04/02/2003
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New Hanover County Health Department
Revenue and Expenditure Summaries for February 2003
Cumulative: 66.67% Month 8 of 12
Revenues
Current Year PrlorYOlIr
ypeol Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remalnln Amount Earned Remalnln
Federal & Slate $ 1.704,431 $ 736,105 $ $1,552,484 604,562 $ 947,922 38,94%
C Faes $ 587,944 $ 342,665 $ $ 533,044 381,187 $ 151,857 71.51%
Medicaid $ 1,035,386 $ 556,999 $ $1,012,934 613,183 $ 399,751 60.54%
Medicaid Max r',J Sd-'f:>OOO $ $ 165,n3 165,773 100.00%
EH Fees $ 312,900 $ 182,866 $ 312,900 186,313 59.54%
Health Fees $ 112,850 $ 113,859 $ 125,850 115,237 91.57%
$ 1,799,544 $ 1,190,579 $1,540,140 995,296 64.82%
Expenditures
Budgeted
Amounl
Curren! YOlIr
Expended
Amounl
Prior Y_
Expended
Al:nount
Balance
Remalnln
%
Balance
Remalnln
%
Budgeted
Amount
Summary
Budgeted Actual %
FY 02-03 FY02-03
Expendnures:
Salaries & Fringe $9,221,703 $5,653,915
Operating Expenses $2,046,412 $1,256,177
capnal Outlay $20,8427 $44,297
Total Expendnures $11,476,542 $6,954,389 60.60%
Revenue: $5,553,055 $3,123,073 56.24%
- Net County $$ $5,923,487 $3,831,316
Revenne and Expenditure Summary
For the Month of February 2003
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NEW HANOVER COUNTY HEALTH DEPARTMENT
BOARD OF HEALTH (BOH) APPROVED
GRANT APPLICATION STATUS FY 02-03
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DatiTBOHI Grant Reauested Pendlna Received Denied
3/512003 No activity to report lor March 2003.
2/5/2003 No activity to report for February 2003.
1/6/2003 NC DHH5- OPH Preparedness and Response $115,950 $33,600 $62,350
12/4/2902 No actlvlty.toreport lor December 2002.
NC Health and Wellness Trust Fund.Teen
-- . - - satien-Pfflll
u..._'.. - . . _" _,g.g, .. ~gS ,....- ----
11/6/2002 ($100,000 per year for 3 years) $100,000 $100,000
Safe Kids Buckle Up Program-North Carolina
10/2/2002 Safe Kids $5,000 $5,000
Developing Geographic Information Systems
(GIS) Capacity In Local Health Department In
Eastern North Carollna-Duke University
, Nicholas School of the Environment and Earth
Sciences (NSEES) $16,000 $16,000
Noa :UV ,to report tor Selll8mDer 2002.
Noa :UV ,to report tor AUguat 2002.
Noa :UV ,to report tor JUly 2002.
- . PROJEC],..8I.oP~renataLHllalth Ed.u!;8tion -- ..
and Information/Referral Services- March of
Dimes Community Grant Program (ThIs_as on
6/5/2002 tntent to apply for S41J,875-1he 8dU8I appUcIUOn for un want went $1,720
IhrOUgtlln October 2002- the amolml changed to $50,000) $50,000 $46,260
Noa v 'to report lOr May 2002.
Noa iilI ;lg report tor ADn~
oa y ,to report lOr Marc '
os y 'to report lOr February 2002.
os IVIIY to report tor January 2002.
Diabetes Education, Management and
12/5/2001 Prevention. CFMF $60,000 $30,000 $30,000
Youth Tobacco Prevention Project. Robert
11/7/2001 Woods Johnson Youth Center $11,600 $11,600
Teens Against TobacCO Use (TATU)-Health
ActIon Counell of NC $350 $350
Healthv Carolinians- NC DHHS $10,000 $10,000
Family Assessment Coordlnatlon- March
9/5/2001 of Dimes $16,500 $16,500
Folic Acid Proiect. March of Dimes $16,618 $3,000 $13,318
Safe Kids Coalition. State Farm"Good
Neiahbor" $500 $500
TB Elimination and Prevention - COC,
8/1/2001 NCDHHD, DPH, TB Control Proaram $10,000 $9,200 $600
Teen Aids Prevention-fTAP1- CFMF $45,500 $25,000 $20,500
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As of 3/1712003
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NEW HANOVER COUNTY HEALTH DEPARTMENT
BOARD OF HEALTH (BOH) APPROVED
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r.RANT .6.PPUr.6,TlnN ST TUl': -. -- --
Dlabetas Today. Diabetas Prevention & Control
7/1112001 Unil, NCDHHS $10,000 $10,000
Lose Weight Wilmington. Cape Fear Memorial
Foundation $75,000 $75,000
Totals $545,218 $0 $204 730 $340,188
0.00%
37.55%
62.39%
.- iPending:Granls:---- .---- ._-------- -- .,,0:--:.--:- ---- ..-0%
Funded Total Requesl 7 44%
Partially Funded 6 38%
Denied Total Request 3 19%
Number of Grants Applied For 16 100%
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As of 3/1712003
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 South 1"" Street
Wilmington, NC 28401-4946
Telephone (910) 343-6500, Fax (910) 341-4146
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Il...,-.E""'lfIb7.E..,....."
DAVID RICE, M P H, M A
Health Director
LYNDA F. SMITH, M P H
Assistant Health Director
March 18, 2003
To: New Hanover County Board of Health
From: Cynthia W Hewett.~siness Officerl HIPAA Privacy Officer
Subject: HIPAA Updates
Privacy Compliance for the Health Insurance Portability and Accountability Act (HIPAA) of 1996 is fast approaching.
As a health care provider, who bills electronically for services provided, the New Hanover County Health Department
(NHCHD) must demonstrate a "good faith effort" toward meeting the April 14, 2003 privacy compliance deadline.
. NHCHD HIP AA Committee is submitting the following items for your information and review:
(I) New Hanover County Health Department Notice of Privacy Practices
a. This document must be provided to patients on their first day of service on or after April 14, 2003.
b. Patients will be asked to sign an acknowledgment of receipt of the Notice of Privacy Practices.
(2) NHCHD HlPAA Designation Form
a. This document identifies the NHCHD as a hybrid covered entity
b. The NHCHD Privacy Officer and contact number are identified.
c. Covered components and Non-covered components (those functions that are being "carved out") are
identified.
(3) NHCHD HlPAA Policies and Procedures (the following have been reviewed and approved by the NHC Legal
Office)
a. Introduction to HIPAA Privacy Rule
b. HIPAA Privacy Rule Privacy Protections
c. Privacy Policy I Procedure Development and Approval Process
d. Privacy Officer and Privacy Official Policy
e. Workforce Policy
(4) New Hanover County Health Department Administrative Requirements
... (5) New Hanover County Health Department Business Associate Agreement (this document has been reviewed and
.. approved by the NHC Legal Office)
(6) New Hanover County Staff will receiving training as follows:
a. General Staff Training (an overview ofHIPAA) is scheduled for Thursday, April 3, 2003.
b. Additional Staff Training will be conducted prior to April 14, 2003 focusing on more specifics related
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to HIP AA Privacy rules, policies and procedures. Several training sessions will be provided to
accommodate staff schedules. This training is intended for staff working in areas identifted as covered
components.
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(7) System updates are scheduled for HSIS (state system) and PCMS (Patient Care Management System, QS
Technologies, Inc.) in April 2003.
(8) NHCHD Authorization and consent forms (for use and disclosure of protected health information (PHI),
treatment, payment and other healthcare operations (TPO)) are being finalized.
The North Carolina Department of Health and Human Services. Division of Public Health has been providing
local health departments with templates for use in developing HIPAA Privacy Policies and Procedures,
Notice of Privacy Practices, and Business Associate Agreements. Additional templates are expected to arrive
for developing the remaining required HIPAA Privacy Policies and Procedures (26 are required by the
HIPAA Privacy Rule). The receipt date of these templates is unknown.
The NHCHD HIPAA Committee is continuing to work diligently toward meeting the HIPAA Privacy Compliance
deadline. The following items are in progress or near completion:
(I) Identifying business associates and modifying contracts (this will be an on-going process)
(2) Identifying and documenting designated record sets
(3) Identifying procedures for obtaining acknowledgements
The HIPAA Security Rule has been ftnalized with a compliance date of April 21, 2005. The Electronic Data
_ Interchange (EDI) Rule compliance date is October 16, 2003. Attached you will also ftnd more speciftcs
., related to the ED! Rule, as well as the Status of HHS HIPAA Administrative Simpliftcation Regulations (as
of February 2003).
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"Your HealJh - Our Priority"
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WE ARE REQUIRED BY LAW TO PROTECT MEDICAL INFORMATION ABOUT YOU
Weare required by law to protect the privacy of medical information about you and that identifies you. This medical information may be
information about health care we provide to you or payment for health care provided to you. It may also be information about your past,
present, or future medical condition.
We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with
respect to medical information. We are legally required to follow the terms of this Notice. In other words, we are only allowed to use and
disclose medical information in the manner that we have described in this Notice.
We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective for any
or all medical information that we maintain. We mayor may not make a change retroactive. Ifwe make changes to the Notice, we will:
. Post the new Notice in our waiting area
. Post the new Notice on our website http://www.nhcgov.comIHLTH/Administration.htm
. Have copies of the new Notice available upon request (you may always contact our Privacy Officer at (910) 343-6500 to obtain
a copy of the current Notice)
The rest of this Notice will:
. Discuss how we may use and disclose medical information about you
_.. Explain your rights with respect to medical information about you
., Describe how and where you may file a privacy-related complaint
If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact
our Privacy Officer at (910) 343-6500.
WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCES
We use and disclose medical information about patients everyday This section of our Notice explains in some detail how we may use and
disclose medical information about you in order to provide health care, obtain payment for that health care, and operate our business
efficiently This section then briefly mentions several other circumstances in which we may use or disclose medical information about you.
For more information about any of these uses or disclosures, or about any of our privacy policies, procedures or practices, contact our
Privacy Officer at (910) 343-6500.
1. Treatment
We may use and disclose medical information about you to provide health care treatment to you. In other words, we may use and disclose
medical information about you to provide, coordinate or manage your health care and related services. This may include communicating
with other health care providers regarding your treatment and coordinating and managing your health care with others. Example: Jane is a
patient at the health department. The receptionist may use medical information about Jane when setting up an appointment. The nurse
practitioner will likely use medical information about Jane when reviewing Jane's condition and ordering a blood test. The laboratory
technician will likely use medical information about Jane when processing or reviewing her blood test results. If, after reviewing the results
of the blood test, the nurse practitioner concludes that Jane should be referred to a specialist, the nurse may disclose medical information
about Jane to the specialist to assist the specialist in providing appropriate care to Jane.
