RCW.

(51) "Zoonotic disease" means an infectious condition of animals that can cause disease when transmitted to humans.

(1) Health care providers and health care facilities shall include the patient's ethnicity as defined in subsection (4) of this section, the patient's race as defined in subsection (5) of this section, and the patient's preferred language as defined in subsection (6) of this section when:

(a) Ordering a laboratory test for a notifiable condition under WAC 246-101-105 (6)(a); and

(b) Submitting a case report under WAC 246-101-115.

(2) Laboratory directors shall include the patient's ethnicity as defined in subsection (4) of this section, the patient's race as defined in subsection (5) of this section, and the patient's preferred language as defined in subsection (6) of this section when:

(a) Referring a specimen of a notifiable condition to a reference laboratory for testing under WAC 246-101-205; and

(b) Submitting a specimen to the Washington state public health laboratories under WAC 246-101-215; and

(c) Submitting a laboratory report under WAC 246-101-225.

(3) A local health officer shall include the patient's ethnicity as defined in subsection (4) of this section, the patient's race as defined in subsection (5) of this section, and the patient's preferred language as defined in subsection (6) of this section when submitting an investigation report under WAC 246-101-513.

(4) Patient's ethnicity shall be identified by the patient and reported using one of the following categories:

(a) Hispanic, Latino/a, Latinx;

(b) Non-Hispanic, Latino/a, Latinx;

(c) Patient declined to respond; or

(d) Unknown.

(5) Patient's race shall be identified by the patient and reported using one or more of the following categories; if the patient self-identifies as more than one race, each race shall be reported:

(a) Afghan;

(b) Afro-Caribbean;

(c) Alaska Native;

(d) American Indian;

(e) Arab;

(f) Asian;

(g) Asian Indian;

(h) Bamar/Burman/Burmese;

(i) Bangladeshi;

(j) Bhutanese;

(k) Black or African American;

(l) Central American;

(m) Cham;

(n) Chicano/a or Chicanx;

(o) Chinese;

(p) Congolese;

(q) Cuban;

(r) Dominican;

(s) Egyptian;

(t) Eritrean;

(u) Ethiopian;

(v) Fijian;

(w) Filipino;

(x) First Nations;

(y) Guamanian or Chamorro;

(z) Hmong/Mong;

(aa) Indigenous-Latino/a or Indigenous-Latinx;

(bb) Indonesian;

(cc) Iranian;

(dd) Iraqi;

(ee) Japanese;

(ff) Jordanian;

(gg) Karen;

(hh) Kenyan;

(ii) Khmer/Cambodian;

(jj) Korean;

(kk) Kuwaiti;

(ll) Lao;

(mm) Lebanese;

(nn) Malaysian;

(oo) Marshallese;

(pp) Mestizo;

(qq) Mexican/Mexican American;

(rr) Middle Eastern;

(ss) Mien;

(tt) Moroccan;

(uu) Native Hawaiian;

(vv) Nepalese;

(ww) North African;

(xx) Oromo;

(yy) Pacific Islander;

(zz) Pakistani;

(aaa) Puerto Rican;

(bbb) Romanian/Rumanian;

(ccc) Russian;

(ddd) Samoan;

(eee) Saudi Arabian;

(fff) Somali;

(ggg) South African;

(hhh) South American;

(iii) Syrian;

(jjj) Taiwanese;

(kkk) Thai;

(lll) Tongan;

(mmm) Ugandan;

(nnn) Ukrainian;

(ooo) Vietnamese;

(ppp) White;

(qqq) Yemeni;

(rrr) Other race;

(sss) Patient declined to respond; and

(ttt) Unknown.

(6) Patient's preferred language shall be identified by the patient and reported using one of the following categories:

(a) Amharic;

(b) Arabic;

(c) Balochi/Baluchi;

(d) Burmese;

(e) Cantonese;

(f) Chinese (unspecified);

(g) Chamorro;

(h) Chuukese;

(i) Dari;

(j) English;

(k) Farsi/Persian;

(l) Fijian;

(m) Filipino/Pilipino;

(n) French;

(o) German;

(p) Hindi;

(q) Hmong;

(r) Japanese;

(s) Karen;

(t) Khmer/Cambodian;

(u) Kinyarwanda;

(v) Korean;

(w) Kosraean;

(x) Lao;

(y) Mandarin;

(z) Marshallese;

(aa) Mixteco;

(bb) Nepali;

(cc) Oromo;

(dd) Panjabi/Punjabi;

(ee) Pashto;

(ff) Portuguese;

(gg) Romanian/Rumanian;

(hh) Russian;

(ii) Samoan;

(jj) Sign languages;

(kk) Somali;

(ll) Spanish/Castilian;

(mm) Swahili/Kiswahili;

(nn) Tagalog;

(oo) Tamil;

(pp) Telugu;

(qq) Thai;

(rr) Tigrinya;

(ss) Ukrainian;

(tt) Urdu;

(uu) Vietnamese;

(vv) Other language;

(ww) Patient declined to respond; or

(xx) Unknown.

(1) For notifiable conditions in this chapter, the state health officer may request additional data components to be submitted with each case report, laboratory report, specimen submittal, investigation report, outbreak report, or animal case report; submission of additional laboratory test results; and submission of additional specimens.

(2) For a condition the state health officer determines should be provisionally reported, the state health officer may request submission of case reports, laboratory reports, investigation reports, outbreak reports, and animal case reports; and submission of specimens.

(3) The state health officer may request information under subsection (1) or (2) of this section when they:

(a) Determine additional information in case reports, laboratory reports, specimen submittals, investigation reports, outbreak reports, or animal case reports, or additional submission of specimens for a notifiable condition is needed in order to properly prevent and control the condition; or

(b) Determine that provisional submission of case reports, laboratory reports, investigation reports, outbreak reports, animal case reports, or specimens for a condition other than a notifiable condition is likely to contribute to understanding the condition, provide information necessary to prevent and control the condition, and improve public health.

