Statement of Basis and Purpose and Specific Statutory Authority for Amendments to Rules and Regulations Pertaining to Preparations for a Bioterrorist Event, Pandemic Influenza, or an Outbreak by a Novel and Highly Fatal Infectious Agent or Biological Toxin Adopted by the Colorado Board of Health on July 16, 2003 Basis and Purpose The rules are established to assure that local public health agencies and medical care providers in the state prepare for the complex and dramatic problems that would ensue following the recognition of a bioterrorist attack or an epidemic of pandemic influenza. The modifications to these rules build on the Preparedness rules adopted in 2001 that required county and district health departments, general and critical access hospitals, managed care organizations, regional emergency medical and trauma services advisory councils, and the Colorado Department of Public Health and Environment to develop preparedness plans. The modifications further the state's preparedness in the following ways: 1) Colorado's 39 public health nursing services, which serve 40 Colorado counties, are added to the entities required to develop notification lists, mutual aid agreements, and disaster emergency plans; 2) These regulations allow for flexibility in how each agency complies with the regulation; 3) These requirements build on the initial requirements and help assure that written plans are timely and effective. Specific Statutory Authority These rules are promulgated pursuant to the following statutes: Section 25-1-107(1)(a), C.R.S. and Sections 25-1-108(1)(c)(I) and (VI), C.R.S.

Preparations for a Bioterrorist Event, Pandemic Influenza, or an Outbreak by a Novel and Highly Fatal Infectious Agent or Biological Toxin In Section 24-32-2103, C.R.S., emergency epidemic is defined as cases of an illness or condition, communicable or noncommunicable, caused by bioterrorism, pandemic influenza, or novel and highly fatal infectious agents or biological toxins.

Regulation 1. Preparations by Local Public Health Agencies for an Emergency Epidemic 1. Each county and district public health department in this state subject to Section 25-1-501 et seq., C.R.S., is required to maintain an up-to-date notification list for an emergency epidemic. The list shall include general or critical access hospitals and the local emergency management agencies within the jurisdiction of the local public health department. The county or district public health department is required to conduct notification tests by a broadcast fax or another communications method for rapid notification at least twice per year.

2. Each county and district public health department in this state subject to Section 25-1-501 et seq., C.R.S., must sign a uniform mutual aid agreement with all other county and district public health departments and local health officers and county public health nursing services subject to Section 25-1-501 and 25-1-601 et seq., C.R.S., that obligates the county or district public health department and local health officers and county public health nursing services to render aid during an emergency epidemic unless the county, district public health department or local health officer and county public health nursing service needs to withhold resources necessary to provide reasonable protection for its own jurisdiction.

3. Each county and district public health department subject to Section 25-1-501 et seq., C.R.S., shall prepare a plan that the agency will implement when the governor declares a disaster emergency that is the result of an occurrence or imminent threat of an emergency epidemic. The plan must be able to be integrated with the Local Emergency Operations Plan(s) (LEOP) and the regional Public Health Preparedness and Response Plan. In addition, the county or district public health department shall provide a copy of the plan submitted pursuant to these regulations to the local offices of emergency management, to all general or critical access hospitals, and to all regional emergency medical and trauma services advisory councils within the jurisdiction of the local public health agency.

A) Organization and assignment of potentially all employees of the agency under an approved incident management system to work on controlling the emergency epidemic;

B) Having sufficient supplies and a process for the provision of personal protective equipment against bacterial and viral infections to county and district public health department employees who are assigned to work in areas where they may be exposed to ill and contagious persons or to infectious agents and waste; personal protective equipment shall, at a minimum, be the equipment and supplies used to achieve standard precautions;

C) Procurement and storage of at least five days supply of doxycycline or other antibiotic, as determined by the state health department, to be used as chemoprophylaxis for all county and district public health department employees. The plan shall include procurement of another antibiotic for a small number of county and district public health department employees who may be unable to take doxycycline;

