C. Except as described in subsection (D), for each case, suspect case, or occurrence for which a report on an individual is required by subsection (A) or (B) and Table 2.1, a
health care provider required to report 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. County of residence;
d. Whether the individual is living on a reservation and, if so, the name of the reservation;
e. Whether the individual is a member of a tribe and, if so, the name of the tribe;
e.f.Telephone number and, if available, email address;
f. g. Date of birth;
g. h. Race and ethnicity;
h. i. Gender;
i. j. If known, whether the individual is pregnant;
j. k. If known, whether the individual is alive or dead;
k. l. If known, the individual's occupation;
l. m. If the individual is attending or working in a school or child care establishment or working in a health care institution or food establishment, the name and address of the school, child care establishment, health care institution, or food establishment; and
m. n. For a case or suspect case who is a child requiring parental consent for treatment, the name, residential address, telephone number, and, if available, email address 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 the result of each laboratory test; and
h. A description of the laboratory test results, including quantitative values if available;
3. If reporting a case or suspect case of tuberculosis:
a. The site of infection;
b. A description of the treatment prescribed, if any, including:
i. The name of each drug prescribed,
ii. The dosage prescribed for each drug, and
iii. The date of prescription for each drug; and
c. Whether the diagnosis was confirmed by a laboratory and, if so, the name, address, and phone number of the laboratory;
4. If reporting a case or suspect case of chancroid, gonorrhea, or infection:
a. The gender of the individuals with whom the case or suspect case had sexual contact;
b. A description of the treatment prescribed, if any, including:
i. The name of each drug prescribed,
ii. The dosage prescribed for each drug, and
iii. The date of prescription for each drug;
c. The site of infection; and
d. Whether the diagnosis was confirmed by a laboratory and, if so, the name, address, and phone number of the laboratory;
5. If reporting a case or suspect case of syphilis:
a. The information required under subsection (C)(4); and
b. Identification of:
i. The stage of the disease, or
ii. Whether the syphilis is congenital;
6. If reporting a case of congenital syphilis in an infant, and in addition to the information required under subsection (C)(5) and A.R.S. §
36-694(A), the following information:
a. The name and date of birth of the infant's mother;
b. The residential address, mailing address, telephone number, and, if available, email address of the infant's mother;
c. The date and test results for the infant's mother of the prenatal syphilis test required in A.R.S. § 36-693; and
d. If the prenatal syphilis test of the infant's mother indicated that the infant's mother was infected with syphilis:
i. Whether the infant's mother received treatment for syphilis,
ii. The name and dosage of each drug prescribed to the infant's mother for treatment of syphilis and the date each drug was prescribed, and
iii. The name and phone number of the health care provider required to report who treated the infant's mother for syphilis;
7. The name, address, telephone number, and, if available, email address of the individual making the report; and
8. The name, address, telephone number, and, if available, email address of the:
a. Health care provider, if reporting under subsection (A) and different from the individual specified in subsection (C)(7); or
b. Health care institution or correctional facility, if reporting under subsection (B).
D. For each unexplained death with a history of fever, a health care provider required to report 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. Date of birth;
d. Telephone number; and
e. 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;
7. The name, address, and telephone number of the individual making the report; and
8. The name and address of the:
a. Health care provider, if reporting under subsection (A) and different from the individual specified in subsection (D)(7); or
b. Health care institution or correctional facility, if reporting under subsection (B).
E.D. For each outbreak for which a report is required by subsection (A) or (B) and Table 2.1, a
health care provider required to report 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 location and setting of the outbreak;
5. The name, address, telephone number, and, if available, email address of the individual making the report; and
6. The name, address, telephone number, and, if available, email address of the:
a. Health care provider, if reporting under subsection (A) and different from the individual specified in subsection (D)(5); or
b. Health care institution or correctional facility, if reporting under subsection (B).
F.E.When an HIV-related test is ordered for an infant who was perinatally exposed to HIV to determine whether the infant is infected with HIV, the health care provider who orders the HIV-related test or the administrator of the health care institution in which the HIV-related test is ordered shall:
1. Report the results of the infant's HIV-related test to the Department, either personally or through a representative, within five working days after receiving the results of the HIV-related test;
2. Include the following information in the report specified in subsection (E)(1):
a. The name and date of birth of the infant;
b. The residential address, mailing address, and telephone number of the infant;
c. The name and date of birth of the infant's mother;
d. The date of the last medical evaluation of the infant;
e. The types of HIV-related tests ordered for the infant;
f. The dates of the infant's HIV-related tests;
g. The results of the infant's HIV-related tests; and
h. The ordering health care provider's name, address, and telephone number; and
3. Include with the report specified in subsection (E)(1) a report for the infant's mother including the following information:
a. The name and date of birth of the infant's mother;
b. The residential address, mailing address, and telephone number of the infant's mother;
c. The date of the last medical evaluation of the infant's mother;
d. The types of HIV-related tests ordered for the infant's mother;
e. The dates of the HIV-related tests for the infant's mother;
f. The results of the HIV-related tests for the infant's mother;
g. What HIV-related risk factors the infant's mother has;
h. Whether the infant's mother delivered the infant vaginally or by C-section;
i. Whether the infant's mother was receiving HIV-related drugs prior to the infant's birth to reduce the risk of perinatal transmission of HIV; and
j. The name, address, and telephone number of the health care provider who ordered the HIV-related tests for the infant's mother.
G. Except as provided in Table 1, a health care provider required to report 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.