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 adults aged 18 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 Health Section as follows:
(1) The report shall be made on the surveillance forms provided by or approved by the Occupational Health Section and shall include the following information:
(A) The name, address, telephone number, date of birth, social security number, race, 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 SENSOR Program, Division of Public Health, 1915 Mail Service Center, Raleigh, North Carolina 27699-1915.
(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, age, gender, race, and social security number;
(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‑458;
Eff. January 4, 1994.