2. Payment
We may use and disclose medical information about you to obtain payment for health care services that you received. This means that,
@inthehealthdepartment,wemay use medical information about you to arrange for payment (such as preparing bills and managing
unts). We also may disclose medical information about you to others (such as insurers, County Attorney, and Consumer Reporting
gencies). In some instances, we may disclose medical information about you to an insurance plan before you receive certain health care
services because, for example, we may want to know whether the insurance plan will pay for a particular service. Example: Jane is a
patient at the health department and she has private insurance. During an appointment with a nurse practitioner, practitioner ordered a
New Hanover County Health Department Notice of Privacy Practices
Effective Date 4/14/03 Updated 3/18/03
Page 1
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blood test. The health department billing clerk will use medical information about Jane when she prepares a bill for the services provided at .
the appointment and the blood test. Medical information about Jane will be disclosed to her insurance company when the billing clerk
sends in the bill. Example: The nurse practitioner referred Jane to a specialist. The specialist recommended several complicated and
expensive tests. The specialist's billing clerk may contact Jane's insurance company before the specialist runs the tests to determine ~
whether the plan would pay for the test. ...
3. Health care operations
We may use and disclose medical information about you in performing a variety of business activities that we call "health care operations."
These "health care operations" activities allow us to, for example, improve the quality of care we provide and reduce health care costs. For
example, we may use or disclose medical information about you in performing the following activities:
. Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.
. Providing training programs for students, trainees, volunteers, health care providers or non-health care professionals to help
them practice or improve their skills.
. Cooperating with outside organizations that evaluate, certify or license health care providers, staff or facilities in a particular
field or specialty
. Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients.
. Improving health care and lowering costs for groups of people who have similar health problems and helping manage and
coordinate the care for these groups of people.
. Cooperating with outside organizations that assess the quality of the care others and we provide, including government agencies
and private organizations.
. Planning for our organization's future operations.
. Resolving grievances within our organization.
. Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly
changes.
. Working with others (such as lawyers, accountants and other providers) who assist us to comply with this Notice and other
applicable laws.
. We may use and/or disclose medical information about you to send you reminders about an appointment or need for services.
. We may use and/or disclose medical information about you in order to inform you of or recommend new treatment or different
methods for treating a medical condition that you have or to inform you of other health related benefits and services that maJA
of interest to you. .,
. We may use medical information about you to contact you in person or by other means to encourage you to purchase or use a
product or service. In some instances, we may use medical information about you to send you a small promotional gift.
Example: Jane was diagnosed with diabetes. The health department used Jane's medical information - as well as medical
information from all of the other health department patients diagnosed with diabetes - to develop an educational program to help
patients recognize the early symptoms of diabetes. The health department sends Jane a flyer with information about the program.
(Note: The educational program would not identify any specific patients without their permission).
Example: Jane complained that she did not receive appropriate health care. The health department reviewed Jane's record to
evaluate the quality of the care provided to Jane. The health department also discussed Jane's care with an attorney
4. Persons involved in your care
We may disclose medical information about you to a relative, close personal friend or any other person you identify if that person is
involved in your care and the information is relevant to your care. If the patient is a minor, we may disclose medical information about the
minor to a parent, guardian or other person responsible for the minor except in limited circumstances. For more information on the privacy
of minors' information, contact our Privacy Officer at (910) 343-6500. We may also use or disclose medical information about you to a
relative, another person involved in your care or possibly a disaster relief organization (such as the Red Cross) if we need to notify someone
about your location or condition. You may ask us at any time not to disclose medical information about you to persons involved in your
care. We will agree to your request and not disclose the information except in certain limited circumstances (such as emergencies) or if the
patient is a minor. If the patient is a minor, we mayor may not be able to agree to your request. Example: Jane's husband regularly comes
to the health department with Jane for her appointments and he helps her with her medication. When the nurse practitioner is discussing a
new medication with Jane, Jane invites her husband to come into the private room. The nurse practitioner discusses the new medication
with Jane and Jane's husband.
5. Required by Law
We will use and disclose medical information about you whenever we are required by law to do so. There are many state and federalla,A.
that require us to use and disclose medical information. For example, state law requires us to report known or suspected child abuse or _
neglect to the Department of Social Services. We will comply with those state laws and with all other applicable laws.
6. National Priority Uses and Disclosures
New Hanover County Health Department Notice of Privacy Practices
Effective Date 4!I4/03 Updated 3/18/03
Page 2
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, 'When permitted by law, we may use or disclose medical information about you without your permission for various activities that are
, recognized as "national priorities." In other words, the goverrunent has determined that under certain circumstances (described below), it is
. so important to disclose medical information that it is acceptable to disclose medical information without the individual's permission. We
Aonly disclose medical information about you in the following circumstances when we are permitted to do so by law Below are brief
"-iptions of the "national priority" activities recognized by law For more information on these types of disclosures, contact our Privacy
Officer at (910) 343-6500.
. Threat to health or safety: We may use or disclose medical information about you if we believe it is necessary to prevent or
lessen a serious threat to health or safety
. Public health activities: We may use or disclose medical information about you for public health activities. Public health
activities require the use of medical information for various activities, including, but not limited to, activities related to
investigating diseases, reporting child abuse and neglect, monitoring drugs or devices regulated by the Food and Drug
Administration, and monitoring work-related illnesses or injuries. For example, if you have been exposed to a communicable
disease (such as a sexually transmitted disease), we may report it to the State and take other actions to prevent the spread of the
disease.
. Abuse, neglect or domestic violence: We may disclose medical information about you to a government authority (such as the
Deparnnent of Social Services) if we reasonably believe that you may be a victim of abuse, neglect or domestic violence.
. Health oversight activities: We may disclose medical information about you to a health oversight agency - which is basically
an agency responsible for overseeing the health care system or certain goverrunent programs. For example, a goverrunent
agency may request information from us while they are investigating possible insurance fraud.
. Court proceedings: We may disclose medical information about you to a court or an officer of the court (such as an attorney).
For example, we would disclose medical information about you to a court if a judge orders us to do so.
. Law enforcement: We may disclose medical information about you to a law enforcement official for specific law enforcement
purposes. For example, we may disclose limited medical information about you to a police officer if the officer needs the
information to help find or identify a missing person.
. Coroners and others: We may disclose medical information about you to a coroner, medical examiner, or funeral director or
to organizations that help with organ, eye and tissue transplants.
. Workers' compensation: We may disclose medical information about you in order to comply with workers' compensation
laws.
. Research organizations: We may use or disclose medical information about you to research organizations if the organization
has satisfied certain conditions about protecting the privacy of medical information.
. Certain government functions: We may use or disclose medical information about you for certain goverrunent functions,
including but not limited to military and veterans' activities and national security and intelligence activities. We may also use
or disclose medical information about you to a correctional institution in some circumstances.
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7. Authorization (Release of Medical Information)
Other than the uses and disclosures described above (# 1-6), we will not use or disclose medical information about you without the
"authorization" - or signed permission to release medical information - of you or your personal representative. In some instances, we may
wish to use or disclose medical information about you and we may contact you to ask you to sign a Release ofInformation form. In other
instances, you may contact us to ask us to disclose medical information and we will ask you to sign a Release ofInformation form.
If you sign a written Release of Information form allowing us to disclose medical information about you, you may later revoke (or cancel)
your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke
your authorization, you may write us a letter revoking your authorization. If you revoke your authorization, we will follow your
instructions except to the extent that we have already relied upon your authorization and taken some action.
YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMA nON ABOUT YOU
You have several rights with respect to medical information about you. This section of the Notice will briefly mention each of these rights.
If you would like to know more about your rights, please contact our Privacy Officer at (910) 343-6500.
1. Right to a copy of this Notice
You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be
posted in our waiting area. If you would like a copy of our Notice, ask the receptionist for a copy or call our Privacy Officer (910) 343-
6500.
ARight of access to inspect and copy
.u have the right to inspect (which means see or review) and receive a copy of medical information about you that we maintain in certain
groups of records. If you would like to inspect or receive a copy of medical information about you, you must provide us with a request in
writing. You may write us a letter requesting access or fill out a Permission for Release of Patient Information Form. Permission for
New Hanover County Health Department Notice of Privacy Practices
Effective Date 4/14/03 Updated 3/18/03
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Release of Patient Information Forms are available from our receptionist. We may deny your request in cerulin circumstances. Ifwe deny
your request, we will explain our reason for doing so in writing. We will also inform you in writing if you have the right to have our "
decision reviewed by another person. If you would like a copy of the information, we will charge you a fee to cover the costs ofthe copy
We may be able to provide you with a summary or explanation of the information. Contact our Privacy Officer for more information 0"
these services and any possible additional fees. ..
3. Right to have medical information amended
You have the right to have us amend (which means correct or supplement) medical information about you that we maintain in certain
groups of records. If you believe that we have information that is either inaccurate or incomDlete, we may amend the information to
indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend
information, you must provide us with a request in writing and explain why you would like us to amend the information. You may either
write us a letter requesting an amendment. We may deny your request in certain circumstances. Ifwe deny your request, we will explain
our reason for doing so in writing. You will have the opportunity to send us a statement explaining why you disagree with our decision to
deny your amendment request and we will share your statement whenever we disclose the information in the future.
4. Right to an accounting of disclosures we have made
You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years.
If you would like to receive an accounting, you may send us a letter requesting an accounting. The accounting will not include several
types of disclosures, including disclosures for treatment, payment or health care operations. It will also not include disclosures made prior
to April 14, 2003. If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the costs of
preparing the accounting.
5. Right to request restrictions on uses and disclosures
You have the right to request restrictions on the information New Hanover County Health Department uses or discloses about you. We are
not required to agree to your requested restriction, but will consider your request and the possibility of accommodating it.
6. Right to request an alternative method of contact
You have the right to request to be contacted at a different location or by a different method. For example, you may prefer to have all
written information mailed to your work address rather than to your home address. We will agree to any reasonable request for alternative
methods of contact. If you would like to request an alternative method of contact, you must provide us with a request in writing.
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YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a
complaint either with us or with the federal government. We will not take any action against you or change our treatment of you in any
way if you file a complaint.
To file a written complaint with the health department, you may bring your complaint to the department or you may mail it to the following
address:
New Hanover County Health Department
Attn: NHCHD Privacy Officer
2029 South 17'" Street
Wilmington, NC 28401
To file a complaint with the federal government, you may send your complaint to the following address:
Office for Civil Rights
US Department of Health & Human Services
Attn: Secretary of US DHHS
Atlanta Federal Center, Suite 3B70
61 Forsyth St., S. W
Atlanta, GA 30303-8909
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New Hannver County Health Department Notice of Privacy Practices
Effective Date 4/14/03 Updated 3/18/03
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HIPAA Desianation Form
For Documentation of Aaencv/CountvlEntitv Status
Section I:
Name of Aaencv/CountvlEntitv:
Coun I H brid Enti
Section II:
Overall Aaencv/CountvlEntitv Desianation (Choose those that applv):
1. Are you a covered entity? 0 No X Yes (If yes, check below all that applies)
o Health Plan 0 Health care clearinghouse
X Health care provider engaging I~ electronic transactions
Page _1_ of _2_
New Hanover County Health Department I New Hanover
2. Are you designating the covered entity as a hybrid entity?
o No (If no and you are a covered entity, all the components within your entity will be subject to HIPAA
compliance.)
X Yes (If yes, complete the Section V below to identify and document the covered and non-covered
com onent within our enti . The covered com onents will be sub'ect to HIPAA com liance.
