Section R9-6-101. Definitions

In this Chapter, unless otherwise specified:

1.        “Active tuberculosis” means the same as in A.R.S. § 36- 711.

2.        “Administrator” means the individual who is the senior leader at a child care establishment, health care institu- tion, correctional facility, school, pharmacy, or shelter.

3.        “Agency” means any board, commission, department, office, or other administrative unit of the federal govern- ment, the state, or a political subdivision of the state.

4.        “Agent” means an organism that may cause a disease, either directly or indirectly.

5.        “AIDS” means Acquired Immunodeficiency Syndrome.

6.        “Airborne precautions” means, in addition to use of stan- dard precautions:

a.        Either:

i.         Placing an individual in a private room with negative air-pressure ventilation, at least six air exchanges per hour, and air either:

(1)     Exhausted directly to the outside of the building containing the room, or

(2)     Recirculated through a HEPA filtration system before being returned to the interior of the building containing the room; or

ii.        If the building in which an individual is located does not have an unoccupied room meeting the specifications in subsection (6)(a)(i):

(1)     Placing the individual in a private room, with the door to the room kept closed when not being used for entering or leaving the room, until the individual is transferred to a health care institution that has a room meeting the specifications in subsection (6)(a)(i) or to the individual’s residence, as medically appropriate; and

(2)     Ensuring that the individual is wearing a mask covering the individual’s nose and mouth; and

b.        Ensuring the use by other individuals, when entering the room in which the individual is located, of a device that is:

i.         Designed to protect the wearer against inhala- tion of an atmosphere that may be harmful to the health of the wearer, and

ii.        At least as protective as a National Institute for Occupational Safety and Health-approved N-95 respirator.

7.        “Approved test for tuberculosis” means a Mantoux skin test or other test for tuberculosis recommended by the Centers for Disease Control and Prevention or the Tuber- culosis Control Officer appointed under A.R.S. § 36-714.

8.        “Arizona State Laboratory” means the part of the Depart- ment authorized by A.R.S. Title 36, Chapter 2, Article 2, and A.R.S. § 36-132(A)(11) that performs serological, microbiological, entomological, and chemical analyses.

9.        “Average window period” means the typical time between exposure to an agent and the ability to detect infection with the agent in human blood.

10.     “Barrier” means a mask, gown, glove, face shield, face mask, or other membrane or filter to prevent the transmis- sion of infectious agents and protect an individual from exposure to body fluids.

11.     “Body fluid” means semen, vaginal secretion, tissue, cerebrospinal fluid, synovial fluid, pleural fluid, perito- neal fluid, pericardial fluid, amniotic fluid, urine, blood, lymph, or saliva.

12.     “Carrier” means an infected individual without symptoms who can spread the infection to a susceptible individual.

13.     “Case” means an individual:

a.        With a communicable disease whose condition is documented:

i.         By laboratory results that support the presence of the agent that causes the disease;

ii.        By a health care provider’s diagnosis based on clinical observation; or

iii.      By epidemiologic associations with the com- municable disease, the agent that causes the disease, or toxic products of the agent;

b.        Who has experienced diarrhea, nausea, or vomiting as part of an outbreak;

c.        Who  has  died  without  apparent  cause  within   48 hours after experiencing a fever; or

d.        Who  has  experienced  a   vaccinia-related  adverse event.

14.     “Case definition” means the disease-specific criteria that must be met for an individual to be classified as a case.

15.     “Chief medical officer” means the senior health care pro- vider in a correctional facility or that individual’s desig- nee who is also a health care provider.

16.     “Child” means an individual younger than 18 years of age.

17.     “Child care establishment” means:

a.        A “child care facility,” as defined in A.R.S. § 36- 881;

b.        A “child care group home,” as defined in A.R.S. § 36-897;

c.        A  child  care  home  registered   with  the  Arizona Department of Education under A.R.S. § 46-321; or

d.        A child care home certified by the Arizona Depart- ment of Economic Security under A.R.S. Title 46, Chapter 7, Article 1.

18.     “Clinical signs and symptoms” means evidence of dis- ease or injury that can be observed by a health care pro- vider or can be inferred by the heath care provider from a patient’s description of subjective complaints.