D) An emergency, after-hours call-down list of persons who may be needed to organize and respond to an emergency epidemic; such list shall include persons with experience and E) Creation of an agency operations center within the agency that integrates with the local emergency operations center(s) or provide staffing to and participation in, activities of the local emergency operations center(s) for the purpose of (i) centralizing telephone, radio, and other electronic communications; (ii) compiling surveillance data; and (iii) maintaining a log of operations, decisions, resources, and orders necessary to control the epidemic;

F) Creation of a system or participation in an organized system to: (i) monitor the situation, including infection control, in each hospital within the agency's jurisdiction, doing this on- site as necessary and with assistance from the state health department as appropriate;

1. (ii) assess and manage infection control in the community outside of the hospital; and (iii) assess and manage, in coordination with hospitals and the county coroner, the disposal of human corpses;

G) The organization, staffing, security, and logistics of the distribution and delivery of antibiotics, antiviral medications, vaccines, or other medications needed in an emergency epidemic following the provisions of State Emergency Function #8, “Health, Medical and Mortuary”;

H) Identification of public spokespersons responsible for providing information to the citizens of their jurisdiction about how to protect themselves, what actions are being taken to control the epidemic, and when the epidemic is over; and I) Implementation of a back-up communications system that will allow communication with the local emergency response structure if and when telephone communications are disabled or not functioning;

Regulation 2. Preparations by General or Critical Access Hospitals for an Emergency Epidemic 1. Each general or critical access hospital in this state is required to maintain an up-to-date notification list for an emergency epidemic. The list shall include any satellite clinics, acute care facilities, or trauma centers operated by the hospital; offices of physicians and health care providers on the staff of the hospital, as available; and the local public health agency serving the county in which the hospital is located. The hospital is required to conduct notification tests by a broadcast fax or by another communications method for rapid notification at least twice per year.

2. Each general or critical access hospital in this state shall prepare a plan that the hospital will implement when the governor declares a disaster emergency that is the result of an occurrence or imminent threat of an emergency epidemic. The plan must be able to be integrated with the Local Emergency Operations Plan (LEOP). In addition, the general or critical access hospital shall provide a copy of the plan submitted pursuant to these regulations to the local public health agency, the local office of emergency management, and the regional emergency medical and trauma services advisory council in the region in which the hospital is located.

A) Organization, assignment and reassignment, under an approved incident management system of all medical staff and all employees of the hospital who may be called on to work during an emergency epidemic;

B) Having sufficient supplies and a process for the provision of personal protective equipment against bacterial and viral infections to all staff and employees who are assigned to work in areas where they may be exposed to ill and contagious persons or to infectious agents and waste; personal protective equipment shall, at a minimum, be the equipment and supplies used to achieve standard precautions;

C) Procurement and storage of at least five days supply of doxycycline or other antibiotic, as determined by the state health department, to be used as chemoprophylaxis for all employees. The plan shall include procurement of another antibiotic for a small number of employees who may be unable to take doxycycline;

D) An emergency call-down list of off-duty or retired health care providers who may be asked to work or volunteer as needed to respond to an emergency epidemic;

E) Creation of a facility operations center within the hospital that integrates with the local emergency operations center(s) or provide staffing to and participation in activities of the local emergency operations center(s) for the purposes of: (i) centralizing telephone, radio, and other electronic communications; (ii) compiling morbidity and mortality data including the number of patients, number of available beds, and number of working staff and employees; (iii) receiving and responding to executive orders of the governor regarding the emergency epidemic; and (iv) maintaining a log of operations, decisions, and resources necessary to maintain operations during the epidemic;

F) Creation of a system or participation in an organized system to assess and manage: (i) infection control within the hospital; and (ii) in coordination with local health departments and the county coroner, the disposal of human corpses;

G) Security of the hospital facility necessary to control large and unruly crowds;

H) Rapid transport of human diagnostic specimens to the state laboratory or as otherwise directed by the Colorado Department of Public Health and Environment;

I) Prevention of the spread of the epidemic disease within the hospital from persons ill with the condition causing the emergency epidemic to staff, employees, and other patients of the hospital; and J) Coordination and communication with other hospitals and pre-hospital care agencies to assure that patients with extreme, life-threatening or emergency medical or traumatic conditions are not unnecessarily diverted from the hospital.