Section III:
Reasonlna Behind Determination:
New Hanover County Health Department is a hybrid covered entity due to some of our programs providing
health care services and billing electronically for those services, while others may provide health care
services and do not bill for those services.
Section IV:
ome of A ene ICount IEntit Privae
ffieer: New Hanover County Health
Department! New Hanover County! Cynthia
W. Hewett
Section V:
Individual
Function/ComDonent
Reviewed
Prlvacv Officer Contact Phone Number:
(910) 343-6680
Deslanation of
Function/ComDonent)
(Indicate if a covered or non-
covered function/com onent
Brief Summary of Reasonlna
Health: Administration -
Information Technology
Covered Component
Administration of Patient Care
Management System including Services
Provided and Billin information
Communicable Disease
Covered Function
Provides health care services and bills
electronically
Exception:
CDD Surveillance
Non-Covered Component
For surveillance CDO would be serving as
Public Health Authority and not subject to
HIPAA Privacy Compliance.
School Health (all Non- Covered Component
com nents of School Health
Provides health care services and bills
electronically
Provides health care services, but does
not bill electronically
Provides health care services, but does
not bill electronicall -exce t for HEP B
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Community Health: Covered Function
Exceptions:
Jail Health . Non Covered Component
.
re non-covered except HEP
rogram administered in
chools)
Shots administered in County Schools
(this portion is a covered component)
Child Health
Covered Function
Provides health care services and bills
electronically
Exceptions:
Child Care
Consultations
Health Non-covered component
Provide health care services, but does not
bill electronically ( if immunizations are
provided and billed for electronically,
these immunizations will be a covered
component)
Laboratory
Covered Function
Indirect Treatment Provider
Women's Health Services
Covered Functions
Provides health care services, bills
electronically and does electronic
eli ibili deter.minations
Provides health care services and bills
electronically
Nutrition I WIC
Covered Functions
ealth Promotion
Covered Functions
Provides health care services and
accesses patient medical records.
Administration (excluding
Information Technology)
Environmental Health
Animal Control
Dental
Jail Health
Non-Covered
Components
Functions
I Does not provide health care services and
does not bill electronically (except for
Information Technology component)
School Health
Provides health care does not bill
electronically
Provides health care does not bill (except
for HEP B shots administered in Schools
Section VI:
Slanature of Authorized Aaencv/CountvlEntitv ReDresentatlve (i.e.. county HIPAA ComDliance Official.
County Manaaer. County Attornev. Aaencv DireCtor. etc.):
Date:
The above authorized signature confirms your agencylcounty/entity's designated HIPAA status and the reasons
for that determination, listing its covered functions/components (if applicable) and designating an appropriate
privacy officer for the coveredlhybrid entity. This form should be filed with the appropriate HIPAA compliance
e documentation for your agencylcounty/entity.
Documentation must be retained for six years from the date of its creation or the date when it last was in effect,
whichever is later. CFR 45 Part 164.53O(j)(2)
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New Hanover County Health Department
HIPAA Policy and Procedure Manual
Introduction to HIPAA Privacy Rule
Introduction
The purpose of the HIPAA Privacy Rule Policy and Procedure Manual is to provide requirements
applicable to New Hanover County Health Department (NHCHD) and its health care components for
protecting the privacy of individually identifiable health information. NHCHD health care components are
defined as all programs within the NHCHD with the exceptions of animal control, environmental health, school
health, jail health, child care health consultation, and communicable disease surveillance. These programs
shall be known as "health care components" throughout this manual.
The Privacy Rule, mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
made significant changes in the protection of individually identifiable health information that is created,
received, and maintained in any form or medium by the NHCHD and its health care components. Health care
providers and health care plans within NHCHD and its health care components that perform specific
electronic transactions (e.g., file health care claims electronically) must comply with the HIPAA regulations.
NHCHD has determined that whenever specific privacy requirements promote better business practices
and/or provide uniform client rights with the NHCHD, the privacy requirements shall apply to all programs.
Each privacy policy developed by the NHCHD shall include a scope statement specifying if the policy applies
to all programs within the NHCHD or only to the health care components.
The county attorney of New Hanover County has determined that NHCHD meets the definition of a
"hybrid entity" and has both covered health care components and non-covered health care components within
its department of health. NHCHD, as a hybrid entity, is responsible for designating which of its departments
and offices (or portions thereof) are covered health components and for ensuring that those components
comply with HIPAA regulations.
The NHCHD shall ensure compliance with HIPAA privacy requirements through the development and
implementation of privacy policies that specify the entity's methods for the protection of individually identifiable
health information. The requirements in these policies shall be based on many business practices already
employed by the entity's departments or offices. In addition, privacy policies shall include other federal and
state law requirements that have an impact on the use and disclosure of health information. Most federal and
state laws that are more stringent than the HIPAA requirements will generally remain in effect and will not be
preempted by HIPAA. However, some state laws may not be preempted, such as categories of laws that
provide for reporting of disease or injury, child abuse, birth or death; and other laws requiring disclosure of
individually identifiable health information.
Each NHCHD program identified in the scope section of each policy is responsible for developing
procedures that correspond to that policy for implementing the requirements for protecting the health
information maintained by each NHCHD health care component.
Each NHCHD health care component may only use and disclose individually identifiable
information as provided in this document and is subject to all of the limitations and requirements specified in
this manual.
Additions or revisions to privacy policies shall be the responsibility of the NHCHD Privacy Officer in
accordance with the Policy Development Process.
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Title:
Chapter:
Governing Body Approval Date:
Effective Date:
Privacy Manual
Introduction
April 14, 2003
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New Hanover County Health Department
HIPAA Policy and Procedure Manual
HIPAA Privacy Rule Privacy Protections
Purpose
The purpose of this policy is to establish the need and acknowledge the intent to develop and implement
specific policies to protect the privacy of individually identifiable health information.
Scope
All employees of the New Hanover County Health Department (NHCHD) shall comply with this policy
Policy
The NHCHD has developed policies that are appropriate for its health care components to implement in
order to protect the privacy of NHCHD individually identifiable health information that is created, received,
and maintained during its regular course of business. Policies are reasonably designed to comply with
state and federal laws, taking into account the scope of the requirement and the nature of activities
undertaken that related to individually identifiable health information. The HIPAA Privacy Rule will be the
primary resource for these policies.
NHCHD Responsibility
The Scope section in each privacy policy identifies which NHCHD health care components must comply
with the requirements set forth in that policy NHCHD will evaluate each privacy policy based primarily on
the HIPAA Privacy Rule to determine if the policy should be applied to all divisions and components
regardless of the HIPAA impact.
Determination, by the NHCHD Privacy Officer, for a department wide approach to policy requirements
takes into account the most efficient and effective methods for ensuring the protection of individually
identifiable health information and equitable client right, while promoting consistency in the management of
health information throughout the NHCHD
NHCHD Health Care Component Responsibility
It is the responsibility of the NHCHD health care components, as identified in the scope section of all
privacy policies, to develop procedures for implementing the policies.
Implementation
The NHCHD has developed policies that address essential administrative privacy requirements so
NHCHD health care components will use and/or disclose individually identifiable health information in a
confidential and secure manner All policies shall be located in the HIPAA Privacy Rule Policy Manual
maintained by the Privacy Officer The policies developed address the following privacy requirements.
_ Privacy Officer
NHCHD has designated a privacy officer to oversee all NHCHD ongoing activities related to the
development, maintenance, and adherence to policies regarding the privacy of and accessibility to
individually identifiable health information, in accordance with state and federal laws and best
business practices. (See Privacy Officer and Privacy Officials Policy)
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NHCHD has developed a policy for training of all members of its workforce who are likely to have
access to individually identifiable health information. At a minimum, training is provided for newly
developed privacy policies, during new employee orientation, and whenever significant changes
are made to privacy policies. (See Workforce Policy)
Safeguards
NHCHD has developed policies that specify administrative, technical, and physical safeguards that
protect the privacy of individually identifiable health information from unauthorized use or
inadvertent disclosure to persons other than the intended recipient. Measures taken relates
directly to the size of NHCHD and the type of activities that NHCHD undertakes. (See Personal
Health Services and Nutrition Policy and Procedures For Assuring Privacy of Protected Health
Information)
Business Associates
NHCHD has developed policies regarding the identification of "Business Associates" and
develops contracts that will limit the business associate's uses and disclosures of individually
identifiable health information to those permitted by the contract.
Limitations on Information Access
NHCHD has developed policies that limit access to NHCHD individually identifiable health
information by members of its workforce, as well as other requesters of information, to the
"minimum necessary" information required to fulfill a need or request. Verification of the identity
and authority of requesters for individually identifiable health information shall be required prior to .
disclosure of the requested information. (See NHCHD Policy' Medical Records Security) .
Use and Disclosure
NHCHD has developed policies that specify the conditions necessary before NHCHD health care
components can use or disclose individually identifying health information including policies on
required consents and authorizations, instances when consents or authorizations are not required,
and requirements for the use of individually identifying health information for research, marketing,
or fund raising purposes. (See Minimum Necessary Policy and NHCHD Policy' Medical Records
Security and Authorization Policy)
Clients Rights
NHCHD has developed policies that will afford clients greater protection and control over their
individually identifying health information maintained by NHCHD health care components. Such
controls shall include notifying clients of the privacy protections in NHCHD and the client's right to
request access to or amendment of their health information. (See NHCHD Policy' Medical
Records Security and Authorization Policy)
Documentation of Complaints
NHCHD has developed policies that provide a mechanism for receiving complaints from
individuals regarding NHCHD and its health care components' compliance with privacy
requirements. Documentation includes identification of a contact person (or office), a record ofthe
complaints that are filed, and a brief explanation of complaint resolution, if any (See Privacy
Officer and Privacy Official Policy)
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Sanctions
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NHCHD has developed policies that specify appropriate sanctions against members of its
workforce who fail to comply with department privacy requirements. Sanctions will be appropriate
to the nature ofthe violation. NHCHD will document any sanctions that are applied in accordance
with the documentation requirements of HIPAA Administrative Requirements. (See NHCHD
Confidentiality Policy)
Sanctions do not apply in the following circumstances:
a. When the member of the workforce discloses PHI while acting as a "whistleblower" -that is,
someone who notifies authorities of the unlawful or unethical actions of NHCHD
and the disclosure is made in accordance with the criteria in HIPAA Administrative
requirements A 164.5020)(1) (the provision setting forth the rules for disclosures by
whistleblowers).
b. When the member of the workforce who discloses PHI is the victim of a crime, and the
disclosure is made in accordance with the criteria in A 164.5020)(2) (the provision
setting forth the rules for disclosures by workforce members who are victims of a
crime.)
c. When the member of the workforce engages in an act described in A 164.530(g)(2)-such as
filing a complaint-that NHCHD may not retaliate against (see Section VI.C.,
Refraining from Intimidating or Retaliatory Acts).