19.     “Cohort room” means a room housing only individuals infected with the same agent and no other agent.

20.     “Communicable disease” means an illness caused by an agent or its toxic products that arises through the trans- mission of that agent or its products to a susceptible host, either directly or indirectly.

21.     “Communicable period” means the time during which an agent may be transmitted directly or indirectly:

a.        From an infected individual to another individual;

b.        From an infected animal, arthropod, or vehicle to an individual; or

c.        From an infected individual to an animal.

22.     “Confirmatory test” means a laboratory analysis, such as a Western blot analysis, approved by the U.S. Food and Drug Administration to be used after a screening test to diagnose or monitor the progression of HIV infection.

23.     “Contact” means an individual who has been exposed to an infectious agent in a manner that may have allowed transmission of the infectious agent to the individual during the communicable period.

24.     “Correctional facility” means any place used for the con- finement or control of an individual:

a.        Charged with or convicted of an offense,

b.        Held for extradition, or

c.        Pursuant to a court order for law enforcement pur- poses.

25.     “Court-ordered subject” means a subject who is required by a court of competent jurisdiction to provide one or more specimens of blood or other body fluids for testing.

26.     “Dentist” means an individual licensed under A.R.S. Title 32, Chapter 11, Article 2.

27.     “Department” means the Arizona Department of Health Services.

28.     “Designated service area” means the same as in A.A.C. R9-18-101.

29.     “Diagnosis” means an identification of a disease by an individual authorized by law to make the identification.

30.     “Disease” means a condition or disorder that causes the human body to deviate from its normal or healthy state.

31.     “Emerging or exotic disease” means:

a.        A new disease resulting from change in an existing organism;

b.        A known disease not usually found in the geo- graphic area or population in which it is found;

c.        A previously unrecognized disease appearing in an area undergoing ecologic transformation; or

d.        A disease reemerging as a result of a situation such as antimicrobial resistance in a known infectious agent, a breakdown in public health measures, or deliberate release.

32.     “Entity” has the same meaning as “person” in A.R.S. § 1- 215.

33.     “Epidemiologic investigation” means the application of scientific methods to ascertain a diagnosis; identify risk factors for a disease; determine the potential for spread- ing a disease; institute control measures; and complete forms and reports such as communicable disease, case investigation, and outbreak reports.

34.     “Fever” means a temperature of 101° F or higher.

35.     “Food establishment” has the same meaning as in the document incorporated by reference in A.A.C. R9-8-107.

36.     “Food handler” means:

a.        A paid or volunteer full-time or part-time worker who prepares or serves food or who otherwise touches food in a food establishment; or

b.        An individual who prepares food for or serves food to a group of two or more individuals in a setting other than a food establishment.

37.     “Foodborne” means that food serves as a mode of trans- mission of an infectious agent.

38.     “Guardian” means an individual who is invested with the authority and charged with the duty of caring for an indi- vidual by a court of competent jurisdiction.

39.     “HBsAg” means hepatitis B surface antigen.

40.     “Health  care   institution”  has  the  same  meaning  as   in

A.R.S. § 36-401.

41.     “Health care provider” means the same as in A.R.S. § 36- 661.

42.     “Health education” means supplying to an individual or a group of individuals:

a.        Information about a communicable disease or options for treatment of a communicable disease, and

b.        Guidance about methods to reduce the risk that the individual or group of individuals will become infected or infect other individuals.

43.     “HIV” means Human Immunodeficiency Virus.

44.     “HIV-related test” has the same meaning as in A.R.S. § 36-661.

45.     “Infected” or “infection” means when an individual has an agent for a disease in a part of the individual’s body where the agent may cause a disease.

46.     “Infectious active tuberculosis” means pulmonary or laryngeal active tuberculosis in an individual, which can be transmitted from the infected individual to another individual.

47.     “Infectious agent” means an agent that can be transmitted to an individual.

48.     “Infant” means a child younger than 12 months of age.

49.     “Isolate” means:

a.        To separate an infected individual or animal from others to limit the transmission of infectious agents, or

b.        A pure strain of an agent obtained from a specimen.

