W. Va. Code R. § 64-94-4 - Registry Contents

4.1. Information to be reported. Reports from health care providers and facilities, as defined in section 2 of this rule shall include the individual's:

4.1.a. Last name, first name and middle initial;

4.1.b. Birth date;

4.1.c. Gender;

4.1.d. Last four digits of the Social security number;

4.1.e. Maiden name( if female);

4.1.f. Race/ethnicity;

4.1.g. Address, including street, city, county, and zip code;

4.1.h. Contact information including secondary contacts;

4.1.i. Brief medical history;

4.1.j. History of Alzheimer's disease and related disorders;

4.1.k. Physician's name;

4.1.l. Physician's contact information including address, phone, fax numbers, or email; and

4.1.m. Other information considered relevant for policy and planning relative to Alzheimer's disease and related disorders.

4.2. Content and design of forms. The content and design of all forms for the Registry shall be consistent with the minimum information necessary to maintain the registry, pursuant to the provisions of W. Va. Code 16-5R-7(a).

4.3. Content and design of reports. The content and design of all reports for the Registry shall provide the most relevant and complete summary statistics and information required to advise policy development, pursuant to the provisions of W. Va. Code § 16-5R-7(c).

Notes

W. Va. Code R. § 64-94-4