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Mitigation
Any harmful effect that is known to NHCHD and its health care components of a use or disclosure
of individually identifiable health information that is in violation of its policies will be mitigated in an
effort to prevent such future occurrences. To the extent possible, NHCHD will mitigate any harmful
effect of a disclosure of PHI that violates the privacy rule or NHCHD's privacy policies and
procedures, when the improper use or disclosure is known to the agency Employees shall report
any improper use or disclosure to the supervisor This provision applies both to improper uses or
disclosures made by NHCHD itself, and to improper uses or disclosures made by the agency's
business associates.
Refraining from Intimidating or Retaliatory Acts
NHCHD will not intimidate, threaten, coerce, discriminate against, or take any other retaliatory
Action against any of the following:
1. An individual who is the subject of PHI who does either ofthe following: (a) exercises any of
the rights granted to individuals by the privacy rule (such as the right to amend PHI), or (b)
participates in any process established under the privacy rule, such as the filing of complaints.
2. Any person (including a member NHCHD's work force) who does any of
the following: (a) Files a complaint with the US DHHS alleging violation ofthe privacy rule;
(b) testifies, assists, or participates in an investigation, compliance review, or enforcement
proceeding or hearing; or (c) opposes any act or practice made unlawful by the privacy rule,
provided both of the following apply'
the person has a good faith that the practice opposed is
unlawful, and
the manner of the opposition is reasonable and does not
involve a disclosure of PHI that is not permitted by the privacy rule.
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NHCHD does not require a client to waive his/her right to file a complaint with NHCHD or the
federal Department of Health and Human Services Secretary as a condition for the provision of
treatment, payment or enrollment in a health plan, or eligibility for health care benefits.
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Transition Phase .
NHCHD privacy policies addresses transition requirements for consents, authorizations or other
express legal permissions used by its health care components. NHCHD will grandfather in and
rely upon consents, authorizations, or other express legal permissions obtained prior to April 14,
2003, to ensure that important functions of the health care system are not impeded. However,
consents, authorizations or other express legal permissions made on or after April 14, 2003, must
meet the NHCHD privacy policy requirements. (See Notice of Privacy Practice Policy)
Policy and Procedure Changes
NHCHD will modify, in a prompt manner, its privacy pOlicies as necessary and appropriate to
comply with changes in the state and federal law and ongoing business practices. Changes to
policies may be made at any time, provided such changes are documented and implemented
according to NHCHD policy requirements. NHCHD health care components will modify, in a
prompt manner, its individual privacy procedures to conform to revised NHCHD policies.
Retention and Disposition
Policies, procedures, and privacy documentation required by the HIPAA Privacy Rule must be maintained
in writing in accordance with the General Schedule for State Agency Records issued by the North Carolina
Department of Cultural Resources, Division of Archives and History, Archives and Records Section,
Government Records Branch.
Compliance
The health care components of NHCHD must comply with the privacy policies developed and .
implemented according to this process by April 14, 2003. This date represents the compliance date
specified in the HIPAA Privacy Rule.
Title:
Chapter:
Governing Body Approval Date:
Effective Date:
Privacy Manual
Administrative Procedures, Privacy Protections
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New Hanover County Health Department
HIPAA Policy and Procedure Manual
Privacy Policy/Procedure Development & Approval Process
I. Introduction
The New Hanover County Health Department (NHCHD) of Wilmington, North Carolina, is
comprised of divisions and programs that are responsible for ensuring the health, safety and well being
of citizens of New Hanover County, providing human service needs such as maternal health, health
promotion, family planning, immunizations, school health, communicable disease, child health, nutrition,
environmental health, and animal control. In providing services to clients, most programs create andlor
maintain individually identifiable health information that is essential for performing routine business
operations.
The health information created and maintained by the NHCHD must be protected from misuse
and unauthorized disclosure. While the HIPAA Privacy Rule was the initial incentive to develop a
privacy manual, it is apparent that all health information created and maintained by the NHCHD should
be protected. Therefore, the NHCHD is establishing its requirements for protecting the health
information of its clients in the New Hanover County Health Department Privacy Policy and Procedure
Manual to reflect all privacy rules.
The following describes the process that will be used by the NHCHD in the development and
approval process for the NHCHD privacy policies and procedures. This process reflects state and
federal laws, county rules and regulations, and current business practices.
II. Privacy PolicylProcedure Development Process
The process for policy/procedure development and approval and review for the NHCHD shall be
as follows:
_ The NHCHD designated Privacy Officer and a representative of each its health care
components is part of a Privacy Policy Workgroup. Members of this workgroup were asked to
serve as members of a team to draft and review Privacy Policies and Procedures required for
compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
The Privacy Officer is the lead person for the workgroup.
_ Draft policies and procedures are developed within a policy category based on the HIPAA
requirements and using NC DHHS templates. They are then reviewed against existing policies
and procedures within the NHCHD and its health care components.
_ As each policy and procedure draft is completed, it is emailed to each workgroup member
through its Privacy Official for review and suggested changes and returned to the Privacy
Official within 30 working days. Representatives from NHCHD health care components will use
this review period to include participation from their respective administrative staff and
personnel within the health care components. All comments from each health care component
must be documented and accompany the policy draft. Those health care components that
have both a HIPAA coordinator and a lead Privacy person must coordinate one response from
the health care component.
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The Privacy Official will incorporate any suggested changes and submit them to the workgroup .
members as stated above allowing for a second review.
Once an initial draft is completed, the Privacy Officer will forward it to the NHCHD Management
Team. Revisions will be sent back to the Privacy Officer for inclusion in the policy draft.
Following NHCHD Management Team review, final drafts will be sent to the New Hanover
County attorney for review from a legal perspective to ensure compliance with HIPAA
requirements and to review the findings based on preemptive legal analysis. Attorney approval
must be received before the policy is approved by the Board of Health.
III. Privacy Policy/Procedure Approval Process
Some NHCHD HIPAA policies/procedures will apply to all NHCHD programs and all will apply
only to the health care components that must comply with HIPAA, county Business Associates,
or health component Business Associates.
The process for the NHCHD final review and approval of the proposed privacy policies
and procedures is as follows:
The Policy Development Workgroup makes recommendations on policy and procedure based
on best practice. The NHCHD Management Team will make the final determinations to be
presented to the Board of Health for final review and approval.
_ As policies and procedures are approved by the Board of Health, the Privacy Officer is e
responsible for establishing and maintaining a policy and procedure manual and ensuring that
all affected health care components and staff are notified of the policy and procedure. The
Privacy Officer is also responsible for revising the policy and procedure manual as needed
following the steps outlined in the Privacy Policy Development Process.
_ The Privacy Officer is responsible for assuring training of staff on approved policies and
procedures.
Title:
Chapter:
Privacy Manual
Administrative Policies, Privacy Policy Development &
Approval Process
Governing Body Approval Date:
Effective Date:
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New Hanover County Health Department
HIPAA Policy and Procedure Manual
Privacy Officer and Privacy Official Policy
Purpose
This policy addresses the role and responsibilities of the New Hanover County Health
Department (NHCHD) Privacy Officer and NHCHD privacy officials who serve as the primary
point of contact for all privacy related issues for the NHCHD and NHCHD health care
components respectively The Privacy Officer and officials are responsible for the
coordination and facilitation of compliance activities associated with the NHCHD privacy
policies. '.
Scope
All NHCHD programs that maintain individually identifiable health information.
Policy
NHCHD and its health care components that maintain individually identifiable health
information shall ensure the privacy and confidentiality of that information by designating a
NHCHD Privacy Officer and NHCHD health care components privacy officials to oversee
the use and disclosure of health information.
Background
The HIP AA Privacy Rule requires the designation of personnel that are responsible for the
implementation of privacy policies and procedures, as well as personnel that are responsible
for receiving privacy complaints and answering questions.
NHCHD as a hybrid entity, has designated the Business Officer as the Privacy Officer who is
responsible for the coordination and implementation of all privacy and confidentiality efforts
within the NHCHD. In addition, NHCHD has determined that every health care component
in the NHCHD that maintains individually identifiable health information has designated
supervisors as privacy officials who are responsible for ensuring the privacy of health
information that is used or disclosed within the health care component.
Responsibilities
NHCHD Privacy Officer
The NHCHD Privacy Officer shall oversee all activities related to the development,
maintenance and adherence to NHCHD policies regarding the use and disclosure of
individually identifiable health information, in accordance with state and federal laws and
best business practices.
The responsibilities of the NHCHD Privacy Officer shall also include, but are not limited to
the following:
_ Act as the NHCHD expert for issues related to privacy in the use and disclosure of
health Information
_ Serve as liaison with the New Hanover county attorney in the analysis and
application of privacy laws
_ Develop and maintain privacy policies related to the use and disclosure of health
. information
_ Provide guidance in the implementation of health information privacy policies and
procedures
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Provide consultation and direction regarding privacy and confidentiality to health care
components within the department
_ Coordinate privacy activities within the NHCHD.
_ Create educational awareness programs and ensure staff and extended workforce
training is conducted
_ Monitor state and federal privacy legislation
_ Monitor NHCHD' compliance with NHCHD privacy policies and report compliance
level to management
_ Escalate privacy issues, as appropriate, to NHCHD management
Communicate ali NHCHD expectations for privacy to NHCHD health care
component privacy officials.
_ Document and maintain records of privacy complaints for NHCHD and coordinate
resolution with NHCHD health care component privacy officials.
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NHCHD Health Care Component Privacy Officials
NHCHD health care component Privacy Officials shall guide all agency activities related to
the maintenance and adherence to NHCHD policies regarding the use and disclosure of
individually identifiable health information, in accordance with state and federal laws and
best business practices.
NHCHD covered health care component Privacy Officials responsibilities shall also include,
but are not limited to, the following:
_ Serve as primary NHCHD health care component contact for privacy issues and
concerns regarding the use and disclosure of health information and for client
accessibility to appropriate health Information
_ Serve as the NHCHD health care component liaison to the NHCHD Privacy Officer e
for privacy related activities
_ Provide clients with further information conceming the Notices of Privacy Practices
_ Coordinate and facilitate efforts to support NHCHD health care components in the
accomplishment of their privacy compliance activities.
The NHCHD Privacy Officials are responsible for ensuring NHCHD health care component
compliance with the NHCHD privacy policies. The following are some of those NHCHD
health care component requirements for which the privacy official would participate:
_ Development of procedures, based on NHCHD privacy policies, to ensure the
protection of individually identifiable health information within the NHCHD health
care component
_ Implementation of NHCHD health care component privacy requirements by
incorporating new operational privacy practices into existing business practices
_ Assurance of applicable privacy training delivery to NHCHD health care
component staff and extended workforce
_ Provision of a designated NHCHD health care component contact for privacy
complaints and assurance that all complaints are appropriately documented
_ Monitoring of agency compliance with NHCHD privacy policies
Assurance of appropriate use and disclosure of indlvidualiy identifiable health
information and client accessibility to appropriate health information
_ Provision of reasonable protections for individually identifiable health information
within a NHCHD health care component
_ Shall serve as the NHCHD health care componenfs contact person for receiving .
complaints
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_ Shall coordinate and provide documentation of complaints to the NHCHD
Privacy Officer
_ Shall assure appropriate access or review of designated record sets to clients
upon request
_ Shall assure for providing accounting of disclosures to clients upon request.