50.     “Isolation” means separation, during the communicable period, of an infected individual or animal from others to limit the transmission of infectious agents.

51.     “Laboratory report” means a document that:

a.        Is produced by a laboratory that conducts a test or tests on a subject’s specimen; and

b.        Shows the outcome of each test, including personal identifying information about the subject.

52.     “Local health agency” means a county health department, a public health services district, a tribal health unit, or a

U.S. Public Health Service Indian Health Service Unit.

53.     “Local health officer” means an individual who has daily control and supervision of a local health agency or the individual’s designee.

54.     “Medical evaluation” means an assessment of an individ- ual’s health by a physician, physician assistant, or regis- tered nurse practitioner.

55.     “Medical examiner” means an individual:

a.        Appointed as a county medical examiner by a county board of supervisors under A.R.S. § 11-592, or

b.        Employed by a county board of supervisors under

A.R.S. § 11-592 to perform the duties of a county medical examiner.

56.     “Multi-drug resistant tuberculosis” means active tubercu- losis that is caused by bacteria that are not susceptible to the antibiotics isoniazid and rifampin.

57.     “Officer in charge” means the individual in the senior leadership position in a correctional facility or that indi- vidual’s designee.

58.     “Outbreak” means an unexpected increase in incidence of a disease, infestation, or sign or symptom of illness.

59.     “Parent” means a biological or adoptive mother or father.

60.     “Petition” means a formal written application to a court requesting judicial action on a matter.

61.     “Pharmacy” has the same meaning as in A.R.S. § 32-

1901.

62.     “Physician” means an individual licensed as a doctor of:

a.        Allopathic medicine under A.R.S. Title 32, Chapter 13;

b.        Naturopathic medicine under A.R.S. Title 32, Chap- ter 14;

c.        Osteopathic medicine under A.R.S. Title 32, Chap- ter 17; or

d.        Homeopathic medicine under A.R.S. Title 32, Chap- ter 29.

63.     “Physician assistant” has the same meaning as in A.R.S.

§ 32-2501.

64.     “Pupil” means a student attending a school.

65.     “Quarantine” means the restriction of activities of an individual or animal that has been exposed to a case or carrier of a communicable disease during the communi- cable period, to prevent transmission of the disease if infection occurs.

66.     “Registered nurse practitioner” has the same meaning as in A.R.S. § 32-1601.

67.     “Risk factor” means an activity or circumstance that increases the chances that an individual will become infected with or develop a communicable disease.

68.     “School” means:

a.        An “accommodation school,” as defined in A.R.S. § 15-101;

b.        A “charter school,” as defined in A.R.S. § 15-101;

c.        A “private school,” as defined in A.R.S. § 15-101;

d.        A “school,” as defined in A.R.S. § 15-101;

e.        A college or university;

f.         An institution that offers a “private vocational pro- gram,” as defined in A.R.S. § 32-3001; or

g.        An institution that grants a “degree,” as defined in

A.R.S. § 32-3001, for completion of an educational program of study.

69.     “Screening test” means a laboratory analysis approved by the U.S. Food and Drug Administration as an initial test to indicate the possibility that an individual is infected with a communicable disease.

70.     “Sexual contact” means vaginal intercourse, anal inter- course, fellatio, or cunnilingus.

71.     “Shelter” means:

a.        A facility or home that provides “shelter care,” as defined in A.R.S. § 8-201;

b.        A “homeless shelter,” as defined in A.R.S. § 16-121; or

c.        A  “shelter  for  victims  of  domestic   violence,”  as defined in A.R.S. § 36-3001.

72.     “Significant exposure” means the same as in A.R.S. § 32- 3207.

73.     “Standard precautions” means the use of barriers by an individual to prevent parenteral, mucous membrane, and nonintact skin exposure to body fluids and secretions other than sweat.

74.     “Subject” means an individual whose blood or other body fluid has been tested or is to be tested.

75.     “Submitting entity” means the same as in A.R.S. § 13- 1415.