(4) The state health officer shall notify the board and local health officers of their request and, as applicable, health care providers, laboratory directors, health care facilities, and the department of agriculture of the request. The notification must include the:

(a) Determination required under subsection (3) of this section including documentation supporting the determination; and

(b) As applicable, the requested:

(i) Test results;

(ii) Timeline for notification;

(iii) Public health authority to be notified;

(iv) Content of notification;

(v) Means of notification;

(vi) Specimen submission;

(vii) Timeline for specimen submission; and

(viii) Specimen submittal documentation for the condition.

(5) Within forty months of the state health officer's designation of a provisional condition or additional information for a notifiable condition, the state health officer shall:

(a) Discontinue the request made under subsection (1) or (2) of this section; or

(b) Request that the board consider revising this chapter to make the request made under subsection (1) or (2) of this section a rule requirement, and provide an estimate of the probable benefits and probable costs.

(6) If the state health officer chooses to discontinue their request, the state health officer shall notify the board and local health officers and, as applicable, health care providers, laboratory directors, health care facilities, and the department of agriculture that the applicable provisional condition or requested additions to the notifiable condition have been discontinued.

(7) If the state health officer makes a request to the board under subsection (5)(b) of this section and the board determines that it will not revise this chapter, the state health officer's request for additional information, specimen submittal, or provisional notification under subsection (4) of this section is automatically discontinued and the board or state health officer shall provide notice to local health officers and, as applicable, health care providers, laboratory directors, health care facilities, and the department of agriculture that the applicable provisional condition or requested additions to the notifiable condition has been discontinued.

(1) For the purposes of this section:

(a) "Local health jurisdiction" means where the patient resides, or, in the event the patient's residence cannot be determined, the local health jurisdiction in which the patient received treatment.

(b) "Unexplained critical illness or death" means a severe illness or death with infectious hallmarks, but no known etiology, in a previously healthy person one to forty-nine years of age excluding those with chronic medical conditions such as malignancy, diabetes, AIDS, or cirrhosis.

(2) The conditions identified in Table HC-1 are notifiable to public health authorities under this table and this chapter.

Table HC-1 (Conditions Notifiable by Health Care Providers and Health Care Facilities)

(1) Unless a health care facility has assumed the notification duties of the principal health care provider under subsection (4) of this section, the principal health care provider shall submit case reports:

(a) To the required public health authority under Table HC-1 of WAC 246-101-101 and the requirements of WAC 246-101-110 and 246-101-115, and this section;

(b) To the local health jurisdiction as required by the local health officer within that health officer's jurisdiction under WAC 246-101-505 (4)(d).

(2) A health care facility shall submit case reports:

(a) To the required public health authority under Table HC-1 of WAC 246-101-101 and the requirements of WAC 246-101-110 and 246-101-115, and this section that occur or are treated in their facilities.

(b) To the local health jurisdiction as required by the local health officer within that health officer's jurisdiction under WAC 246-101-505 (4)(d).

(3) This section does not require a health care provider or a health care facility to confirm the absence of cases of conditions listed in Table HC-1 of WAC 246-101-101.

(4) A health care facility may assume the notification requirements established in this chapter for a health care provider practicing within the health care facility.

(5) A health care facility shall not assume the notification requirements established in this chapter for a laboratory that is a component of the health care facility.

(6) Health care providers and health care facilities shall:

(a) Provide the laboratory with the following information for each test ordered for a notifiable condition:

(i) Patient's first and last name;

(ii) Patient's physical address including zip code;

(iii) Patient's date of birth;

(iv) Patient's sex;

(v) Patient's ethnicity, as required in WAC 246-101-011(4);

(vi) Patient's race, as required in WAC 246-101-011(5);

(vii) Patient's preferred language, as required in WAC 246-101-011(6);

(viii) For hepatitis B tests, pregnancy status (pregnant/not pregnant/unknown) of patients twelve to fifty years of age;

(ix) Patient's best contact telephone number;

(x) For blood lead level tests, medicaid status of patients less than seventy-two months of age;

(xi) Requesting health care provider's name;

(xii) Requesting health care provider's phone number;

(xiii) Address where patient received care;

(xiv) Specimen type;

(xv) Specimen collection date; and

(xvi) Condition being tested for.

(b) For specimens associated with a notifiable condition sent to a laboratory outside of Washington state, provide the laboratory with the information under (a) of this subsection, Table Lab-1 of WAC 246-101-201, 246-101-220, and 246-101-225.

If the presumptive or final test results from an out-of-state laboratory are consistent with Table Lab-1 of WAC 246-101-201, the health care provider or health care facility shall either:

(i) Confirm the laboratory submitted the laboratory report consistent with WAC 246-101-220 and 246-101-225; or

(ii) Submit the presumptive and final test results from the out-of-state laboratory with the case report according to the requirements of this chapter.

(c) Cooperate with public health authorities during investigation of:

(i) A case of a notifiable condition; and

(ii) An outbreak or suspected outbreak.

(d) Maintain an infection control program as described in WAC 246-320-176 for hospitals and WAC 246-330-176 for ambulatory surgical facilities;

(e) Provide adequate and understandable instruction in disease control measures to each patient who has been diagnosed with a case of a communicable disease, and to contacts who may have been exposed to the disease; and

(f) Notify the local health jurisdiction of:

(i) Known barriers that might impede or prevent compliance with disease control measures; and

(ii) Name, address, and other pertinent information for any case or carrier refusing to comply with disease control measures.

(7) Health care providers and health care facilities may provide health information, demographic information, or infectious or noninfectious condition information in addition to the information required under this chapter when the provider or facility determines that the additional information will aid the public health authority in protecting and improving the public's health through prevention and control of infectious and noninfectious conditions.

(8) When a health care provider or health care facility submits information under subsection (7) of this section, they shall submit the information under the requirements of WAC 246-101-110.

Health care providers and health care facilities shall:

(1) Submit a case report for each case under Table HC-1 of WAC 246-101-101, 246-101-115, and this section by secure electronic data transmission;

(2) Submit a case report to the department instead of the local health jurisdiction when:

(a) The local health jurisdiction is closed or representatives of the local health jurisdiction are unavailable:

(i) For immediately notifiable conditions; or

(ii) At the time an outbreak or suspected outbreak of a communicable disease occurs.