Implementation
NHCHD shall appoint a NHCHD Privacy Officer The NHCHD Privacy Officer shall maintain
the list of all designated NHCHD health care component privacy officials within the NHCHD.
Each NHCHD health care component that maintains individually identifiable health
information has designated supervisors to serve as the NHCHD' Health Care Component
Privacy Official.
Organizationally, privacy officials report to their supervisor within the agency. Privacy
officials shall have an indirect reporting relationship to the NHCHD Privacy Officer for privacy
related activities. Upon request from the NHCHD health care component's supervisor, the
NHCHD Privacy Officer shall provide input to the privacy official's annual performance
evaluation as applicable to privacy related activities.
Title:
Chapter:
Governing Body Approval Date:
Effective Date:
Privacy Manual
Administrative Procedures, Privacy Official
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New Hanover County Health Department
HIPAA Polley and Procedure Manual
Workforce Policy
Purpose
This policy addresses the requirement to document the personnel designations of the New
Hanover County Health Department (NHCHD) that shall be known as its .workforce." This
policy also describes the overall organizational approach of training the workforce on the
policies and procedures of NHCHD.
Scope
All NHCHD and health care components that have been designated as a hybrid entity and
are subject to adherence of the HIPAA Privacy Rule.
Policy
The workforce of the NHCHD shall be all those persons or disciplines that are listed below
whose conduct, in the performance of work for the NHCHD is under the direct control of the
NHCHD and must abide by its policies and procedures while performing their duties.
Workforce:
NHCHD Employees (full- and part-time)
NHCHD Volunteers having access to PHI
Students/lntems assigned to NHCHD having access to PHI
Business Associates:
Contracted Health Care Providers
Interpreter Services
Background
The HIPAA Privacy Rule requires the documentation of personnel designations for the
workforce of NHCHD. NHCHD will train all members of its workforce on Its policies and
procedures with respect to protected health information required by the HIPAA Privacy Rule
as necessary and appropriate for the members of the workforce to carry out their functions
within NHCHD.
ResponslblJlty
The Privacy Officer of the NHCHD shall create educational awareness programs and
ensure staff and extended workforce training is conducted (see Privacy Officer and Privacy
Official Policy). The Privacy Officer shall be responsible for documenting and maintaining
the documentation that the training required by the HIPAA Privacy Rule has been provided
to the workforce of the NHCHD as described in the Workforce Policy.
Implementation
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1. Each member of the workforce of the NHCHD as designated in the Workforce Policy
shall be provided training on the policies and procedures required by the HIPAA
Privacy Rule no later than April 14, 2003.
2. Each new member of the workforce of the NHCHD that is employed after April 14,
2003, shall be provided training on the policies and procedures that are required by
the HIPAA Privacy Rule within one (1) week or before having access to PHI,
whichever comes first after the person joins the workforce of NHCHD.
3. Each member of the workforce whose functions are affected by material changes in
the policies or procedures of the NHCHD that are required by the HIPAA Privacy
Rule shall be provided training within 90 days after the material change becomes
effective.
Titie: Privacy Manual
Chapter: Administrative Procedures, Workforce Policy
Governing Body Approval Date:
Effective Date:
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New Hanover County Health Department
HIPAA Administrative Requirements (~ 164.530)
I.
Designating Required Personnel: ~ 164530(a)
A.
Privacy Officer and Privacy Officials
. New Hanover County Health Department (NHCHD) has designated the Business
Officer as the privacy official who is responsible for the development and implementation of the
agency's privacy policies and procedures.
. NHCHD Privacy Officials are supervisors working in the health care components.
B. Contact Person/Office
. NHCHD has designated the Administration Division:
a. responsible for receiving complaints, and
b. able to provide further information about matters covered by the required
Notice of Privacy Practices.
. The contact person is the Business Officer
NHCHD documented personnel designations in accordance with the documentation
requirements. A part of training the workforce will include identification of Privacy Official and
process to contact.
II. Implementing Written Policies and Procedures: ~164.530(i)
A. NHCHD has implemented policies and procedures designed to comply with the privacy
rule.
1. The policies and procedures are in writing.
2. The policies and procedures are reasonably designed, taking into account the
size and the type of activities the NHCHD undertakes that relate to PHI.
a. This provision is not interpreted to permit or excuse any action that
violates the privacy rule.
B. Changes to Policies and Procedures
1 NHCHD will change its policies and procedures when necessary to comply with
changes in the law, including changes to the privacy rule.
a.
Whenever a change in law necessitates a change in policy or
procedures, NHCHD will promptly document and implement the revised
policy and procedure.
If the change in law materially affects the content of NHCHD Notice of
Privacy Practice, the agency will promptly revise its notice in accordance
with ~ 164.520(b)(3).
i. Ordinarily, when a Notice is revised, the changes to the Notice will
not be implemented before the effective date of the revised notice.
b.
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However, when the revision is required to comply with a change in the
law, NHCHD will comply with the change in law whenever it becomes
effective, rather than waiting for the effective date of its revised Notice.
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2. When NHCHD makes a change to a privacy practice that is described in its
Notice of Privacy Practices, it will make the changes retroactive to PHI that it
created or received before making the change, since the agency has included a
statement expressly reserving the right to do so in its Notice.
a. To implement a change that affects the Notice, the NHCHD will do all of
the following:
i. Ensure that the revised policy or procedure complies with the
privacy rule;
ii. Document the revised policy or procedure in accordance with the
documentation requirements; and
Iii. Revise the Notice in accordance with the requirements in
~ 164.520(b) (stating the changed practice) and (c) (making the
revised notice available).
iv Except when a change to the Notice reflects a change in policies
or procedures brought about by a change in law, NHCHD will not
implement the change in policy and procedure prior to the
effective date of the revised Notice.
b. See also ~ 1640520(b)(1)(v)(c) and the outline, Right to a Notice of
Privacy Practices.
3. Notice of Privacy Practices will be laminated and handed to patients during the registration
process. Patients will be asked to read the notice and sign a statement confirming notice was
provided. Copies of the Notice of Privacy Practices will be available in hard copy and will be
given to any patient requesting a copy
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4 Signatures confirming receipt of Notice of privacy practices will be a hard copy Signatures
submitted as hard copy will be maintained in the patient's medical record.
5. Notice of Privacy Practices must be available in a format that can be understood by the
consenting individual and includes versions in English, Spanish,audio, and by using interpreters
when necessary
. NHCHD may make changes to policies and procedures not reflected in the Notice at
any time, provided that both of the following conditions are met:
a. The changes comply with the privacy rule, and
b. Before the effective date of the change, the change is documented in
accordance with the documentation requirements.
III. Training the Workforce: ~ 164.530(b)
A.
The NHCHD trains all members of its workforce in the agency's privacy policies and
procedures. The training enables the workforce to carry out their function within the
agency in accordance with HIPPA regulations.
1 The HIPPA regulations define "workforce" as "employees, volunteers, trainees,
and other persons whose conduct, in the performance of work for a covered
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entity, is under the direct control of such entity, whether or not they are paid by
the covered entity" 45 C.F.R. ~ 160.103. In NHCHD this includes employees,
volunteers, and students who have access to PHI.
2.
Contracted personnel who have access to PHI will be defined as a business
associate. They must sign a Business Associate Agreement that states they will
comply with HIPAA regulations.
B. Training will be provided to each member of the workforce prior to the compliance date
approved for the agency Thereafter, training will be provided to each new member of
the workforce prior to having access to PHI. There will be two categories for workforce
training. All employees will receive basic introduction to HIPAA rules, since those
individuals who are not authorized to access PHI must be aware of regulations. Those
individuals authorized to access PHI will receive specific training.
C. NHCHD will document the training that has been provided in accordance with the
documentation requirements. Copies of the training records will be maintained by the
Privacy Officer and by each employee's supervisor
IV. Receiving Complaints: ~ 164.530(d)
A.
The NHCHD will provide a process for individuals to make complaints about the
agency's privacy policies and procedures or its compliance with the privacy rule or its
own privacy policies and procedures.
1 In its Notice of Privacy Practices, NHCHD has identified the Administration
Division who will receive the complaints.
2. NHCHD is not required to respond to or act upon the complaints it receives.
However, if NHCHD does respond or act, NHCHD's response or action will be
documented.
B. NHCHD will document all complaints received and any disposition of those complaints
in accordance with the documentation. There is a Documentation of Complaint Policy
and Form that may be used to record the complaint. A complaint log will be maintained
by the Privacy Officer
V. Documentation Requirements: ~ 164.530(j)
A. All documentation that is required by the privacy rule and NHCHD HIPAA policies and
procedures will be on paper or in electronic form.
B. Specific requirements
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NHCHD will maintain its policies and procedures in written form. This includes all
administrative and division specific policies and procedures related to HIPAA, as
well as Medical Records' Policies and Procedures. THE NHCHD HIPAA Manual
(complete) will be located in the office of the Privacy Officer
2.
Documentation of receipt of Notice of Privacy Policies will be hard copy
33
C.
Retention of documentation: NHCHD will retain any documentation that is required by
the privacy rule for six years from the date it was created, or from the date it was last in
effect, whichever is later Actions regarding medical records' releases and amendments
will be documented in the records and retained according to the records' retention
guidelines from the state.
VI. Other requirements of ~ 164.530
A. Establishing Safeguards to Protect the Privacy of PHI: ~ 164.530(c)
B.
1 Requirements regarding safeguards:
a. NHCHD has in place appropriate administrative, technical, and physical
safeguards to protect the privacy of PH I.
b. NHCHD reasonably safeguards PHI from any intentional or unintentional
use or disclosure that is in violation of the privacy rule. See Division
specific policies and procedures.
2. Disclosures
a. NHCHD has policies in place for denying release of PHI information and
denying a request to amend a medical record. See NHCHD POLICY.
Medical Records Security
b. NHCHD will accept requests, in writing, from clients to limit the use and
disclosure of their medical information for treatment, payment, and
healthcare operations. NHCHD is not required to agree with the request.
If we do, we must follow the client's restrictions (except if the information
is necessary for emergency treatment). The client may cancel their
restrictions at any time in writing, and we may cancel a restriction as
long as we notify the client and continue to apply the restriction to
information collected before the cancellation.
c. NHCHD will accept requests, in writing, from clients wanting an
accounting of any disclosure of PHI for the previous six years. The
Privacy Officer will review the medical record and provide a list of dates, a
summary of PHI that was released, and where the requested PHI was
sent. A copy the accounting of disclosure provided to the client will be
kept in the medical record.
3. Alternative Methods of Contact
Clients/patients have the right to request to be contacted at a different location or
by a different method. For example, a client/patient may prefer to have all
written information mailed to their work address rather than their home address.
The NHCHD may agree to any reasonable request for alternative methods of
contact. Clients/patients who would like to request an alternative method of
contact must provide the NHCHD with a written request.
Establishing and Applying Sanctions: ~ 164.530(e)
1. NHCHD has established appropriate sanctions for failure to comply with the with
the privacy rule and the agency's privacy policies and procedures. See NHCHD
Confidentiality Policy
2.
Sanctions do not apply in the following circumstances:
a. When the member of the workforce disclosed PHI while acting as a
t
.
.
.
34
I
.
.
.
b.