76.     “Suspect case” means an individual whose medical his- tory, signs, or symptoms indicate that the individual:

a.        May have or is developing a communicable disease;

b.        May have experienced diarrhea, nausea, or vomiting as part of an outbreak;

c.        May have died without apparent cause within 48 hours after experiencing a fever; or

d.        May  have  experienced  a   vaccinia-related  adverse event.

77.     “Syndrome” means a pattern of signs and symptoms characteristic of a disease.

78.     “Test” means an analysis performed on blood or other body fluid to evaluate for the presence or absence of a disease.

79.     “Test result” means information about the outcome of a laboratory analysis of a subject’s specimen and does not include personal identifying information about the sub- ject.

80.     “Treatment” means a procedure or method to cure, improve, or palliate an illness or a disease.

81.     “Tuberculosis   control  officer”  means  the  same  as   in

A.R.S. § 36-711.

82.     “Unexplained death with a history of fever” means the demise of an individual who has had a fever within 48 hours before death and whose illness has not been diag- nosed at the time of death.

83.     “Vaccinia-related adverse event” means a reaction to the administration of a vaccine against smallpox that requires medical evaluation of the reaction.

84.     “Victim” means an individual on whom another individ- ual is alleged to have committed a sexual offense, as defined in A.R.S. § 13-1415.

85.     “Viral hemorrhagic fever” means disease characterized by fever and hemorrhaging and caused by a virus.

86.     “Waterborne” means that water serves as a mode of trans- mission of an infectious agent.

87.     “Working day” means the period from 8:00 a.m. to 5:00

p.m. on a Monday, Tuesday, Wednesday, Thursday, or Friday that is not a state holiday.

Historical Note

Adopted effective January 28, 1987 (Supp. 87-1).

Amended effective September 14, 1990 (Supp. 90-3).

Amended effective October 19, 1993 (Supp. 93-4). Amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Amended by final rulemaking

at 10 A.A.R. 3559, effective October 2, 2004 (Supp. 04-

3). Amended by final rulemaking at 14 A.A.R. 1502,

effective April 1, 2008 (Supp. 08-2). Amended by final

8.        “Emergency care or assistance” means actions performed by an individual on or for another individual, which are necessary to prevent death or impairment of the health of the other individual.

9.        “Emergency department” has the same meaning as in

A.A.C. R9-11-101.

10.     “Good Samaritan” has the same meaning as in A.R.S. § 36-661.

11.     “In writing” means:

a.        An original document,

b.        A photocopy,

c.        A facsimile, or

d.        An e-mail.

12.    