(b) The patient who is the subject of the case report resides outside Washington state and is a visitor to Washington state;

(3) Call the public health authority designated for the condition in Table HC-1 of WAC 246-101-101 immediately and confirm receipt of a case report for conditions designated as:

(a) Immediately notifiable; or

(b) Notifiable within twenty-four hours if the case report is submitted outside of the local health jurisdiction's normal business hours.

(1) Health care providers and health care facilities shall provide the following information in each case report:

(a) Patient's first and last name;

(b) Patient's physical address including zip code;

(c) Patient's date of birth;

(d) Patient's sex;

(e) Patient's ethnicity, as required in WAC 246-101-011(4);

(f) Patient's race, as required in WAC 246-101-011(5);

(g) Patient's preferred language, as required in WAC 246-101-011(6);

(h) For hepatitis B acute or chronic infection case reports, pregnancy status (pregnant/not pregnant/unknown) of patients twelve to fifty years of age;

(i) Patient's best contact telephone number;

(j) Name of the principal health care provider;

(k) Telephone number of the principal health care provider;

(l) Address where patient received care;

(m) Name of the person providing the report;

(n) Telephone number of the person providing the report;

(o) Diagnosis or suspected diagnosis of the condition; and

(p) Pertinent laboratory results, if available.

(2) Both the local health officer and the state health officer may request additional information of epidemiological or public health value when conducting a case investigation or to otherwise prevent and control a specific notifiable condition.

(1) Health care providers, health care facilities, and health care facility personnel shall maintain the confidentiality of patient health care information consistent with chapter 70.02 RCW and any other applicable confidentiality laws.

(2) Health care providers and health care facilities shall:

(a) Establish and implement policies and procedures to maintain confidentiality of health care information.

(b) When conducting a clinical HIV research project, report the identity of an individual participating in the project unless:

(i) The project has been approved by an institutional review board; and

(ii) The project has a system in place to remind referring health care providers of notification requirements under this chapter.

An individual or entity including, but not limited to, health care providers and health care facilities, that conduct an RST for any of the following conditions, meets the definition of a laboratory under this chapter, and shall comply with WAC 246-101-201 through 246-101-230:

(1) Blood lead level testing;

(2) Hepatitis C (acute infection);

(3) Hepatitis C (chronic infection);

(4) HIV infection; or

(5) Novel coronavirus (COVID-19).

(1) For the purposes of Table Lab-1:

(a) "At least annually" means deidentified negative screening results may be submitted in a single report no less than once per year, but may be submitted more frequently as a single report or as individual screening results.

(b) "Deidentified negative screening result" means an initial test result that indicates the absence of disease, and that has personally identifiable information removed from it using the Health Insurance Portability and Accountability Act of 1996 Safe Harbor method defined in 45 C.F.R. 164.514. A deidentified negative screening result does not include a negative test result associated with a previous positive test result, such as a negative nucleic acid or viral load test that is performed after a positive antibody or antigen test.

(c) "LHJ" means where the patient resides, or, in the event that patient residence cannot be determined, the local health jurisdiction in which the ordering health care provider practices, or the local health jurisdiction in which the laboratory operates.

(d) "Within two business days" means specimens must be in transit to the Washington state public health laboratories within two business days of:

(i) Completing a test and the specimen being ready for packaging; or

(ii) Receiving a request from a local health jurisdiction or the department, provided the specimen is still available at the time of the request.

(2) This chapter does not require a laboratory to:

(a) Test for agents (conditions) or speciate if the laboratory does not perform the test as part of its normal work. A laboratory director shall only report a condition if it is identified as part of their normal testing protocols; or

(b) Retain specimens indefinitely in anticipation of a request from a local health jurisdiction or the department.

(3) The agents (conditions) in Table Lab-1 are notifiable by a laboratory director as indicated in Table Lab-1 and this chapter.

Table Lab-1 (Conditions Notifiable by Laboratory Directors)

(1) A laboratory director shall:

(a) Submit laboratory reports:

(i) To the local health jurisdiction or the department as required in Table Lab-1 of WAC 246-101-201, and under the requirements of WAC 246-101-220, 246-101-225, and this section; and

(ii) To the local health jurisdiction as required by the local health officer within that health officer's jurisdiction under WAC 246-101-505 (4)(d).

(b) Notify the department of conditions designated as notifiable to the local health jurisdiction when:

(i) A local health jurisdiction is closed or representatives of the local health jurisdiction are unavailable at the time a presumptive or final test result of an immediately notifiable condition occurs; or

(ii) The notifiable test result pertains to a patient who resides outside of and is visiting Washington state as indicated by information provided by the requesting health care provider or health care facility.

(c) Submit specimens required in Table Lab-1 of WAC 246-101-201 under the requirements of WAC 246-101-210 and 246-101-215, and this section;

(d) Cooperate with public health authorities during investigation of:

(i) The circumstances of a case of a notifiable condition; or

(ii) An outbreak or suspected outbreak of disease.

(2) A laboratory director may designate responsibility for working and cooperating with public health authorities to certain employees as long as designated employees are:

(a) Readily available; and

(b) Able to provide requested information in a timely manner.

(3) A laboratory director may refer a specimen of a notifiable condition to a reference laboratory for testing.