"whistleblower" -that is, someone who notifies authorities of the unlawful
or unethical actions of the covered entity-and the disclosure is made in
accordance with the criteria in ~ 164.5020)(1) (the provision setting forth
the rules for disclosures by whistleblowers).
When the member of the workforce who discloses PHI is the victim of a
crime, and the disclosure is made in accordance with the criteria in
~ 164.502(j)(2) (the provision setting forth the rules for disclosures by
workforce members who are victims of a crime.)
When the member of the workforce engages in an act described in
~ 164.530(g)(2)-such as filing a complaint that NHCHD may not retaliate
against.
c.
3. NHCHD will document any sanctions that are applied in accordance with the
documentation requirements.
C. Mitigating Harmful Effects of Improper Uses or Disclosures: lJ 164.530(f)
1 To the extent possible, NHCHD will mitigate any harmful effect of a
disclosure of PHI that violates the privacy rule or NHCHD's privacy policies and
procedures, when the improper use or disclosure is known to the agency
Employees shall report any improper use or disclosure to the supervisor
2.
The provision applies both to improper uses or disclosures made by NHCHD
itself, and to improper uses or disclosures made by the agency's business
associates.
D. Refraining from Intimidating or Retaliatory Acts: ~ 164.530(g)
1 NHCHD will not intimidate, threaten, coerce, discriminate against, or take any
other retaliatory action against any of the following:
a.
An individual who is the subject of PHI who does either of the following:
i. exercises any of the rights granted to individuals by the privacy
rule (such as the right to amend PHI), or
1. participates in any process established under the
privacy rule, such as the filing of complaints.
Any person (including a member NHCHD's work force) who does any of
the following:
i. Files a complaint with the US DHHS alleging violation of the
privacy rule;
ii. Testifies, assists, or participates in an investigation, compliance
review, or enforcement proceeding or hearing; or
lll. Opposes any act or practice made unlawful by the privacy rule,
provided both of the following apply'
the person has a good faith that the practice opposed is
unlawful, and
the manner of the opposition is reasonable and does not
involve a disclosure of PHI that is not permitted by the
privacy rule.
b.
35
E.
No Conditioning Treatment, Payment, Enrollment, or Benefit Eligibility on Waiver of
Rights: ~ 164.530(h)
1 NHCHD does not require individuals to waive their rights under the privacy rule
or their right to file a complaint with US DHHS as a condition of treatment,
payment, enrollment in a health plan, or eligibility for benefits.
,
I
.
.
.
36
4;
I,
\
~~
e
NEW HANOVER COUNTY HEALTH DEPARTMENT
BUSINESS ASSOCIATE AGREEMENT
This Agreement is made effective the _ of _, 200_, by and between
, hereinafter referred to as "Covered Entity", and
hereinafter referred to as "Business Associate", (individually, a "Party" and collectively, the "Parties").
WITNESSETH:
WHEREAS, Sections 261 through 264 of the federal Health Insurance Portability and Accountability Act
of 1996, Public Law 104-191, known as "the Administrative Simplification provisions," direct the Department of
Health and Human Services to develop standards to protect the security, confidentiality and integrity of health
information; and
WHEREAS, pursuant to the Administrative Simplification provisions, the Secretary of Health and
Human Services has issued regulations modifying 45 CFR Parts 160 and 164 (the "HIPAA Privacy Rule"); and
WHEREAS, the Parties wish to enter into or have entered into an arrangement whereby Business
Associate will provide certain services to Covered Entity, and, pursuant to such arrangement, Business
associate may be considered a "business associate" of Covered Entity as defined in the HIPAA Privacy Rule
.,e agreement evidencing such arrangement is entitled
, dated
, and is hereby referred to as the "Arrangement Agreemenr); and
WHEREAS, Business Associate may have access to Protected Health Information (as defined below)
in fulfilling its responsibilities under such arrangement;
THEREFORE, in consideration of the Parties' continuing obligations under the Arrangement
Agreement, compliance with the HIPAA Privacy Rule, and other good and valuable consideration, the receipt
and sufficiency of which is hereby acknowledged, the Parties agree to the provisions of this Agreement in
order to address the requirements of the HIPAA Privacy Rule and to protect the interests of both Parties.
I. DEFINITIONS
Except as otherwise defined herein, any and all capitalized terms in this Section shall have the definitions set
forth in the HIPAA Privacy Rule. In the event of an inconsistency between the provisions of this Agreement and
mandatory provisions of the HIPAA Privacy Rule, as amended, the HIPAA Privacy Rule shall control. Where
provisions of this Agreement are different than those mandated in the HIPAA Privacy Rule, but are
nonetheless permitted by the HIPAA Privacy Rule, the provisions of this Agreement shall control.
The term "Protected Health Information" means individually identifiable health information including, without
limitation, all information, data, documentation, and materials, including without limitation, demographic,
medical and financial information, that relates to the past, present, or future physical or mental health or
.A>ndition of an individual; the provision of health care to an individual; or the past, present, or future payment
.r the provision of health care to an individual; and that identifies the individual or with respect to which there
is a reasonable basis to believe the information can be used to identify the individual.
37
'i.
.
If
Business Associate acknowledges and agrees that all Protected Health Information that is created or received
by Covered Entity and disclosed or made available in any form, including paper record, oral communication,
audio recording, and electronic display by Covered Entity or its operating units to Business Associate or is
created or received by Business Associate on Covered Entity's behalf shall be subject to this Agreement.
e
II. CONFIDENTIALITY REQUIREMENTS
(A) Business Associate agrees:
(I) to use or disclose any Protected Health Information solely: (1) for meeting its obligations
as set forth in any agreements between the Parties evidencing their business
relationship, or (2) as required by applicable law, rule or regulation, or by accrediting or
credentialing organization to whom Covered Entity is required to disclose such
information or as otherwise permitted under this Agreement, the Arrangement
Agreement (if consistent with this Agreement and the HIPAA Privacy Rule), or the
HIPAA Privacy Rule, and (3) as would be permitted by the HIPAA Privacy Rule if such
use or disclosure were made by Covered Entity;
(ii) at termination of this Agreement, the Arrangement Agreement (or any similar
documentation of the business relationship of the Parties), or upon request of Covered
Entity, whichever occurs first, if feasible, Business Associate will return or destroy all
Protected Health Information received from or created or received by Business
Associate on behalf of Covered Entity that Business Associate still maintains in any form
and retain no copies of such information, or if such return or destruction is not feasible,
Business Associate will extend the protections of this Agreement to the information and ..
limit further uses and disclosures to those purposes that make the return or destruction ..
of the information not feasible; and
(iii) to ensure that its agents, including a subcontractor, to whom it provides Protected
Health Information received from or created by Business Associate on behalf of Covered
Entity, agrees to the same restrictions and conditions that apply to Business Associate
with respect to such information. In addition, Business Associate agrees to take
reasonable steps to ensure that its employees' actions or omissions do not cause
Business Associate to breach the terms of this Agreement.
(B) Notwithstanding the prohibitions set forth in this Agreement, Business Associate may use and
disclose Protected Health Information as follows:
(i) if necessary, for the proper management and administration of Business Associate or to
carry out the legal responsibilities of Business Associate, provided that as to any such
disclosure, the following requirements are met:
(a) the disclosure is required by law; or
(b) Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will be held confidentially and used or further
disclosed only as required by law or for the purpose for which it was disclosed to
the person, and the person notifies Business Associate of any instances of which
it is aware in which the confidentiality of the information has been breached;
(il) for data aggregation services, if to be provided by Business Associate for the health care
operations of Covered Entity pursuant to any agreements between the Parties
evidencing their business relationship. For purposes of this Agreement, data .
aggregation services means the combining of Protected Health Information by Business
Associate with the protected health information received by Business Associate in its
38
,
e
capacity as a business associate of another covered entity, to permit data analyses that
relate to the health care operations of the respective covered entities.
(C)
Business Associate will implement appropriate safeguards to prevent use or disclosure of
Protected Health Information other than as permitted in this Agreement. The Secretary of
Health and Human Services shall have the right to audit Business Associate's records and
practices related to use and disclosure of Protected Health Information to ensure Covered
Entity's compliance with the terms of the HIPAA Privacy Rule. Business Associate shall report
to Covered Entity any use or disclosure of Protected Health Information which is not in
compliance with the terms of this Agreement of which it becomes aware. In addition, Business
Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to
Business Associate of a use or disclosure of Protected Health Information by Business
Associate in violation of the requirements of this Agreement.
III. AVAILABILITY OF PHI
Business Associate agrees to make available Protected Health Information to the extent and in the manner
required by Section 164.524 of the HIPAA Privacy Rule. Business Associate agrees to make Protected Health
Information available for amendment and incorporate any amendments to Protected Health Information in
accordance with the requirements of Section 164.526 of the HIPAA Privacy Rule. In addition, Business
Associate agrees to make Protected Health Information available for purposes of accounting of disclosures, as
required by Section 164.528 of the HIPAA Privacy Rule.
e
IV. TERMINATION
Notwithstanding anything in this Agreement to the contrary, Covered Entity shall have the right to terminate
this Agreement and the Arrangement Agreement immediately if Covered Entity determines that Business
Associate has violated any material term of this Agreement. If Covered Entity reasonably believes that
Business Associate will violate a material term of this Agreement and, where practicable, Covered Entity gives
written notice to Business Associate of such belief within a reasonable time after forming such beljef, and
Business Associate fails to provide adequate written assurances to Covered Entity that it will not breach the
cited term of this Agreement within a reasonable period of time given the specific circumstances, but in any
event, before the threatened breach is to occur, then Covered Entity shall have the right to terminate this
Agreement and the Arrangement Agreement immediately.
V. MISCELLANEOUS
Except as expressly stated herein or the HIPAA Privacy Rule, the parties to this Agreement do not intend to
create any rights in any third parties. The obligations of Business Associate under this Section shall survive the
expiration, termination, or cancellation of this Agreement, the Arrangement Agreement and/or the business
elationshiP otthe parties, and shall continue to bind Business Associate, its agents, employees, contractors,
uccessors, and assigns as set forth herein.
39
r
This Agreement may be amended or modified only in a writing signed by the Parties. No Party may assign its .-
respective rights and obligations under this Agreement without the prior written consent of the other Party ,.,
None of the provisions of this Agreement are intended to create, nor will they be deemed to create any
relationship between the Parties other than that of independent parties contracting with each other solely for
the purposes of effecting the provisions of this Agreement and any other agreements between the Parties
evidencing their business relationship. This Agreement will be governed by the laws of the State of North
Carolina. No change, waiver or discharge of any liability or obligation hereunder on anyone or more
occasions shall be deemed a waiver of performance of any continuing or other obligation, or shall prohibit
enforcement of any obligation, on any other occasion.
The parties agree that, in the event that any documentation of the arrangement pursuant to which Business
Associate provides services to Covered Entity contains provisions relating to the use or disclosure of Protected
Health Information which are more restrictive than the provisions of this Agreement, the provisions of the more
restrictive documentation will control. The provisions of this Agreement are intended to establish the minimum
requirements regarding Business Associate's use and disclosure of Protected Health Information.