rulemaking at 15 A.A.R. 215, effective March 7, 2009 (Supp. 09-1). a.     A physician or a registered nurse practitioner work- ing in an emergency department or urgent care unit; R9-6-102.       Release of Information   b.     An  occupational  health  provider  as  defined  in A  person  shall  release  information,  including  protected  health   A.A.C. R9-6-801; or information as defined in 45 CFR 160.103, to the Department or a   c.     Any other health care provider knowledgeable in local health agency upon request if the information is:   determining circumstances when post-exposure pro- 1.     Requested by the Department or the local health agency   phylaxis is necessary. for the purpose of:   13.   “Mucous membrane” means a thin, pliable layer of tissue a.     Detecting, preventing, or controlling a communica-   that lines passageways and cavities in the human body ble disease; or   that lead to the outside, such as the mouth, gastrointesti- b.     Preventing injury or disability that may result from a   nal tract, nose, vagina, and urethra. communicable disease; and   14.   “Notarized” means signed and dated by a notary. 2.     In the possession of the person.   15.   “Notary” means any individual authorized to perform the Historical Note   acts specified under A.R.S. § 41-313. Adopted effective May 2, 1991 (Supp. 91-2). Former   16.   “Post-exposure prophylaxis” means treatment provided Section R9-6-102 renumbered to R9-6-105, new Section   to an individual who may have been exposed to a com- R9-6-102 renumbered from R9-6-106 and amended   municable disease, which is intended to prevent infection effective October 19, 1993 (Supp. 93-4). Amended by   of the individual. final rulemaking at 8 A.A.R. 1953, effective April 3,   17.   “Significant exposure risk” has the same meaning as in 2002 (Supp. 02-2). Former R9-6-102 renumbered to R9-   A.R.S. § 36-661. 6-201; new R9-6-102 made by final rulemaking at 10   18.   “Under oath or affirmation” means a sworn or affirmed A.A.R. 3559, effective October 2, 2004 (Supp. 04-3).   statement made by a Good Samaritan to a notary under Amended by final rulemaking at 14 A.A.R. 4522, effec-   the penalty of perjury. tive December 2, 2008 (Supp. 08-4).   19.  “Urgent care unit” has the same meaning as in A.A.C.     R9-11-201. R9-6-103.       Disclosure   of   Communicable   Disease-Related B. A significant exposure risk may occur when a Good Samari- Information to a Good Samaritan   tan’s interaction with an individual results in: A.    In this Section, unless otherwise specified, the following defi-   1.     A transfer of blood or body fluids from the individual nitions apply:   onto the mucous membranes or into breaks in the skin of 1.     “Affidavit” means a voluntary declaration or statement of   the Good Samaritan; or facts that is made in writing and under oath or affirma-   2.     A sharing of airspace between the Good Samaritan and tion.   the individual. 2.     “Assisted  person”  means  the individual with whom a C. If a Good Samaritan makes a disclosure request to the Depart- Good Samaritan alleges interaction constituting a signifi-   ment or a local health agency 72 hours or less after an alleged cant exposure risk.   significant exposure risk, the disclosure request shall include: 3.     “Available” means in the possession of or accessible by   1.     The Good Samaritan’s name; the  Designated  Officer  who  is  reviewing  a  disclosure   2.     The Good Samaritan’s mailing address or e-mail address; request.   3.     The telephone number at which the Good Samaritan may 4.     “Communicable  disease-related  information”  has  the   be reached during a working day; same meaning as in A.R.S. § 36-661.   4.     A description of the accident, fire, or other life-threaten- 5.     “Designated Officer” means an individual appointed by   ing emergency, in which the Good Samaritan rendered the Director or a local health officer to:   emergency care or assistance; a.     Review a disclosure request from a Good Samaritan;   5.     A description of the: b.     Determine whether disclosure of communicable dis-   a.     Emergency care or assistance rendered by the Good ease-related information is required under A.R.S. §   Samaritan at the accident, fire, or other life-threaten- 36-664(E) and this Section; and   ing emergency; and c.     Respond to the Good Samaritan.   b.     Circumstances  that  the  Good  Samaritan  believes 6.     “Director” has the same meaning as in A.R.S. § 36-101.   constitute a significant exposure risk; 7.     “Disclosure request” means the information submitted by   6.     If known, the name of the assisted person; a Good Samaritan according to A.R.S. § 36-664(E) and   7.     If known, the date of birth of the assisted person; and subsection (C) or (D).

“Medical consultation” means discussion between a Good Samaritan and:

8. Any additional information that may identify the assisted person.

D.      If a Good Samaritan makes a disclosure request to the Depart- ment or a local health agency more than 72 hours after an alleged significant exposure risk, the disclosure request shall include:

1.        A statement in writing that the Good Samaritan is requesting communicable disease-related information for an assisted person as allowed under A.R.S. § 36-664(E);

2.        Documentation concerning the accident, fire, or other life-threatening emergency in which the Good Samaritan rendered emergency care or assistance; and

3.        A notarized affidavit that contains:

a.        The information specified in subsections (C)(1) through (8);

b.        A statement that the Good Samaritan understands that the Good Samaritan may seek medical consulta- tion to determine whether post-exposure prophylaxis for a communicable disease is needed;

c.        A statement that the Good Samaritan certifies that the declarations contained within the affidavit are truthful to the best of the Good Samaritan’s knowl- edge; and

d.        The Good Samaritan’s signature.