(4) When a laboratory director refers a specimen of a notifiable condition to a reference laboratory for testing, the laboratory director shall:

(a) Provide the reference laboratory with Table Lab-1 of WAC 246-101-201, 246-101-220, 246-101-225, and this section; and the following information for each specimen:

(i) Patient's first and last name;

(ii) Patient's physical address including zip code;

(iii) Patient's date of birth;

(iv) Patient's sex;

(v) Patient's ethnicity, as required in WAC 246-101-011(4);

(vi) Patient's race, as required in WAC 246-101-011(5);

(vii) Patient's preferred language, as required in WAC 246-101-011(6);

(viii) For hepatitis B virus tests, pregnancy status (pregnant, not pregnant, or unknown) of patients twelve to fifty years of age;

(ix) Patient's best contact telephone number;

(x) For blood lead level tests, medicaid status of patients less than seventy-two months of age;

(xi) Requesting health care provider's name;

(xii) Requesting health care provider's phone number;

(xiii) Address where patient received care;

(xiv) Name of submitting laboratory;

(xv) Telephone number of submitting laboratory;

(xvi) Specimen type;

(xvii) Specimen collection date;

(xviii) Date laboratory received specimen; and

(xix) Test method requested.

(b) Ensure the laboratory report is submitted appropriately either by:

(i) Arranging for the reference laboratory to submit the laboratory report under Table Lab-1 of WAC 246-101-201, 246-101-220, and 246-101-225; or

(ii) Submitting the laboratory report under Table Lab-1 of WAC 246-101-201, 246-101-220, and 246-101-225.

(5) A laboratory director may provide health information, demographic information, or infectious or noninfectious condition information in addition to the information required under this chapter when the provider or facility determines that the additional information will aid the appropriate public health authority in protecting and improving the public's health through prevention and control of infectious and noninfectious conditions.

(6) When a laboratory director submits information under subsection (4) of this section, they shall submit the information under the requirements of WAC 246-101-220.

(1) A laboratory director shall submit specimens as required in Table Lab-1 of WAC 246-101-201 in accordance with the requirements of this chapter.

(2) For test results notifiable to local health jurisdictions, the local health officer may temporarily waive specimen submission requirements and notify laboratories, including the Washington state public health laboratories, of the basis for the waiver, which requirements are being waived and how long the waiver will be in effect.

(3) A laboratory shall forward required specimens to:

Washington State Public Health Laboratories

Washington State Department of Health

1610 N.E. 150th Street

Shoreline, WA 98155

(4) The state health officer may designate additional laboratories as public health reference laboratories.

A laboratory director shall provide the following information with each specimen submitted under this chapter to the Washington state public health laboratories:

(1) Patient's first and last name;

(2) Patient's physical address including zip code;

(3) Patient's date of birth;

(4) Patient's sex;

(5) Patient's ethnicity, as required in WAC 246-101-011(4);

(6) Patient's race, as required in WAC 246-101-011(5);

(7) Patient's preferred language, as required in WAC 246-101-011(6);

(8) For hepatitis B virus, pregnancy status (pregnant, not pregnant, or unknown) of patients twelve to fifty years of age;

(9) Patient's best contact telephone number;

(10) Requesting health care provider's name;

(11) Requesting health care provider's phone number;

(12) Address where patient received care;

(13) Name of submitting laboratory;

(14) Telephone number of submitting laboratory;

(15) Specimen type;

(16) Specimen collection date;

(17) Date laboratory received specimen;

(18) Test method used; and

(19) Test result.

A laboratory director shall:

(1) Submit laboratory reports as required under this chapter by secure electronic data transmission.

(2) Call the local health jurisdiction in which the case occurred immediately and confirm receipt of a presumptive or final test result for a condition designated as:

(a) Immediately notifiable; or

(b) Notifiable within twenty-four hours when submitting the test result outside the local health jurisdiction's normal business hours.

(1) A laboratory director shall provide the following information in each laboratory report required under this chapter:

(a) Patient's first and last name;

(b) Patient's physical address including zip code;

(c) Patient's date of birth;

(d) Patient's sex;

(e) Patient's ethnicity, as required in WAC 246-101-011(4);

(f) Patient's race, as required in WAC 246-101-011(5);

(g) Patient's preferred language, as required in WAC 246-101-011(6);

(h) For hepatitis B virus, pregnancy status (pregnant, not pregnant, or unknown) of patients twelve to fifty years of age;

(i) Patient's best contact telephone number;

(j) For blood lead level, medicaid status of patients less than seventy-two months of age;

(k) Requesting health care provider's name;

(l) Requesting health care provider's phone number;

(m) Address where patient received care;

(n) Name of submitting laboratory;

(o) Telephone number of submitting laboratory;

(p) Specimen type;

(q) Specimen collection date;

(r) Date laboratory received specimen;

(s) Test method used; and

(t) Test result.

(2) The local health officer or the state health officer may request additional information of epidemiological or public health value when conducting a case investigation or otherwise for prevention and control of a specific notifiable condition.

(1) A laboratory shall maintain the confidentiality of health care information consistent with chapter 70.02 RCW and any other applicable confidentiality laws.

(2) A laboratory director shall establish and implement policies and procedures to maintain confidentiality of health care information.

(1) A veterinarian shall cooperate with public health authorities in their:

(a) Investigation of human and animal cases, outbreaks, suspected outbreaks, and clusters of zoonotic disease; and

(b) Implementation of infection control measures.

(2) Cooperation with public health authorities includes, but is not limited to:

(a) Providing information requested by the department or local health jurisdiction; and

(b) Following infection control measures for:

(i) Humans under chapter 246-100 WAC;

(ii) Dogs, cats, ferrets, and hybrids under WAC 246-100-197; and

(iii) Other animals under chapter 16.36 RCW.

(1) For the purposes of this section "food establishment" has the same meaning as defined and referenced under WAC 246-215-01115.

(2) The person in charge of a food establishment shall:

(a) Notify the local health jurisdiction of potential foodborne disease as required in WAC 246-215-02215.

(b) Cooperate with public health authorities in their investigation and control of cases, outbreaks, and suspected outbreaks. This includes, but is not limited to, the release of the name and other pertinent information about food handlers diagnosed with a notifiable condition or other communicable disease to the public health authority.

(c) Not release identifying information about food handlers with a notifiable condition or other communicable disease to other employees or the general public.

(1) For the purposes of this section "child care facility" means an agency that regularly provides early childhood education and early learning services for a group of children for less than twenty-four hours a day and is subject to licensing under chapter 74.15 or 43.216 RCW, or both.