In the event that any provision of this Agreement is held by a court of competent jurisdiction to be invalid or
unenforceable, the remainder of the provisions of this Agreement will remain in full force and effect. In
addition, in the event a party believes in good faith that any provision of this Agreement fails to comply with the
then-current requirements of the HIPAA Privacy Rule, such party shall notify the other party in writing, For a
period of up to thirty days, the parties shall address in good faith such concern and amend the terms of this
Agreement, if necessary to bring it into compliance. If, after such thirty-day period, the Agreement fails to
comply with the HIPAA Privacy Rule, then either party has the right to terminate upon written notice to the
other party
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the day and year written
above.
e
COVERED ENTITY
BUSINESS ASSOCIATE:
By:
Title:
By'
Title:
.
40
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Electronic Data Interchange (ED! Rule)
Proposed Rnle Published: May 7, 1998
Final Rule Published: August 17, 2000
Compliance Date: October 16, 2002 (unless submitted Compliance Plan which
allows for a one year extension to October 16, 2003). Small health plans have until
10/16/03
The transactions under mandated standardization are:
~
837 - Professional Health Care claim or encounter
837 - Institutional Healthcare claim or encounter
837 - Dental Healthcare claim or encounter
835 - Health Care Claim Payment/Remittance Advice
270 - Health Insurance Eligibility request verification for covered benefits
271 - Health Insurance Eligibility response verification for covered benefits
834 - Enro11ment/Disenrollment to a health plan
276 - Health Care Claim, inquiry to request the status of a health claim
277 - Health Care Claim, response to request the status of a health claim
278 - Health Care Services, to request authorizations and referrals
820 - Premium Payment, for enrolled health plan members
The code sets under mandated standardization are:
ICD-9: International Classification of Diseases
NDC and J-Codes - National Drug Codes
CDT -L - Code on Dental Procedures and Nomenclatures
HCPCS - Health Care Financing Administration Common Procedure Coding
System
CPT -4 - Current Procedura1 Terminology
.
42
---..""- ,.. ..~-~--_.,._,. .-, '.-
~,._,-~_._--_...-
.._..-..-.--............
--------.
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STATUS OF REGULATIONS
February 2903
Status of HHS HIP AA Administrative Simnlification Re2UlatiODs
-
TITLE DFSCRIYnON STATUS
Standards for Electronic The fina1 rule adopts the initial Final
Tmnsactioos standardized fonnats for Published August 17,2000.
65 FR 50312 transactions and code sets for
several types of transactions, Compliance date 10/16/2002 (or
including health claims, eligibility, 10/16/2003 if compliance
verification and health plan extension plan submitted).
enrollment. Adopted standardized
code sets that are used to
communicate medical information,
such as diagnoses or medical
Drocedures CU. ICD-9 codes).
St;mdards for Privacy & The fina1 rule adopted standards for Final
Individually J<Jp.nrifiable Health the privacy of personal health Published 12/28/2000.
Infonnation iuformation. Establishes a
65 FR82461 comprehensive framework for the Complianoe date 4/1 4/2003.
use and disclosure of iMmifiable
health infonnation. Establishes
several new individual ril!bts.
Privacy Guidance Provides answers to general Issued 7/6/2001 addresses Privacy
questions regarding the Standards Rule published 12/28/00.
for Privacy of Individually
1d_ifiable Health Information (the
Privacy Rule) that was published
l2!28/00.
An additional guidance docmnent Issued 1214/02 addresses Privacy
publisbed to answer general Rule published 12/28/00 aud the
auesrions re the PrivacY Rule. modifications nublished 8/14/02.
Modifications to Standards for Changes/modifications to the Final
Privacy of Individually Privacy Rule published 12/28/00. Published 08/14/02
IdeatifiabIe lllL...ation These rhAV" affect: (NPRM Published 3/2102)
4S CFRS31&2 - Consent and Nolice
- AuthorizatioDs
- Jncidcota1 uses & disc\osuIes Compliance date 4/1412003.
- Business Associate <Jrace
Period
- Employment Records
- Hybrid entity definition
- Minor.;
- Research
.-..---.--..-.--- - MaIketiDg----
- .ACCOUDIing of disclosmes
e
1
43
. .--.
.-"- - .-.-----_.
_.__._---_._~_. ,.------.----.---....
-- --..-
_..-- ...---......-..--
.__~ _a ____
__._. _.n___
----.----
- ------..
TITLE DESCRIPTION STATUS
Standard Unique Identifier for This fina1 rule was jointly developed Final .
Employers by CMS, Treasury, Labor, and Published 5/31/02
CMS..0047-F Defeme. The regulation adopts the Effective date 713C)f1Yl
employer's tax ID number or Complianoe date 7/30104
Employer Ideutification Number
(EIN) as the standard for electronic
transactions, impIe...",utiug an
administrative simplification
initiative that has a national scope
beyond the Medicare and Medicaid
programs. Covers any business that
pays wages to one or more
employees.
Security Standards (HIPAA) This final rule is being jointly Proposed 8/12/98
45 CRF 8334 developed by CMS and the Final rule published 2120/03
CMS-0049-F Department of Commerce. This
rule adopts standards for the Complianoe date 4121/05.
security of certain electronic
idP.rIIifiable health infurmation of
health plans, health care (Complianoe date for small health
clearinghouses, aud certain health plans is 4121/06.)
care provider.;. It implement~
administrative simplification
initiatives that have a national scope
beyond the Medkare and Medicaid
programs. Will require entities to
establish administrative, procedural
and teclmicaI safeguards to protect
health information 1JI'lm"'ined by
the entity.
Standard Unique Health Care .. This final rule establi~hes a Proposed 5nJ9&
Provider Id-rifier standard unique ID, adoptiIIg the Final rule estimated pub1icaPOI,I
CMS-0045-F NFl as the standard identifier for all date January 2003
hea1th care providers nnder HlPAA. . .
The role implemeots administrative Comp1iam:e date 2 years after r
simplification initiatives that have a effective date.
national scope beyoDd Medicare
aud Medicaid. Will establish a
system for assigning a unique
idenrifier to all health care
providers.
2
. __on. _ ~__
- .---....--..-.,
. -..-...---.-
.._---_..~....
- - ----
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44
.
v,
.
TITLE
for Claims
Attaclm1ents
CMS..o05O-P
Standard Unique Health Plan
Identifier
CMS-41 45-P
Enfor=ncnt
Modifications to Standards for
Electronic Transactions
45 CFR 8381
CMS-0003-F
Revisions to Transactions lIDd
Code Set Standards for Electronic
T~
45 CFIU381
CMS-OOOS-F
-
----_..---
--.
DESCRIPTION
This rule proposes to adopt a
standard for claims anacbments,
Which frequently accompany health
care standard tIaDSactions. Will
adopt or establish a standard for
transmitting claims attacbments.
Small Entities Affected:
Businesses
Govermnent Levels Affected:
State, Local, Federal, Tnbal
This rule proposes the standard
health plan identifier. Will
establish a system foT assigning a
unique identifier to all health care
plans.
Proposed rule is under
development.
This proposed rule adopts a revised
National Council for Prescription
Drug Programs (NCPDP) standard
for batched retail pbannacy
1!'a"o<oclions, adopts a revised
standard fur pn..nna<:y remittance
. advice and prior authorization, and
retradS the NDC code as the
standard for drugs in all
transaCtions except retail
harmacies.
This proposed rule adopts
modifications recommended by the
Delo;g....tM Standards M~;m,.,llJtCe
Orpni~""!i:.
3
.._.. ..__"..__. _ _.____u___~_.
STATUS
Unpublished-under development.
Proposed rule .,.;tiauated
publication date mid-2003.
Compliance date 2 years after
effective date.
UnpubIished-under development.
Proposed rule estimated
pnblication date Spring 2003.
Compliance date 2 years after
effective date.
Unknown-ilO tiJncVohle set.
Proposed 5/31/02.
Final rule published 2f20103.
Compliance date 10/16/03 with
exceptions.
Proposed 5/31/02.
Final rule pub1ished 2120/03.
Compliance date 10/16103 wUh
45
~.,
.
HIPAA Administrative SimplifICation Provisions Pending External Input
e
TITLE DESCRIPTION STATUS
StI'ndarq forEIectronic Signature An electronic signature standard Regulation will DOt be developed
was proposed in the Security until NCVHS bas made a
NPRM. Comments indicated lack recommendation.
of consensus. Industry continues to
worlt on this issue. NCVHS is Implementation of other standards
m s. is not affected.
Srandard Transaction for First This transaction was named in the Industry expected to propose
Report of Injury statute, but industry continues to standard-later this year Proposed
worlt on a consensus standard. role will be developed at that time.
Implementation of other standards
is not affected.
Unique Jdentiner fur Individuals Worlt on this identifier was halted On hold.
due to privacy conccms. Would Appropriations Ianguagc probibits
establish a system for assigning a CMS from expending funds.
, unique identifier to all individuals. ImpICl1J<>.,.>tiOI1 of other standards
is not affected.
Administrative Sim lification Com liante Act R
TITLE DESCRIPTION
Administrative Simplification ASCA required the Secretary to
Compliance Act (ASCA). develop a model compliance
extension plan for use by covered
Model Compliance Extension Plan entities when requesting the one-
Federal Register Notice year extension for implementing the
HIPAA transactions and code sets.
Exclusion from MaIK:arc
Proposed Rule
ASCA gives the Sccrctary ~
to exclude from the Medicare
PU.'lSliWl any covered P.I1ritiell that
an: not compliant by 10/16102 AND
have not subwittW a compliance
extension Ian.
ASCA adds an additional coverage
requirement for Medicare effective
1012003. Claims must be submitted
- ""==--:=~ - --~-
c~y using nac.n.n=---~-----
compliant fonnats. Specifies
ex . , e. ., for small roviders.
Medicare Coverage Requirement
Electronic Submission of Claims
inHIPAA-compliant Fonnat
PiOjlOsCdRule. ----.~-.
4
lations
STATUS
Congressional Act passed
12127/01. Public Law 107-105,
Administrative Simplification
Compliance Act (ASCA). CMS
issued model compliance plan
3/29/02. Coven:d entities must
submit an electronic compliance
plan for an extension by October
15, 2002. A ro..ered eotity does
not have to file a compliance plan
if it will be compliant with the
tra~clions rule by October 16,
2002, ewn if its tradiD& parlnelS
an: Dot liant.
Unpublishc:d-undcr dcvdopmcnt. .
e
Unpublished-under developmeot.
Proposed rule .,.;1:...~tAtI
publication date March 2003.
- (Includes conditions for obt~mi.1g
a waiver.
e
46
.
Countdown to Comnliance
What Covered Entities Must Do Before Anril14. 2003
. Identify and document the covered entity and the health care
compOnents
. Appoint and educate privacy officer
. Identify your workforce
"
. Identify business associates and modify contracts
. Identify and document designated record sets
e · Draft policies and procedures Z {, ~ IJ W fr.fV~ 7kA-
. hnplement reasonable safeguards
. Draft notice of privacy practices
. Identify procedures to be used for obtaining acknowledgements
. Draft consent forms (optional- Exception: not optional for l~
. . .= -=-~-
pub1i<: health departments m NC)
-::::=- -::: .:::;::. .::::::=
. Draft authorization forms
. Train workforce
__u__n__I!t. LO;;J C? t1)rK ~ ~/ I/lfAA
_ __...___. ._______...____ ._____n~
e
47
(II .
