Title of Rule: WAC 246-100-042 Reporting of blood lead levels.

Purpose: Adverse health effects resulting from elevated levels of lead in the blood has been acknowledged as a public health concern throughout the United States; epidemiologic investigation based on reports of the results of blood level tests may contribute to the understanding of the condition, its prevalence within the state of Washington, and especially the extent to which the condition affects both children and those who may be exposed to lead in the work place; rapid follow-up and appropriate management of potentially hazardous blood lead levels is necessary to assure safe public health, and assists in development of programs to prevent future lead overexposure.

Statutory Authority for Adoption: RCW 43.20.050.

Statute Being Implemented: RCW 43.20.050.

Summary: Removes the current expiration date from this section of WAC.

Reasons Supporting Proposal: Removal of the expiration date is necessary to assure continued operation of the data bases it is incorporated into the revised, integrated notifiable conditions system.

Name of Agency Personnel Responsible for Drafting: Greg Smith, Department of Health, P.O. Box 47815, Olympia, WA 98504-7815, (360) 236-3704; Implementation and Enforcement: Juliet VanEenwyk, Department of Health, P.O. Box 47812, Olympia, WA 98504-7812, (360) 236-4250.

Name of Proponent: Department of Health and Department of Labor and Industries, governmental.

Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Greg Smith, Washington State Department of Health, Office of Health Policy, P.O. Box 47815, Olympia, WA 98504-7815.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: Repeals the expiration date currently found in the rule. The reporting of increased blood lead level incidence will continue and ultimately be integrated into an integrated notifiable conditions surveillance system.

Proposal Changes the Following Existing Rules: Repeals the subsection describing the effective date.

February 24, 1999

Dennis Braddock, Chairman

State Board of Health

OTS-2802.1

AMENDATORY SECTION(Amending WSR 96-11-077, filed 5/13/96, effective 6/13/96)

WAC 246-100-042
Reporting of blood lead levels.

(1) ((Pursuant to WAC 246-100-041,)) The state health officer finds as follows:

(a) Adverse health effects resulting from elevated levels of lead in the blood has been acknowledged as a public health concern throughout the United States;

(b) Epidemiologic investigation based on reports of the results of blood level tests may contribute to the understanding of the condition, its prevalence within the state of Washington, and especially the extent to which the condition affects both children and those who may be exposed to lead in the work place;

(c) Rapid follow-up and appropriate management of potentially hazardous blood lead levels is necessary to assure safe public health, and assists in development of programs to prevent future lead over-exposure.

(2) Definitions. For the purposes of this section, the following words and phrases have the following meanings:

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

(b) "Reporting organization" means any medical laboratory which performs blood lead analysis at a site within the state of Washington; or any individual or organization which sends blood specimens to an out-of-state medical laboratory for lead testing, including in-state organizations which receive blood specimens from other in-state individuals or organizations, and then send those specimens to an out-of-state testing laboratory.

(c) "Testing laboratory" means a medical laboratory which performs a blood lead analysis.

(3) Reporting of blood lead levels.

(a) A reporting organization shall report all blood lead levels to the department of health, including those which are within normal limits.  The department of health shall send a copy of any report with a blood lead level equal to or greater than 40 micrograms per deciliter in adults, or equal to or greater than 10 micrograms per deciliter in children less than 15 years of age, to the local health department serving the jurisdiction in which the tested person resides.

(b) An individual or organization which sends blood specimens to an out-of-state laboratory may fulfill its reporting obligation by arranging for the testing laboratory to submit adequate reports.

(c) Reports shall be made in a format approved by the department.

(d) For blood lead levels equal to or greater than 40 micrograms per deciliter for adults, or equal to or greater than 20 micrograms per deciliter in children less than 15 years of age, the department must be notified by telephone, fax or mail within seven calendar days of the date test was performed, or if the test was performed by an out-of-state laboratory the date when the test result was received.  Telephone reports must be supplemented by a written report submitted no later than the fifth business day of the next month after the telephone contact.  In event age of patient is not known, the reporting organization shall follow the reporting schedule for children less than 15 years of age.

(e) For blood lead levels equal to or greater than 20 micrograms per deciliter in adults, or equal to or greater than 10 micrograms per deciliter in children less than 15 years of age, a report shall be made to the department no later than the fifth business day of the next month after the month in which the test was performed, or if the test was performed by an out-of-state laboratory the month during which the test result was received.  In the event age of patient is not known, the reporting organization shall follow the reporting schedule for children less than 15 years of age.

(f) Information to be reported to the department for blood lead levels specified in parts (3)(d) and (3)(e) shall include the following:

(i) Name of the person tested;

(ii) Name of the reporting organization;

(iii) Name of the testing laboratory;

(iv) Date specimen received;

(v) Blood lead level of person tested;

(vi) Name of health care provider ordering test;

(vii) Address or telephone number of health care provider ordering test, if available;

(viii) Date of birth or the age of the person tested, if available;

(ix) Sex of person tested, if available;

(x) Race and ethnicity of person tested, if available;

(xi) Whether blood specimen is venous or capillary, if available;

(xii) Free erythrocyte or zinc protoporphyrin or zinc protoporphyrin/heme ratio, if performed, when available;

(xiii) Address and occupation of the person tested, or if a child the parents' occupation, if available;

(xiv) Name, address and telephone number of the employer, or if a child the parents' employer, if available;

(g) For all other blood lead levels, the reporting organization must either report the information specified in (3)(f) or submit a monthly summary report by the fifth day of the next month.  The monthly summary must be categorized by the number of tests performed on specimens for children less than 15 years of age, the number of tests performed for individuals 15 years of age or older and the number of tests performed where patient's age is unknown.  In each category the number of tests must be sorted by one of the following geographic indicators: patient county of residence, or patient postal zip code of residence, or provider county of practice, or provider postal zip code of practice.

(4) Responsibilities of health care providers. Upon request of a representative of the department of health or the department of labor and industries, a health care provider who has ordered a blood lead test shall provide the patient's address and telephone number to the department of health or the department of labor and industries, and when known the following information:

(a) Circumstances of lead exposure;

(b) Employer's name, address and telephone number, or, if a child, the same information on the employers of the parents;

(c) Occupation of person tested, or, if a child, occupation of parents;

(d) Type of industry of employer of person tested, or, if a child, type of industry of the employers of the parents;

(e) Reason for drawing lead level.

(5) Confidentiality.

(a) The medical laboratory report and all patient information provided by the health care provider shall be maintained in a confidential manner as with other disease reports and are not subject to public disclosure in any form under which the patient may be identified.

(b) The department of labor and industries shall have full access to information collected pursuant to this section, for the purposes of research, analysis, and follow-up of blood lead levels.

(((6) This rule shall apply to tests performed for blood specimens drawn between May 15, 1996, and May 14, 1999.))

[Statutory Authority: RCW 43.20.050.  96-11-077, § 246-100-042, filed 5/13/96, effective 6/13/96.  Statutory Authority: RCW 43.20.050(3).  93-10-038 (Order 358), § 246-100-042, filed 4/28/93, effective 5/29/93.]

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