(2) A child care facility shall:

(a) Notify the local health jurisdiction of cases, outbreaks, and suspected outbreaks of notifiable conditions in Table HC-1 of WAC 246-101-101 that may be associated with the child care facility.

(b) Consult with a health care provider or the local health jurisdiction for information about the control and prevention of infectious conditions, as necessary.

(c) Cooperate with public health authorities in their investigation and control of cases, outbreaks, and suspected outbreaks that may be associated with the child care facility.

(d) Establish and implement policies and procedures to maintain confidentiality related to health care information in their possession.

A school shall:

(1) Notify the local health jurisdiction of cases, outbreaks, and suspected outbreaks of notifiable conditions in Table HC-1 of WAC 246-101-101 that may be associated with the school.

(2) Cooperate with the local health jurisdiction in monitoring influenza.

(3) Consult with a health care provider or the local health jurisdiction for information about the control and prevention of infectious conditions, as necessary.

(4) Cooperate with public health authorities in their investigation and control of cases, outbreaks, and suspected outbreaks that may be associated with the school.

(5) Release identifying information only to other individuals responsible for protecting the health and well-being of the public through control of disease.

(6) Establish and implement policies and procedures to maintain confidentiality related to health care information in their possession.

(1) Members of the general public shall cooperate with:

(a) Public health authorities in their investigation and control of cases, outbreaks, and suspected outbreaks; and

(b) Implementation of infection control measures.

(2) Members of the general public may notify the local health jurisdiction of any case, outbreak, or suspected outbreak.

(1) A local health officer or local health jurisdiction shall:

(a) Review and determine appropriate action for:

(i) Each case of a notifiable condition submitted to the local health jurisdiction;

(ii) Any condition considered a threat to public health; and

(iii) Each outbreak or suspected outbreak of disease submitted to the local health jurisdiction, and request assistance from the department in carrying out any of these investigations when necessary.

(b) Establish a system at the local health jurisdiction for maintaining confidentiality of records under WAC 246-101-515;

(c) Notify health care providers, laboratories, and health care facilities within the local health jurisdiction of requirements in this chapter;

(d) Notify the department of cases of conditions notifiable to the local health jurisdiction under this chapter;

(e) Notify the principal health care provider named in the case report or laboratory report, if possible, prior to initiating a case investigation;

(f) Allow laboratories to contact the health care provider ordering the diagnostic test before initiating patient contact if requested and the delay is unlikely to jeopardize public health; and

(g) Conduct investigations and institute infection control measures in accordance with chapter 246-100 WAC.

(2) The local health jurisdiction may:

(a) Adopt alternate arrangements for meeting the requirements under this chapter through cooperative agreement between the local health jurisdiction and any health care provider, laboratory, or health care facility. The alternative must provide the same level of public health protection as the reporting requirement for which an alternative is sought;

(b) Receive health information, demographic information, and infectious or noninfectious condition information in addition to that required under this chapter from health care providers, health care facilities, laboratories, the department of agriculture, and the department of labor and industries when the entity submitting the information determines that the additional information will aid the public health authority in protecting and improving the public's health through prevention and control of infectious and noninfectious conditions.

(3) When the local health jurisdiction receives information under subsection (2)(b) of this section, the local health jurisdiction shall handle the information under the requirements of WAC 246-101-515.

(4) Each local health officer may:

(a) Carry out additional steps necessary to verify a diagnosis reported by a health care provider;

(b) Require any person suspected of having a notifiable condition to submit to examinations necessary to determine the presence or absence of the condition;

(c) Investigate any case of a notifiable condition or other infectious or noninfectious condition, if deemed necessary; and

(d) Require the notification of additional conditions of public health importance occurring within the jurisdiction of the local health officer.

(1) A local health jurisdiction shall:

(a) Maintain a twenty-four-hour telephone number to receive confirmation calls of case reports or laboratory reports submitted under this chapter for:

(i) Immediately notifiable conditions; and

(ii) Conditions designated as notifiable within twenty-four hours.

(b) Notify the department immediately using either telephone or secure electronic data transmission:

(i) Upon receiving a case report or laboratory report for a condition that is immediately notifiable to the local health jurisdiction under this chapter, excluding Meningococcal disease, invasive (Neisseria meningitides); Shiga toxin-producing E. coli (STEC)/enterohemorrhagic E. coli; and Vaccinia; and

(ii) Of an outbreak or suspected outbreak within their jurisdiction;

(c) Notify the department using a secure electronic disease surveillance system within three business days of receiving a case report or laboratory report for a condition that is not immediately notifiable to the local health jurisdiction under this chapter;

(d) If after submitting a notification to the department, the local health officer determines no further investigation is necessary, indicate in the secure electronic disease surveillance system that no further investigation is warranted within three business days of the determination.

(e) Immediately reassign cases to the department upon determining the patient who is the subject of the case:

(i) Is a resident of another local health jurisdiction; or

(ii) Resides outside Washington state.

(f) Submit an investigation report to the department using a secure electronic disease surveillance system for each case report or laboratory report received by the local health jurisdiction for which the local health officer determined an investigation was necessary:

(i) Within seven days of completing the investigation for any condition notifiable to the local health jurisdiction; or

(ii) Within twenty-one days of receiving the case report or laboratory report if the investigation is not complete.

(g) Submit an outbreak report to the department using secure electronic data transmission within seven days of completing an outbreak investigation. The department may waive this requirement if notification under (b)(ii) of this subsection provided sufficient information.

(2) The local health officer shall confirm that each case is based on clinical criteria, or laboratory criteria, or both prior to submitting the investigation report to the department. These criteria include, but are not limited to, the Centers for Disease Control and Prevention, National Notifiable Diseases Surveillance System, Council of State and Territorial Epidemiologists case definitions.

A local health officer shall provide the following information for each notification, investigation report, and outbreak report submitted under WAC 246-101-510:

(1) Notifications must include:

(a) Patient's first and last name;

(b) Patient's notifiable condition;

(c) Date local health jurisdiction was notified;

(d) Condition symptom onset date (preferred), or alternatively, diagnosis date;

(e) Patient's date of birth; and

(f) Patient's sex.