E.       Within two working days after the Department or a  local health agency receives a disclosure request from a Good Samaritan, the Designated Officer shall:

1.        If the Designated Officer determines that the information provided as specified in subsection (C) or (D) indicates a significant exposure risk to the Good Samaritan and com- municable disease-related information is available for the assisted person:

a.        Attempt to contact the Good Samaritan by telephone and provide the Good Samaritan with the communi- cable disease-related information:

i.         For the assisted person;

ii.        Pertaining to the specific communicable dis- ease or diseases that may be transmitted through the interaction between the Good Samaritan and the assisted person; and

iii.      Without revealing the assisted person’s name;

b.        Attempt to contact the Good Samaritan by telephone and notify the Good Samaritan that disclosure of communicable disease-related information for one communicable disease does not rule out the possibil- ity that the Good Samaritan was exposed to other communicable diseases about which information is not available to the Designated Officer;

c.        Attempt to contact the Good Samaritan by telephone and provide to the Good Samaritan information con- cerning the agent causing the communicable disease for which the Designated Officer is disclosing com- municable disease-related information, including:

i.         A description of the disease or syndrome caused by the agent, including its symptoms;

ii.        A description of how the agent is transmitted to others;

iii.      The average window period for the agent;

iv.      An explanation that exposure to an individual with a communicable disease does not mean that infection has occurred or will occur;

v.        Measures to reduce the likelihood of transmit- ting the agent to others and that it is necessary to continue the measures until a negative test

result is obtained after the average window period has passed or until an infection, if detected, is eliminated;

vi.      That it is necessary to notify others that they may be or may have been exposed to the agent through interaction with the Good Samaritan; and

vii.     The availability of assistance from the Depart- ment, local health agencies, or other resources; and

d.        Send to the Good Samaritan in writing:

i.         The information specified in subsection (E)(1)(a);

ii.        The notification specified in subsection (E)(1)(b);

iii.      The information specified in subsection (E)(1)(c); and

iv.      A statement that the confidentiality of the dis- closed communicable disease-related informa- tion is protected by A.R.S. §§ 36-664(G) and 36-666(A)(2);

2.        If the Designated Officer determines that the information provided as specified in subsection (C) or (D) indicates a significant exposure risk to the Good Samaritan, but the Designated Officer is unable to provide communicable disease-related information for the assisted person:

a.        Attempt to contact the Good Samaritan by telephone and notify the Good Samaritan that either:

i.         Communicable disease-related information, pertaining to the specific communicable dis- ease or diseases that may be transmitted through the interaction between the Good Samaritan and the assisted person, is not avail- able to the Designated Officer; or

ii.        The Designated Officer is unable to identify the assisted person from the information provided in the Good Samaritan’s disclosure request, as specified in subsection (C) or (D);

b.        Attempt to contact the Good Samaritan by telephone and notify the Good Samaritan that:

i.         The Good Samaritan’s interaction with the assisted person may pose a significant exposure risk to the Good Samaritan; and

ii.        The Good Samaritan may seek medical consul- tation on the need for post-exposure prophy- laxis; and

c.        Send to the Good Samaritan in writing the notifica- tions specified in subsections (E)(2)(a) and (b); and

3.        If the Designated Officer determines that the information provided as specified in subsection (C) or (D) does not indicate a significant exposure risk to the Good Samari- tan:

a.        Attempt to contact the Good Samaritan by telephone and notify the Good Samaritan that the Designated Officer will not disclose any available communica- ble disease-related information for the assisted per- son; and

b.        Send to the Good Samaritan in writing:

i.         The notification specified in subsection (E)(3)(a);

ii.        A statement that the Designated Officer’s deci- sion not to disclose communicable disease- related information to the Good Samaritan is based on A.R.S. § 36-664(E) and this Section;

iii.      The Designated Officer’s reasons for not dis- closing communicable disease-related informa- tion to the Good Samaritan; and

iv.      A statement that the Good Samaritan has the right to obtain a hearing as specified in A.R.S.

§ 41-1092.03(B).

Historical Note

Renumbered from R9-6-107 and amended effective October 19, 1993 (Supp. 93-4). Amended effective April

4, 1997 (Supp. 97-2). Amended by final rulemaking at 8

A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Sec- tion renumbered to R9-6-301 by final rulemaking at 10

A.A.R. 3559, effective October 2, 2004 (Supp. 04-3). New Section made by final rulemaking at 14 A.A.R.

4641, effective January 31, 2009 (Supp. 08-4).