Regulation 3. Preparations by Managed Care Organizations for an Emergency Epidemic 1. Each managed care organization licensed in this state by the division of insurance and that operates medical facilities or pharmacies is required to maintain an up-to-date notification list for an emergency epidemic. The list shall include any satellite clinics, acute care facilities, or trauma centers operated by the organization, as well as offices of physicians and health care providers working as full-time contractors or staff of the organization. The organization is required to conduct notification tests by a broadcast fax or another communications method for rapid notification at least twice per year.

2. Each managed care organization operating medical facilities or pharmacies in this state shall prepare a plan that the organization would implement when the governor declares a disaster emergency that is the result of an occurrence or imminent threat of an emergency epidemic. The plan must be able to be integrated with the Local Emergency Operations Plan (LEOP). The plan shall address the following areas:

A) Rapid transport of human diagnostic specimens to the state laboratory from facilities that are operated by the organization;

B) A rapid method of determining the inventory of broad spectrum antibiotics in facilities and pharmacies that are operated by the organization, including pill counts of doxycycline or other antibiotic, as determined by the state health department;

C) A rapid method of securing and protecting antibiotics, antiviral medications, vaccines, and personal protective equipment within facilities and pharmacies that are operated by the organization; personal protective equipment shall, at a minimum, be the equipment and supplies used to achieve standard precautions; and D) Delivery or transfer of the supplies listed in paragraph C to authorized personnel as directed by executive orders of the governor.

Regulation 4. Preparations by Regional Emercency Medical and Trauma Services Advisory Councils for an Emergency Epidemic 1. Each regional emergency medical and trauma services advisory council in this state is required to maintain an up-to-date notification list of organizations for an emergency epidemic. The list shall include all pre-hospital care organizations within the jurisdiction of the regional emergency medical and trauma services advisory council. The council is required to conduct or participate in notification tests by a broadcast fax or by another communications method for rapid notification of these organizations at least twice per year.

2. Each regional emergency medical and trauma services advisory council shall advise the pre-hospital care organizations within its jurisdiction to develop a plan that the organization would implement when the governor declares a disaster emergency that is the result of an occurrence or imminent threat of an emergency epidemic. The organizations shall be advised that the plan should address the following areas:

A) Organization, assignment, reassignment, and alteration of normal work schedules of all staff and all employees of the organization under an approved incident management system who may be called on to work during an emergency epidemic;

B) Having sufficient supplies and a process for the provision of personal protective equipment against bacterial and viral infections to all staff and employees who are assigned to work in areas where they may be exposed to ill and contagious persons or to infectious agents and waste; personal protective equipment shall, at a minimum, be the equipment and supplies used to achieve standard precautions;

C) Procurement and storage of at least five days supply of doxycycline or other antibiotic, as determined by the state health department, to be used as chemoprophylaxis for all employees. The plan should include procurement of another antibiotic for a small number of employees who may be unable to take doxycycline;

D) An emergency call-down list of off-duty or retired emergency medical service providers who may be asked to work or volunteer as needed to respond to an emergency epidemic. Regulation 5. Preparations by the Colorado Department of Public Health and Environment for an Emergency Epidemic 1. The Department of Public Health and Environment (“the Department”) is required to maintain an up-to- date notification list of contacts for an Emergency Epidemic. The list shall include the Governor's Office, members of the Governor's Expert Emergency Epidemic Response Committee, general or critical access hospitals, county and district public health departments, regional emergency medical and trauma services advisory councils, and the state Office of Emergency Management. The Department is required to conduct notification tests by a broadcast fax or by another communications system for rapid notification of these contacts at least twice per year.