(2) Investigation reports must include:

(a) Patient's first and last name;

(b) Patient's date of birth;

(c) Patient's ethnicity, as required in WAC 246-101-011(4);

(d) Patient's race, as required in WAC 246-101-011(5);

(e) Patient's preferred language, as required in WAC 246-101-011(6);

(f) For hepatitis B acute or chronic infection investigation reports, pregnancy status (pregnant, not pregnant, or unknown) of patients twelve to fifty years of age;

(g) Investigation start date;

(h) Investigation completion date;

(i) Initial notification source;

(j) Hospitalization status of patient;

(k) Whether the patient died during this illness;

(l) Probable geographic region of exposure (i.e., county, state, or country other than the United States of America);

(m) Travel out of the country (as applicable);

(n) Whether the case is associated with an ongoing outbreak investigation; and

(o) The data used to verify the case meets clinical criteria, or laboratory criteria, or both. These criteria include, but are not limited to, the Centers for Disease Control and Prevention, National Notifiable Diseases Surveillance System, Council of State and Territorial Epidemiologists case definitions.

(3) Outbreak reports must include:

(a) Organism or suspected organism;

(b) Source or suspected source; and

(c) Number of persons infected and potentially exposed.

(1) Local health officers and local health jurisdiction employees shall maintain the confidentiality of health care information consistent with chapter 70.02 RCW, RCW 42.56.360(2), and any other applicable confidentiality laws.

(2) Local health officers or local health jurisdictions shall establish and implement confidentiality policies and procedures related to employee handling of health care information.

(3) Local health officers shall:

(a) Require all local health jurisdiction employees with access to health care information to sign confidentiality agreements;

(b) Retain current signed confidentiality agreements;

(c) Reference in confidentiality agreements the penalties for violation of chapter 70.24 RCW and administrative actions that may be taken by the local health jurisdiction if the confidentiality agreement is violated; and

(d) Renew confidentiality agreements at least annually.

(1) The local health officer and local health jurisdiction personnel shall maintain individual case reports, laboratory reports, investigation reports, and other data and supporting information for AIDS and HIV as confidential records consistent with the requirements of RCW 70.02.220 and any other applicable confidentiality laws.

(2) The local health officer and local health jurisdiction personnel shall:

(a) Use identifying information of individuals tested, diagnosed, or reported with HIV only:

(i) To contact the individual tested, diagnosed, or reported with HIV to provide test results or refer the individual to social and medical services; or

(ii) To contact persons who have been identified as sex or injection equipment-sharing partners; or

(iii) To link with other name-based public health disease registries when doing so will improve ability to provide needed care services and disease prevention, provided that the identity or identifying information of the individual tested, diagnosed, or reported with HIV is not disclosed outside of the local health jurisdiction; or

(iv) As specified in WAC 246-100-072; or

(v) To provide case reports, laboratory reports, or investigation reports to the department; or

(vi) To conduct investigations under RCW 70.24.022 or 70.24.024.

(b) Within ninety days of completing an investigation report, or of receiving a complete investigation report from another public health authority:

(i) Destroy case reports, laboratory reports, investigation reports, and other data and supporting identifying information on individuals tested, diagnosed, or reported with HIV received as a result of this chapter. If an investigation is not conducted for a case, then the identifying information for that case shall be destroyed within ninety days of receiving a complete HIV case report or laboratory report; or

(ii) Maintain HIV case reports, laboratory reports, investigation reports, and other data and supporting information in secure systems consistent with the 2011 DataSecurity and Confidentiality Guidelinesfor HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action published by the Centers for Disease Control and Prevention.

(3) The local health officer shall:

(a) Describe the secure systems in written policies and review the policies annually;

(b) Limit access to case report, laboratory report, investigation report, and other data and supporting information to local health jurisdiction staff who need the information to perform their job duties;

(c) Maintain a current list of local health jurisdiction staff with access to case report, laboratory report, investigation report, and other data and supporting information;

(d) Enclose physical locations containing electronic or paper copies of surveillance data in a locked, secured area with limited access and not accessible by window;

(e) Store paper copies or electronic media containing surveillance information inside locked file cabinets that are in the locked, secured area;

(f) Destroy information by either shredding it with a crosscut shredder or appropriately sanitizing electronic media prior to disposal;

(g) Store files or databases containing confidential information on either stand-alone computers with restricted access or on networked drives with proper access controls, encryption software, and firewall protection;

(h) Protect electronic communication of confidential information by encryption standards and review the standards annually; and

(i) Make available locking briefcases for transporting confidential information.

(4) The local health officer and local health jurisdiction staff shall:

(a) If maintaining identifying information on individuals tested, diagnosed, or reported with HIV more than ninety days following completion of an investigation report or receipt of a complete investigation report from another public health authority, cooperate with the department in biennial review of system security measures described in subsection (2)(b) of this section.

(b) Not disclose identifying information received as a result of this chapter unless:

(i) Explicitly and specifically required to do so by state or federal law;

(ii) Permitted under RCW 70.02.220; or

(iii) Authorized by written patient consent.

(5) Local health officers shall investigate potential breaches of the confidentiality of HIV identifying information by health jurisdiction employees. The local health officer shall report all breaches of confidentiality to the state health officer for review and appropriate action.

A local health jurisdiction shall:

(1) Maintain a surveillance system for influenza during the influenza season which may include:

(a) Monitoring of excess school absenteeism;

(b) Requesting information from health care providers and health care facilities regarding influenza-like illnesses; and

(c) Monitoring workplace absenteeism and other mechanisms.

(2) Request submission of appropriate clinical specimens from a sample of patients with influenza-like illness to the Washington state public health laboratories or other laboratory approved by the state health officer.

(1) The department shall:

(a) Upon request, provide consultation and technical assistance to local health jurisdictions, the department of labor and industries, and the department of agriculture when they are investigating notifiable conditions.

