1. (1) patient's name;
2. (2) patient's date of birth;
3. (3) patient's address;
4. (4) home phone;
5. (5) patient's sex;
6. (6) mother's name;
7. (7) mother's date of birth;
8. (8) provider name;
9. (9) provider degree;
10. (10) provider specialty;
11. (11) provider address;
12. (12) provider phone number;
13. (13) diagnosis of autistic disorder, atypical autism, Pervasive Developmental Disorder-not otherwise specified, Asperger's syndrome, or special education classification which makes the individual eligible to receive special education services; and
14. (14) date of diagnosis.

Diagnostic, treatment or educational facilities which provide specialized care or individualized education programs for ASD and related disorders shall report or cause to report the following to the Department within 30 days of making an ASD diagnosis or special education classification for autism or other disabilities related to autism:

KEY: autism spectrum, intellectual disability, reporting

Date of Last Change: November 5, 2023

Notice of Continuation: January 22, 2024

Authorizing, and Implemented or Interpreted Law: 26B-1-202(27) through 26B-1-202(30); 26B-1-229; 53E-9-308(6)(b); 26B-7-115