PURPOSE: This rule establishes the responsibility of laboratories to report to the Missouri Department of Health specified results of tests and to submit isolates/specimens for certain diseases and conditions.

1. (1) The director or person in charge of any laboratory shall report to the local health authority or the Missouri Department of Health the result of any test that is positive for, or suggestive of, any disease or condition listed in 19 CSR 20-20.020. These reports shall be made according to the time and manner specified for each disease or condition following completion of the test and shall designate the test performed, the results of test, the name and address of the attending physician, the name of the disease or condition diagnosed or suspected, the date the test results were obtained, the name and home address (with zip code) of the patient and the patient’s age, date of birth, sex, and race.
2. (2) In reporting findings for diseases or conditions listed in 19 CSR 20-20.020, laboratories shall report— Arsenic (urinary) level greater than or equal to one hundred micrograms per liter (≥100 µg/l) in a 24-hour urine sample; Cadmium (urinary) level greater than or equal to three micrograms per liter (≥3.0 µg/l) in a 24-hour urine sample; Carboxyhemoglobin level greater than fifteen percent (15%); Chemical/pesticide (blood or serum) level greater than the Lowest Quantifiable Limit; Lead (blood) level—report all results; Mercury (blood) level greater than or equal to three-tenths micrograms per deciliter (≥0.3 µ/dl); Mercury (urinary) level greater than or equal to twenty micrograms per liter (≥20 µg/l) in a 24-hour urine sample; and Methemoglobin proportion greater than or equal to seventy-five percent (≥75%).
3. (3) Isolates or specimens positive for the following reportable diseases or conditions must be submitted to the State Public Health Laboratory for epidemiological or confirmation purposes: Anthrax (Bacillus anthracis) Cholera (Vibrio cholerae) Diphtheria (Corynebacterium diphtheriae) Enteric Escherichia coli infection (E. coli O157:H7) Haemophilus influenza, invasive disease Malaria (Plasmodium species) Measles (rubeola) Mycobacterium tuberculosis Neisseria meningitides, invasive disease Pertussis (Bordetella pertussis) Plague (Yersinia pestis) Salmonellosis (all Salmonella species) Shigellosis (all Shigella species) Vancomycin Resistant Staphylococcus aureus

AUTHORITY: sections 192.006, RSMo Supp. 1999 and 192.020, RSMo 1994.* This rule was previously filed as 13 CSR 50-101.090. Original rule filed July 15, 1948, effective Sept. 13, 1948. Amended: Filed Aug. 4, 1986, effective Oct. 11, 1986. Amended: Filed Aug. 14, 1992, effective April 8, 1993. Amended: Filed Sept. 15, 1995, effective April 30, 1996. Emergency rule filed June 1, 2000, effective June 15, 2000, expired Dec. 11, 2000. Emergency rescission filed June 2, 2000, effective June 15, 2000, expired Dec. 11, 2000. Previous version of rule rescinded filed June 1, 2000, effective Jan. 30, 2001. Readopted: Filed June 1, 2000, effective Nov. 30, 2000. Communicable Disease Prevention

*Original authority: 192.006, RSMo 1993, amended 1995; 192.020, RSMo 1939, amended 1945, 1951.