(b) Upon request, provide consultation and technical assistance to health care providers, laboratories, health care facilities, and others required to comply with this chapter.

(c) Develop, maintain, and make available for local health jurisdictions guidance on investigation and control measures for notifiable conditions.

(d) Make case report, laboratory report, specimen submittal forms, and investigation report forms available to local health jurisdictions, health care providers, laboratories, health care facilities, and others required to comply with this chapter.

(e) Maintain a twenty-four hour telephone number to receive:

(i) Confirmation calls for immediately notifiable condition case reports and laboratory reports; and

(ii) Notification of immediately notifiable conditions including outbreaks and suspected outbreaks from local health jurisdictions.

(f) Develop routine data dissemination mechanisms that describe and analyze notifiable conditions case investigations and data in accordance with WAC 246-101-615.

(g) Conduct investigations and institute infection control measures as necessary.

(h) Document the known environmental, human, and other variables associated with a case of pesticide poisoning.

(i) Report the results of the pesticide poisoning investigation to the principal health care provider named in the case report or laboratory report and to the local health officer in whose jurisdiction the case occurred.

(2) The department may:

(a) Negotiate alternatives for meeting requirements under this chapter through cooperative agreement between the department and any health care provider, laboratory, health care facility, or state agency. An alternative must provide the same level of public health protection as the reporting requirement for which an alternative is sought.

(b) Under an approved cooperative agreement, relieve a health care provider, laboratory, or health care facility of the duty to notify a local health jurisdiction, if the department can consolidate and submit notifications to the local health jurisdiction within the time frame for notification required under Table HC-1 of WAC 246-101-101 and Table Lab-1 of WAC 246-101-201.

(c) Receive health care information, demographic information, and infectious or noninfectious condition information in addition to that required under this chapter from health care providers, health care facilities, laboratories, and public health authorities.

(3) When the department receives information under subsection (2)(c) of this section, the department shall handle the information under the requirements of WAC 246-101-610.

(1) The state health officer and department employees shall maintain the confidentiality of health care information in accordance with chapter 70.02 RCW, RCW 42.56.360(2), and any other applicable confidentiality laws.

(2) The state health officer shall establish and implement confidentiality policies and procedures related to employee handling of health care information under this chapter.

(3) The state health officer or department shall:

(a) Require all department employees, contractors, and others with access to health information to sign confidentiality agreements;

(b) Retain current signed confidentiality agreements;

(c) Reference in confidentiality agreements the penalties for violation of chapter 70.24 RCW and administrative actions that may be taken by the department if the confidentiality agreement is violated; and

(d) Renew confidentiality agreements at least annually.

The department shall:

(1) Distribute periodic epidemiological summary reports and an annual review of public health issues to local health officers, local health jurisdictions, and the department of labor and industries.

(2) Make available case investigation documentation for notifiable conditions reported directly to the department to local health officers or the department of labor and industries within twenty-four hours of receipt by the department.

(3) Make other data necessary to conduct case investigations or epidemiological summaries available within two business days of a request from a public health authority.

(4) Periodically distribute statistical summaries and epidemiological studies based on individual case reports, laboratory reports, and investigation reports if no patient is identified or identifiable.

The department shall:

(1) Maintain a surveillance system for monitoring antibiotic resistant disease that may include:

(a) Development of a sentinel network of laboratories to provide information regarding antibiotic resistant disease; and

(b) Sample checks with health care providers and health care facilities regarding antibiotic resistant disease; and

(2) Request the health care providers and laboratories submit specimens from a sample of patients with antibiotic resistant disease to the Washington state public health laboratories or other laboratory approved by the state health officer.

The following provisions apply to the use of AIDS and HIV notifiable conditions case reports, laboratory reports, and investigation reports, related information, and data and is in addition to the requirements established under WAC 246-101-610:

(1) Department personnel shall not disclose health care information related to a case of AIDS or HIV unless:

(a) Explicitly and specifically required to do so by state or federal law;

(b) Permitted under RCW 70.02.220; or

(c) Authorized by written patient consent.

(2) Department personnel may use HIV identifying information related to a case of AIDS or HIV only for the following purposes:

(a) Notification of persons identified as sex or injection equipment-sharing partners;

(b) Referral of the individual tested, diagnosed, or reported with HIV to social and medical services; and

(c) Linkage to other public health databases, provided that the identity or identifying information of the individual tested, diagnosed, or reported with HIV is not disclosed outside the department.

(3) The state health officer shall require and maintain signed confidentiality agreements with all department employees with access to HIV identifying information. The state health officer shall ensure these agreements are renewed at least annually and include reference to penalties for violation of chapter 70.24 RCW and administrative actions that may be taken by the department.

(4) The state health officer shall investigate potential breaches of the confidentiality of HIV identifying information by department employees. All breaches of confidentiality shall be reported to the state health officer or their authorized representative for review and appropriate action.

(5) The department shall maintain all HIV case reports, laboratory reports, and investigation reports and other data and supporting information in a name-based surveillance system solely for the purpose of complying with HIV reporting guidelines from the Centers for Disease Control and Prevention, and shall not disclose or otherwise use any information contained in that system for any other purpose, except as expressly permitted by this section.

(6) The department shall:

(a) Maintain HIV case reports, laboratory reports, and investigation reports and other data and supporting information in secure systems that meet the following standards and are consistent with the 2011 DataSecurity and Confidentiality Guidelinesfor HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action published by the Centers for Disease Control and Prevention;

(b) Describe secure systems in written policies and review the policies annually;

(c) Limit access to case report, laboratory report, and investigation report and other data and supporting information to department staff who need it to perform their job duties;

(d) Maintain a current list of department staff with access to case report, laboratory report, and investigation report and other data and supporting information;

(e) Enclose all physical locations containing electronic or paper copies of surveillance data in a locked, secured area with limited access and not accessible by window;

(f) Store paper copies or electronic media containing surveillance information inside locked file cabinets that are in the locked, secured area;

(g) Destroy information by either shredding it with a crosscut shredder or appropriately sanitizing electronic media prior to disposal;

(h) Store files or databases containing confidential information on either stand-alone computers with restricted access or on networked drives with proper access controls, encryption software, and firewall protection;

(i) Protect electronic communication of confidential information by encryption standards and review the standards annually;

(j) Use locking briefcases for transporting confidential information.

