10A NCAC 41C .0703 METHOD OF REPORTING
(a) When a physician makes a report of a disease, illness, injury, or elevated blood lead level for persons aged 16 years of age and above pursuant to G.S. 130A‑456 or a medical facility makes such a report pursuant to G.S. 130A‑457, the report shall be made to the Occupational and Environmental Epidemiology Branch as follows:
(1) The report shall be made on the surveillance forms provided by the Occupational and Environmental Epidemiology Branch and shall include the following information:
(A) The name, address, telephone number, date of birth, race, ethnicity, gender, and job title of the person;
(B) The name, address, telephone number, and type of business of the person's employer;
(C) The name of the disease, illness, or injury being reported; and
(D) The name, address, and telephone number of the physician, laboratory, or medical facility.
(2) Surveillance forms are available from the Occupational and Environmental Epidemiology Branch, Epidemiology Section, Division of Public Health, N.C. Department of Health and Human Services, 1912 Mail Service Center, Raleigh, NC 27699-1912. The form can also be requested by calling (919) 707-5900.
(b) When a laboratory providing diagnostic service in North Carolina reports laboratory findings related to occupational disease or illness pursuant to G.S. 130A‑458, the report shall include:
(1) the specimen collection date;
(2) the person's name, date of birth, gender, race, and ethnicity;
(3) the submitting physician/employer name, address, and telephone number; and
(4) the name, address, and telephone number of the laboratory.
History Note: Authority G.S. 130A‑455; 130A-456; 130A‑458;
Eff. January 4, 1994;
Readopted Eff. January 1, 2020.