PURPOSE: This rule establishes guidelines specific to physicians and other health care professionals working under physician orders for HIV testing, pretest and posttest consultation (client-centered counseling), and for the reporting of persons diagnosed with HIV infection.

1. (1) The following definitions shall be used in administering this rule:

   1. (A) Conduct means to direct, lead, order or undertake to perform or to provide guidance as a licensed physician to a patient;
   2. (B) Confirmed HIV infection means the clinical diagnosis and conclusion that a patient is infected with HIV, made in the professional judgment of the physician based upon clinical history, physician examination, diagnostic or laboratory testing or other available clinical information which allows the physician to make clinical and therapeutic decisions based upon this infected status;
   3. (C) Department means the Missouri Department of Health;
   4. (D) Physician means any person licensed to practice as a physician and surgeon under Chapter 334, RSMo; and
   5. (E) Physician’s delegated representative means state licensed professional involved in direct patient care, other than those persons licensed as physicians under Chapter 334, RSMo.

2. (2) The physician or the physician’s delegated representative shall provide consultation with the patient or his/her legal guardian or custodian prior to conducting HIV testing, and to the patient, guardian or custodian during the reporting of the test results or diagnosis.

   1. (A) The physician or the physician’s delegated representative shall only be allowed to provide consultation through the use of protocols and standing orders which shall be written, signed and dated by the physician prior to their implementation or, in the case of a hospital, the policies and procedures as approved by the medical staff.
   2. (B) The scope of the consultation shall be governed by the physician’s professional judgment based on the clinical situation, including the purpose of and need for HIV testing, and shall be at least as comprehensive as the type of consultation provided for other diagnostic tests or procedures.
3. (3) The physician shall report to the department or its designated representative the identity of any person with confirmed HIV infection along with related clinical and identifying information within three (3) days of receipt of the test results on forms provided by the department (see Form #1 following 19 CSR 20-26.030).

4. (4) Physicians testing persons under the following situations shall be exempt from reporting the identity of the person testing positive for HIV. In these situations, physicians shall report HIV positive test results as well as related clinical and other information within three (3) days of receipt of the test results on forms provided by the department (see Form #1 following 19 CSR 20-26.030), but shall be exempt from reporting the patient’s name and street address—instead a unique patient identifier shall be used.

   1. (A) Persons tested as part of a research project which is approved by an institutional review board and in which, as part of the research, subjects are tested for HIV infection. Written documentation of institutional review board approval must be submitted to the department’s Office of Surveillance; or
   2. (B) Where prohibited by federal law or regulation.
5. (5) All persons reported with HIV infection to the department or its designated representative can be contacted by public health personnel for partner elicitation/notification services according to protocols and procedures established by the department.
6. (6) Laboratories which perform HIV testing shall report identifying information as specified in 19 CSR 20-20.080.

AUTHORITY: sections 191.653, 191.656, and 192.006, RSMo Supp. 1999 and 192.020, RSMo 1994.* Original rule filed April 14, 1992, effective Dec. 3, 1992. Emergency amendment filed June 1, 2000, effective June 15, 2000, expired Dec. 11, 2000. Amended: Filed June 1, 2000, effective Nov. 30, 2000.

*Original authority: 191.653, RSMo 1988, amended 1996; 191.656, RSMo 1988, amended 1992, 1993, 1996, 1999; 192.006, RSMo 1993, amended 1995; 192.020, RSMo 1939, amended 1945, 1951.