2. The Department shall prepare an internal emergency response plan that the Department will implement when there is an occurrence or imminent threat of an emergency epidemic. The plan must be able to be integrated with the State Emergency Operations Plan (SEOP) and the regional Public Health Preparedness and Response Plans. The plan shall address the following areas:

A) Organization and assignment of potentially all employees of the Department under an approved incident management system to work on controlling the emergency epidemic;

B) Having sufficient supplies and a process for the provision of personal protective equipment against bacterial and viral infections to Department employees who are assigned to work in areas where they may be exposed to ill and contagious persons or to infectious agents and waste; personal protective equipment shall, at a minimum, be the equipment and supplies used to achieve standard precautions;

C) Procurement and storage of at least five days supply of doxycycline or other antibiotic, as determined by the state health department, to be used as chemoprophylaxis for all Department employees. The plan shall include procurement of another antibiotic for a small number of employees who may be unable to take doxycycline;

D) An emergency, after-hours call-down list of persons who may be needed to organize and respond to an emergency epidemic; such list shall include persons with experience and E) Creation and furnishing of an agency operations center within the Department that integrates with the State Emergency Operations Center and the federal joint operations center (if established) for the purpose of (i) centralizing telephone, radio, and other electronic communications; (ii) compiling surveillance data; and (iii) maintaining a log of operations, decisions, resources, and orders necessary to control the epidemic;

F) Creation of a system or participation in an organized system to: (i) monitor the situation in each hospital where the emergency epidemic is occurring; (ii) assess and manage infection control in the community outside of the hospital; and (iii) assess and manage, in coordination with hospitals and the county coroner, the disposal of human corpses in accordance with state emergency function #8;

G) Assurance of the appropriate distribution and delivery of antibiotics, antiviral medications, vaccines, or other medications needed in an emergency epidemic to locations identified in regional public health response plans;

H) Identification of public spokespersons responsible for providing information to the citizens of the state about how to protect themselves, what actions are being taken to control the epidemic, and when the epidemic is over; and I) Implementation of a back-up communications system that will be used to communicate with the state Office of Emergency Management and local health agencies if and when telephone communications are disabled or not functioning.

4. The Department shall provide to each county and district public health department subject to Section 25-1-501 et seq., C.R.S., and to the state Office of Emergency Management a copy of the plan submitted pursuant to these regulations. The plan shall be provided upon request to general and critical access hospitals, managed care organizations, regional emergency medical and trauma services advisory councils, local offices of emergency management and public health nursing services.

Regulation 6. Assessing Compliance With These Regulations For the purposes of determining eligibility for the protections of Section 24-32-2111.5, C.R.S., the Department of Public Health and Environment may review plans submitted to the Board of Health pursuant to Regulations One through Four and Seven and may examine and inspect faxes transmitted or documentation of other communications methods used for rapid notification of contacts and agencies pursuant to Regulations One through Four and Seven. Each county and district public health department, local health officer and county public health nursing service subject to Section 25-1-501 and 25-1-601 et seq., C.R.S., general or critical access hospital, managed care organization, regional emergency medical and trauma services advisory council, shall certify that the plan required by Regulations One through Four and Seven fully meet the requirements.

Regulation 7. Preparations by Public Health Nursing Services for an Emergency Epidemic 1. Each local health officer and county public health nursing service in this state subject to Section 25-1- 601 et seq., C.R.S., is required to maintain an up-to-date notification list for an emergency epidemic. The list shall include general or critical access hospitals and the local emergency management agencies within the jurisdiction of the local health officer and county public health nursing service. The local health officer and county public health nursing service is required to conduct notification tests by a broadcast fax or another communications method for rapid notification at least twice per year.

2. Each local health officer and county public health nursing service in this state subject to Section 25-1- 601 et seq., C.R.S., must sign a uniform mutual aid agreement with all other county and district public health departments and local health officers and county public health nursing services subject to Section 25-1-501 and 25-1-601 et seq., C.R.S., that obligates the county or district public health department and local health officers and county public health nursing services to render aid during an emergency epidemic unless the county district public health department or local health officer and county public health nursing service needs to withhold resources necessary to provide reasonable protection for its own jurisdiction.

3. Each local health officer and county public health nursing service subject to Section 25-1-601 et seq., C.R.S., shall prepare a plan that will be implemented when the governor declares a disaster emergency that is the result of an occurrence or imminent threat of an emergency epidemic. The plan must be able to be integrated with the Local Emergency Operations Plan(s) (LEOP) and the regional Public Health Preparedness and Response Plan. In addition, the local health officers and county public health nursing services shall provide a copy of the plan submitted pursuant to these regulations to the local offices of emergency management, to all general or critical access hospitals, and to all regional emergency medical and trauma services advisory councils within the jurisdiction of the public health nursing service.