(7) The state health officer shall conduct a biennial review of local health jurisdictions system security measures described in WAC 246-101-520 that are maintaining records by name.

(8) When providing technical assistance to a local health jurisdiction, authorized representatives of the department may temporarily, and subject to the time limitations in WAC 246-101-520, receive the names of reportable cases of HIV infection for the purpose of partner notification, or special studies. Upon completion of the activities by representatives of the department, named information will be provided to the local health jurisdiction subject to the provisions of WAC 246-101-520.

(9) The state health officer shall provide a report to the state board of health if federal policy no longer requires that HIV surveillance systems be name-based.

The department shall enter into a data sharing agreement with the office of the superintendent of public instruction (the superintendent) to access data from databases maintained by the superintendent containing student health information for the purpose of identifying cases of autism or other conditions of public health interest.

(1) The department of labor and industries shall:

(a) Be responsible for the investigation of cases identified as notifiable to the department of labor and industries under this chapter;

(b) Provide consultation and technical assistance to local health jurisdictions and the department investigating cases;

(c) Upon request, provide consultation and technical assistance to health care providers, laboratories, health care facilities, and others required to notify and cooperate with public health authorities under this chapter;

(d) Provide technical assistance to businesses and labor organizations for understanding the use of notifiable conditions data collected and analyzed by the department of labor and industries; and

(e) Develop routine data dissemination mechanisms that describe and analyze notifiable conditions case investigations and data. These may include annual and monthly reports and other mechanisms for data dissemination as developed by the department of labor and industries.

(2) The department of labor and industries may:

(a) Receive data through cooperative agreement negotiated by the department of labor and industries and a health care provider, laboratory, or health care facility;

(b) Receive health information, demographic information, and infectious or noninfectious condition information in addition to that required under this chapter from health care providers and health care facilities.

(3) When the department of labor and industries receives information under this section, the department of labor and industries shall handle the information under the requirements of WAC 246-101-710.

(1) The director of the department of labor and industries and department of labor and industries employees shall maintain the confidentiality of health care information consistent with chapter 70.02 RCW, RCW 42.56.360(2), and any other applicable confidentiality laws.

(2) The director of the department of labor and industries shall:

(a) Require all employees, contractors, and others with access to health care information, to sign confidentiality agreements;

(b) Retain signed confidentiality agreements;

(c) Reference in confidentiality agreements the administrative actions that may be taken by the department of labor and industries if the confidentiality agreement is violated; and

(d) Renew confidentiality agreements at least annually.

The department of labor and industries shall:

(1) Distribute periodic epidemiological summary reports and an annual review of public health issues to local health officers, local health jurisdictions, and the department.

(2) Make available case investigation documentation for notifiable conditions reported directly to the department of labor and industries, data necessary to conduct case investigations, or epidemiological summaries to local health officers or the department within two business days of a request.

The department of labor and industries shall maintain a surveillance system for monitoring hospitalized burn patients that may include:

(1) Development of a sentinel network of burn treatment centers and hospitals to provide information regarding hospitalized burn patients; and

(2) Sample checks with health care providers and health care facilities regarding hospitalized burn patients.

(1) For the purposes of this section, "new, emerging, or unusual animal diseases or disease clusters with potential public health significance" means zoonotic or potentially zoonotic diseases in animals that have never or rarely been observed in Washington state (new or emerging); or appear in a new species or show evidence of higher pathogenicity than expected (unusual); or appear in a higher than expected number of animals clustered in time or space (cluster).

(2) The department of agriculture shall:

(a) Submit an individual animal case report for each animal case of a condition identified in Table Agriculture-1 to the department immediately upon being notified of the animal case using secure electronic data transmission under this table and this chapter.

(b) Call the department and confirm receipt immediately after submitting an animal case report for the following conditions:

(i) Anthrax (Bacillus anthracis or Bacillus cereus biovar anthracis);

(ii) Coronavirus infection (SARS-associated coronavirus, MERS-associated coronavirus, and Novel coronavirus (COVID-19));

(iii) Influenza virus in swine, influenza H5 and H7 (avian);

(iv) Livestock exposed to toxic substances which may threaten public health;

(v) Plague (Yersinia pestis);

(vi) Rabies (suspected human or animal);

(vii) Transmissible Spongiform Encephalopathy; and

(viii) Tularemia (Francisella tularensis).

Table Agriculture-1 (Conditions Notifiable by the Department of Agriculture)

(3) The department of agriculture may provide additional health information, demographic information, or infectious or noninfectious condition information than is required under this chapter to the department, local health jurisdiction, or both when it determines that the additional information will aid the public health authority in protecting and improving the public's health through prevention and control of infectious and noninfectious conditions.

(4) When the department of agriculture submits information under subsection (3) of this section, they shall submit the information using secure electronic data transmission.

(5) The department shall:

(a) Consult with the department of agriculture on all animal cases; and

(b) Notify the local health jurisdiction of animal cases submitted to the department.

(1) The state department of agriculture shall provide the following information for each animal case required under WAC 246-101-805:

(a) Animal species;

(b) Animal county of current residence;

(c) Diagnosis or suspected diagnosis of the condition;

(d) Contact name;

(e) Contact address;

(f) Contact telephone number;

(g) Pertinent laboratory data, if available; and

(h) Other information of public health significance collected under chapter 16-70 WAC.

(2) The local health officer or state health officer may request additional information of epidemiological or public health value when conducting a case investigation or for control of a notifiable condition.

(3) The department and local health jurisdiction shall handle all information received under this chapter including, but not limited to, information collected under this section and WAC 246-101-805 and information collected during case investigations or for investigation or control of a notifiable condition, consistent with applicable provisions of WAC 246-101-515, 246-101-610, and RCW 42.56.380.