(1) Upon written or telephone request of the Department, a health care provider who has ordered a blood lead test shall provide the patient's address and telephone number to the Lead Registry, and, when known, the following information:

1. (a) Race and ethnicity;
2. (b) Date of birth;
3. (c) Circumstances of lead exposure;
4. (d) Occupation;
5. (e) Type of industry of employer of person tested; and
6. (f) Employer's name, address and telephone number.