A) Organization and assignment of potentially all employees of the public health nursing service under an approved incident management system to work on controlling the emergency epidemic;

B) Having sufficient supplies and a process for the provision of personal protective equipment against bacterial and viral infections to public health nursing services employees who are assigned to work in areas where they may be exposed to ill and contagious persons or to infectious agents and waste; personal protective equipment shall, at a minimum, be the equipment and supplies used to achieve standard precautions;

C) Procurement and storage of at least five days supply of doxycycline or other antibiotic, as determined by the state health department, to be used as chemoprophylaxis for all public health nursing services employees. The plan shall include procurement of another antibiotic for a small number of public health nursing services employees who may be unable to take doxycycline;

D) An emergency, after-hours call-down list of persons who may be needed to organize and respond to an emergency epidemic; such list shall include persons with experience and E) Provide staffing to and participation in activities of the local emergency operations center (s) for the purpose of (i) centralizing telephone, radio, and other electronic communications;

1. (ii) compiling surveillance data; and (iii) maintaining a log of operations, decisions, resources, and orders necessary to control the epidemic;

F) Creation of a system or participation in an organized system to: (i) monitor the situation, including infection control, in each hospital within the public health nursing service's jurisdiction, doing this on-site as necessary and with assistance from the state health department as appropriate; (ii) assess and manage infection control in the community outside of the hospital; and (iii) assess and manage, in coordination with hospitals and the county coroner, the disposal of human corpses;

G) The organization, staffing, security, and logistics of the distribution and delivery of antibiotics, antiviral medications, vaccines, or other medications needed in an emergency epidemic following the provisions of State Emergency Function #8, “Health, Medical and Mortuary”;

H) Identification of public spokespersons responsible for providing information to the citizens of their jurisdiction about how to protect themselves, what actions are being taken to control the epidemic, and when the epidemic is over; and I) Implementation of a back-up communications system that will allow communication with the local emergency response structure if and when telephone communications are disabled or not functioning;

Regulation 1. Reportable Diseases For the purpose of these regulations, the diseases named in the lists below and any epidemic of environmental or chronic disease are declared to be dangerous to the public health and shall be reportable in accordance with the provisions of these regulations. Reportable outbreaks or epidemics of environmental or chronic diseases include those which may be a risk to the public and which may affect large numbers or specific groups of persons or be outbreaks caused by a chemical or radioactive terrorist agent or incident or be a newly recognized entity. Such outbreaks may include, but are not limited to, those related to environmental contamination by any hazardous chemical, radiological material, or biologic substance. The occurrence of a single case of any unusual disease or manifestation of illness which the health care provider determines or suspects may be caused by or related to a chemical or radioactive terrorist agent or incident must be reported immediately by telephone to the state or local health department by the health care provider and the hospital, emergency department, clinic, health care center, and laboratory in which the person is examined, tested, and/or treated. The same immediate reporting is required for any unusual cluster of illnesses that may be caused by or related to a chemical or radioactive terrorist agent or incident. Chemical terrorist agents include, but are not limited to, Sarin (GB), VX (V agent), and HD (distilled mustard).

List A. Environmental and Chronic Diseases Reportable by Physicians or Other Health Care Providers Diagnosis (Confirmed or Reportable Within:

Suspected)

Fetal Alcohol Syndrome 30 days (Age less than or equal to six years)

Muscular Dystrophies 120 days List B. Environmental and Chronic Diseases Reportable by Hospitals and Other Health Care Facilities Diagnosis (Confirmed or Reportable Within:

Suspected)

Spinal cord injuries 120 days Birth defects, 120 days developmental disabilities, and medical risk factors for developmental delay in Colorado residents diagnosed prenatally, at birth, or through the third birthday* ; with the exception of muscular dystrophies, which shall be reported without age limit Head injuries requiring 120 days admission to hospitals or resulting in death Autism Spectrum 30 days ** Disorders (ASD) (Age less than or equal to ten years) (Including Autistic Disorder, Asperger's Syndrome, and Pervasive Developmental Disorder- Not Otherwise Specified)

* Appendix A is an inclusive list of conditions that must be reported. ** Seven-county Metro Denver Area (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson). List C. Environmental and Chronic Diseases Reportable by Laboratories All of the findings below are to be reported within 30 days. Blood lead level: >25 µ g/dL if age >18 years.

