1. a) Total Center encounters:

   1. 1) Total poisonings,
   2. 2) Information requests,
   3. 3) Education requests.

2. b) Age group of poison contact subject:

   1. 1) Under 5 years old,
   2. 2) 5-12 years old,
   3. 3) 13-18 years old,
   4. 4) 19-30 years old,
   5. 5) 31 years old and over, or
   6. 6) Unknown age.

3. c) Substance encountered:

   1. 1) Prescription medications,
   2. 2) Over-the-counter medications,
   3. 3) Veterinary medication,
   4. 4) Household products,
   5. 5) Insect/arachnid/reptile/animal bite/sting,
   6. 6) Beauty aids/cosmetics,
   7. 7) Plants,
   8. 8) Pesticides,
   9. 9) Hydrocarbon,
   10. 10) Street drug, or
   11. 11) Other.

4. d) Routes of poison contact:

   1. 1) Ingested,
   2. 2) Inhaled,
   3. 3) Skin contact,
   4. 4) Bites/stings,
   5. 5) Wound/puncture,
   6. 6) Eye contact, or
   7. 7) Other.

5. e) Reason why contact occurred:

   1. 1) Accident,
   2. 2) Prescribed,
   3. 3) Intentional,
   4. 4) Recreational,
   5. 5) Suicide,
   6. 6) Industrial/work-related, or
   7. 7) Other.

6. f) Source of call:

   1. 1) Local hospital,
   2. 2) Clinic/physician office,
   3. 3) Family/friend,
   4. 4) Self, or
   5. 5) Other.

7. g) Initial Center treatment rendered:

   1. 1) Instructed in home care, including follow-up calls and documented to private physician;
   2. 2) Local medical facility or physician office advised in initial care of patient;
   3. 3) After initial instructions, patient referred to local human poison control center;
   4. 4) After initial instructions, patient referred to local hospital;
   5. 5) Patient referred directly to private physician; or
   6. 6) After initial instructions, patient referred to ophthalmologist.

8. h) Final disposition of patients treated from subsections (g)(2), (3), (4), (5) and (6) of this Section:

   1. 1) Patient treated at medical facility and released;
   2. 2) Patient treated at medical facility and admitted;
   3. 3) Patient treated at medical facility and transferred to Regional Poison Control Center;
   4. 4) Patient refused care recommendations;
   5. 5) Death; or
   6. 6) Unknown.
9. i) Use of grant funds, if applicable.

The following data shall be collected by the Center and submitted to the Department, as a three-month total, by the 30th of the month following March 31, June 30, September 30 and December 31. The Department shall audit quarterly reports in response to a complaint if the complaint concerns information submitted in the report.