Report all blood lead levels if age = 18 years and report levels =10 µ g/dL within one week of analysis.

Blood mercury >0.5 µ g/dL Urine mercury >20 µ g/L Chromosomal abnormalities and neural tube defects diagnosed by prenatal testing or by genetic testing in Colorado residents through the third birthday (reportable within 90 days) Physicians, health care providers, and clinics performing blood lead level testing in an office or outpatient setting are required to report results the same as the requirement above for laboratories. Regulation 2. Manner of Reporting and Information To Be Submitted. The diseases in the lists in Regulation 1 shall be reported to the Department of Health within the specified time frame after the diagnosis is made by the physician, health care provider, or confirmed in a laboratory. The information to be submitted shall consist of the diagnosis; the patient's name, age, sex, race/ethnicity, and address; the name and address of responsible physician; the employer (for reportable work-related conditions); and such other information as is needed by the Department to locate the patient for follow-up. With regard to birth defects, developmental disabilities, chromosomal abnormalities, and neural tube defects reported pursuant to regulation 1, the department shall collect no additional information about pregnancy outcome other than what is required for the vital record form. When hospitals and laboratories transmit disease reports electronically using systems and protocols developed by the department that ensure protection of confidentiality, such reporting is acceptable and is considered good faith reporting. Laboratory findings in List C of regulation 1 shall be reported by all laboratories which maintain an office or collection facility in Colorado or which arrange for collection of specimens in Colorado. Results must be reported by the laboratory which performs the test, but an in-state laboratory which sends specimens to an out of state referral laboratory is also responsible for reporting the results. In addition to physicians, health facilities, and laboratories, any person having knowledge of a reportable disease, outbreak, or epidemic, such as coroners, persons in charge of schools (including school nursing staff), or persons or employees having knowledge of exposure of large numbers or specific groups of persons to a known or suspected public health hazard shall report such disease, outbreak, or epidemic. The Department shall develop systems and forms for reporting for physicians, other health care providers, hospitals, and laboratories. For birth defects and developmental disabilities, hospitalized head injuries, and spinal cord injuries, hospital reporting shall be through a central computerized data system operated by or for the department.

Reports on hospitalized patients may be made part of a report by the hospital as a whole. Regulation 3. Procedures for the Investigation of Environmental and Chronic Diseases The State or local health department shall employ reasonable investigative techniques as part of systematic surveillance for environmental and chronic diseases. Reports of diseases related to exposure to a hazardous substance or agent in one environmental setting may lead the state or local health department to investigate whether or not the public health is endangered either in the same setting or in other settings physically removed but environmentally similar to that of the reported case. Investigations shall be considered official duties of the health department or health agency and shall be pertinent, relevant and only as intrusive as necessary. Such investigative techniques include but are not limited to:

(a) review by authorized personnel of pertinent, relevant medical records necessary to identify and characterize the index case and other cases in a region, community, or workplace; such review of records may occur without patient consent and shall be conducted at reasonable times and with such notice as is reasonable under the circumstances;

(b) review of Workers' Compensation claims;

(c) review of toxic tort or product liability claims filed with state or federal courts within the state;

(d) medical examination and testing of persons with the explicit consent of such persons;

(e) obtaining from public or private businesses or institutions lists of persons with a similar or common potential exposure to the hazardous substance or agent as a reported case; such exposure may be current or have occurred in the past;

(f) performing follow-up interview(s) with a reported case or persons knowledgeable about the case to collect pertinent and relevant information about the cause and/or risk factors associated with the reportable environmental or chronic disease;

(g) interviewing or administering questionnaire surveys confidentially to any resident of a community or any agent, owner, operator, employer, or employee of a public or private business or institution, that is either epidemiologically associated with a reported case or has had a similar hazardous environmental exposure as a reported case;

(h) collecting environmental samples of substances or measurements of physical agents;

(i) taking photographs related to the purpose of the investigation; if the photographs are taken in a business, the employer shall have the opportunity to review the photographs taken or obtained for the purpose of identifying those which contain or might reveal a trade secret;

(j) entering a place of employment for the purpose of conducting investigations of those processes, conditions, structures, machines, apparatus, devices, equipment, records, and materials within the place of employment which are relevant, pertinent, and necessary to the investigation; such investigations shall be conducted during regular working hours or at other reasonable times and with such notice as is reasonable under the circumstances.

Regulation 4. Information Sharing Whenever a local health department or health agency learns of a case of a reportable disease in Regulation 1 or an environmental exposure potentially threatening the public health, it shall notify the State Department of Health in a timely manner, usually within the timeframe for reporting in Regulation 1. The State Department of Health shall, in turn, notify the appropriate local health department or agency in a timely manner, usually within the timeframe for reporting in Regulation 1, whenever it learns of a case of a disease reportable in Regulation 1 or it learns of an environmental exposure potentially threatening the public health.

These requirements shall not apply if the State and local health agencies mutually agree not to share information on reported cases.

Sharing of medical information on persons with reportable diseases or illnesses as defined in Regulation 1 between authorized personnel of State and local health departments shall be restricted to information necessary for the treatment, control, investigation, and prevention of environmental and chronic diseases dangerous to the public health.

Sharing of trade secrets; and confidential commercial, geological, or geophysical data shall be performed in a manner that preserves the confidentiality of the information. Regulation 5. Reporting of Diseases Among Animals Every veterinarian, livestock owner, veterinary diagnostic laboratory director, or other person having the care of, or knowledge of, the existence of animals having or suspected of having any disease resulting from exposure to known or suspected hazardous chemicals, radiologic materials, or biologic substances which may endanger the public health, shall promptly report the facts to the State or local health department or health agency.

Regulation 6. Confidentiality All personal medical records and reports held by the state or local health department in compliance with these regulations shall be confidential information subject to C.R.S. 25-1-122(4). In addition, trade secrets and confidential commercial, geological, or geophysical data submitted to or held by the Colorado Department of Health in compliance with these regulations shall be confidential. This information is to be used by the Department as source material for necessary disease control efforts and the development of prevention programs. Reasonable efforts shall be made by the Department to consult with the attending physician or medical facility caring for the patient prior to any further follow-up by State or local health departments or health agencies.

Appendix A.

Reportable Birth Defects and Developmental Disabilities [Listed conditions relate directly to ICD-9-CM codes (International Classification of Diseases)] Major congenital anomalies and chromosomal abnormalities Congenital ( perinatal ) infections Congenital syphilisCongenital rubellaCytomegalovirusToxoplasmosis/herpes simplexNeonatal hepatitis Sensory impairments Hearing lossBlindness and low vision Other disabilities Specific delays in developmentMental retardationInfantile cerebral palsyAutism spectrum disorders (ASD)

Genetic and endocrine/metabolic diseases HypothyroidismDisorders of amino acid transport and metabolismDisorders of carbohydrate transport and metabolismLipodosesDisorders of copper metabolismCystic fibrosisOther disorders of purine and pyrimidine metabolismMucopolysaccharidosisSickle cell anemiaBiotinidase deficiencyCongenital adrenal hyperplasia Infections EncephalitisMeningitis Injuries Traumatic brain injuriesSpinal cord injuries Other diagnoses Amniotic bandsCerebral cystsCerebral lipidosesChild maltreatment syndromeChorioretinitisConvulsions/seizuresDrug withdrawal syndrome in the newbornFailure to thriveFamilial degenerative CNS diseaseInfantile spasmsMuscular dystrophiesNoxious influences affecting fetus (includes Fetal Alcohol Syndrome)Renal tubular acidosisRetinal degenerationWerdnig Hoffman diseaseIntracranial hemorrhageBirth traumaSlow fetal growth and fetal malnutrition