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 South 17th Street
Wilmington, NC 28401-4946
Telephone (910) 343-6500, Fax (910) 341-4146
E..,......E...,.,.E~.
DAVID RICE, M PH, M A
Health Director
LYNDA F. SMITH, M P H
Assistant Health Director
March 18, 2003
To: New Hanover County Board of Health
From: Cynthia W. Hewett, Business Officer ~~
Subject: Changes in CPT Codes and Fees
We are requesting approval for the following changes related to CPT Codes and fees:
Addition! CPT Code Fee Justification
Deletion
Addition 36416 $14.00 Currently, we use CPT Code 36415 for Collection of Venous Blood
by Venipuncture and Collection of Capillary Blood Specimen by
Fingerstick with a charge of $14.00. Due to a revision in CPT
coding for 2003, we are now able to separate these two services.
36415 will continue to be used for venipuncture and 36416 (new
code for 2003) will now be used for fingersticks. The charge for
each of these services will be $14.00.
Deletion 8447926 Handling This service (T3 or T4) was sent to the State Lab for processing.
Fee Only The State Lab is no longer providing this service.
Deletion 84443 26 Handling This service (Assay Thyroid Stirn Hormone) was sent to the State
Fee Only Lab for processing. The State Lab is no longer providing this
service.
.
"Your Health. Our Priority"
48
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I ~ Sharon Neuschafer
~ 041011200301:27 PM
To: Malcolm.Blalock@ncmail.net
ee: J.D.Potts@ncmall.net, Christina.Millar@ncmail.net, Mark
BoyerINHC@NHC, David E RicelNHC@NHC, Dianne
HarveIIlNHC@NHC, (bee: archive) ~
Subject: R~onal Water Quality - Public M urs~y,; W
The Recreational Water Quality Public Meeting has been scheduled. lJ
Date: Thursday, April 24, 2003 I
Time: 7 PM
Location: New Hanover County Commissioners Assembly Room
Historic Courthouse
24 North Third Street
I have spoken with Mart Boyer and the meeting will be broadcast on the NHC TV station.
Malcolm,
Please e-mail Mart Boyer the particulars of your presentation. powerpolnt presentetion, etc. His e-mail
is mboyer@nhcgov.com
Please let me know if I can be of further assistance.
Sharon
Sharon Neuschafer
Administrative Support Supervisor
New Hanover County Health Department
Environmental Health
Tel: (910) 343-6585
Fax: (910) n2-7810
NOTICE. E-mail correspondence to and from this address may be subject to the North Carofina Public Records Law and may be
disclosed to third parties by an authorized county official.
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North Carolina Department of Health and Human Services
Division of Public Health
1915 Mail Service Center 0 Raleigh, North Carolina 27699-1915
Tel 919-733-7081 0 Fax 919-715-3341
Michael F Easley, Governor
Carmen Hooker
Odorn, Secretary
March 26, 2003
Memorandum
To'
Local Health Directors
Carol Tant, Head (\ vl
Children & Y outh Br~h
From:
Re:
Child Health Agreement Addenda
I have enclosed information on baseline data for negotiations related to your child health
agreement addenda. I was under the impression this information had already been distributed to
you, so I apologize for any inconvenience. One of the Child Health Nurse Consultants let me
know yesterday that at least some health departments did not receive this data.
We appreciate your ongoing efforts in delivering children's services.
c: Child Health Nurse Consultants
@
Location: 1330 St. Marv', Street. Raleigh. N~
-\0 ElJual Opportunity Employer
-------------------------------------
FOR LOCAL USE ONLY - DO NOT SUBMIT TO DPH
-------------------------------------
CHILD HEALTH AGREEMENT ADDENDA
BASELINE DATA
New Hanover County
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Section A: Process/Outcome Measures
1 Percentage of resident Medicaid eligible
children birth to 21 years of age who
received Health Check preventive services
2. Percentage of all children one through two
years residing in the county who received a
direct blood lead test
Year Countv
State
CY 2001 71.3%
69.3%
CY 2001 65.9%
35.0%
3. Percentage of all Medicaid eligible children CY 2001 718% 53.7%
one through two years residing in the
county who received a direct blood lead test
4. Percentage of children < 12 months of age FY 01-02 100.0% 86.6%
that are served in the Child Health Clinic
who received WIC Program services* ----'"
5. Percentage of children one to five years of FY 01-0 76.9% e
age that are served in Child Health Clinic
who received WIC Program services*
6. Percentage of children who received services
from the health department who had a Body
Mass Index below the 95th percentile but
above the 5th percentile for age and gender**'
a. Children 2-4 years CY 2001 84.0% 82.5%
b. Children 5-11 years: CY 2001 75.4% 75.7%
c. Children 12-18 years CY 2001 69.2% 71.5%
Section E: School Health Program
1. Percentage of children enrolling in public School 97.7% 97.3%
kindergarten who received a preschool Year
health assessment within the prescribed 01-02
time lines
. If there are no data present, no children were seen in the child health clinic at the local health
department for this age group.
.. If there are no data present, there were either no children seen in the child health clinic at the e
local health department or none of the children who were seen fell into this 8Ml range.
FOR LOCAL USE ONLY - DO NOT SUBMIT TO DPH
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New Hanover County Health Department
Strategic Planning Retreat
March 22, 2003
Summary Report
Facilitators: Pennington (Penny) Whiteside, Jr., MSPH
Deputy Director, NCIPH
William T (Bill) Herzog, MSPH
Consultant
Sheila S. Pfaender, MS
Research Associate, NCIPH
Attendees:
Edwin Link, Melody Speck, Robert Greer, Gela Hunter, Edward Weaver, Henry Estep, Sandra
Miles, David Rice, Ellen Harrison, Frances DeVane, Elisabeth Constandy, Cindy Hewett, Marilyn
Roberts, Pat Johnson, Dina Sarvo, Betsy Summey, Betty Jo McCorkle, Jean McNeil, David
McDaniel, Nancy Nail, Dianne Harvell, Diane Vosnock, Alene Mabry
Strateaic Plannina Kick-off
Mr Herzog began planning session by welcoming participants and presenting the goals for the session.
1 Goals
a. Modify strategic priorities
b. Set three to four achievable strategic goals
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Mr Herzog indicated the accomplishments that stand out from the Strategic Planning Session in 2002 were the
goals that were measurable and tangible.
Mr Rice expressed his thanks for the support of leadership from the Institute of Public Health and for Mr
Whiteside's allowing Mr Herzog to help us with the process.
Mr Whiteside said he was pleased to be able to work with us and congratulated the Board of Health for being
selected as the Outstanding Board of Health in NC.
Work-GrouDs
Mr Herzog instructed participants to form work-groups of people who have worked together very little to help bring
a variety of viewpoints to the group. Three work-groups were formed, and after one-on-one interviews, participants
were introduced.
Health Statistics
Elisabeth Constandy reviewed health statistics relative to the Healthy Carolinians / Healthy People 2010 Goals.
I.
Infant Mortality
1 NC has 3rd highest infant mortality rate in US
2. Rates in NC have declined, but progress has slowed
3. High NC rates among African American women
4. Minority infant mortality rate getting worse compared to White rate (NC)
5. Birth defects leading cause of infant death
6. Other factors: alcohol and tobacco
7 NHC Data
a. NHC women more likely to smoke while pregnant
b. Minority rates better than state average, still high compared to US average
c. White fetal death rate higher than state average
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Strategic Planning Retreat 03/22/03
Summary Report
Page 1 of7
II.
1
2.
3.
4.
5.
6.
7
III.
1
2.
3.
4.
5.
6.
7
8.
Asthma
Over 130,000 NC children suffer from asthma
Leading cause of school absence, ED visits, and hospitalization
African American and Latino children are more likely to be hospitalized, use ED for primary care, and die
from asthma
Controlled by reducing exposure to triggers, proper medication use, education
Eastern NC has higher rates of absenteeism and hospitalization from asthma than state average
NHC has lower hospitalization rates than state and region
NHC has higher rates of diagnosed asthma, undiagnosed wheezing, total % wheezing, % reporting missing
school and activities, and % of students who smoke
Cancer
2nd leading cause of death in US and NC
NC is slightly higher than US for newly diagnosed cancers of lung, bronchus, prostate, female breast,
colon, and rectal cancers
In NC, African Americans are 35% more likely to die from cancer than Whites (females from breast and
colon, males from colorectal, lung, and prostate), even though incidence is similar or lower than White rates
Eastern NC rates for cancer screening are similar to state average; Urban NC rates are better than state
average
Eastern NC mortality rates are higher than state rates for breast, lung, colorectal, cervical, and prostate
Urban NC mortality rates are similar to state rates
NHC incidence rates are similar to state rates for colorectal and lung, and better than state rates for female
breast and prostate
BRFSS Data 2001 NHC vs NC
a. NHC has lower reported numbers of men who have had a Prostate Specific Antigen (PSA) blood test to
screen for prostate cancer
b. NHC has higher reported numbers of residents who have used a blood stool kit to screen for colorectal
cancer
IV Diabetes
17th leading cause of death in US and NC
2. A leading cause of disability and hospitalization
3. Estimated 14 of people with diabetes in NC are not aware of it
4. Incidence is 57% higher in African Americans than Whites; African Americans are 3 times as likely to die
from diabetes than Whites
5. More common in people over 60
6. BRFSS 2001 Data: NHC vs NC
a. Fewer NHC residents have been told they have diabetes than state rates
b. However, during pregnancy, more NHC residents have been told they have diabetes as compared to
state rates
c. NHC has higher mortality rates for total population, specifically people over age 65, White Males,
Minority Males, and Minority Females
d. Mortality rate for Minority Females is extremely high in NHC, compared to NC
V Heart Disease and Stroke
1 Heart disease is leading cause of death in NC and US; Stroke is 3rd leading cause of death
2. Our region is the "Buckle" of the Stroke Belt; highest levels in the Nation
3. NC and regional residents have higher prevalence of leading risk factors: tobacco use, sedentary lifestyle,
and overweight/obesity
4. While Urban areas of NC have lower death rates from CVD and Stroke, Eastern region has rates much
higher than state and national rates
5. BRFSS 2001 Data: NHC vs NC
a. NHC residents report similar rate to state data for having cholesterol checked
b. NHC has lower percentage of adults that report being told they have hypertension.
Strategic Planning Retreat 03/22/03
Summary Report
Page 2 of 7
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VI. Immunization
1 Influenza and pneumonia are leading vaccine preventable diseases among adults
2. Almost 90% of deaths from these diseases occur in adults over age 65
3. Under-vaccinated areas tend to have lower SES and access to health care
4 NHC rates for age-appropriate vaccination are higher than state rates
5. BRFSS Data: NHC has lower adult flu vaccine rate than state rate
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VII.
1
2.
3.
4
5.
VIII.
1
2.
_IX.
1
2.
3.
4.
5.
6.
X.
1
2.
3.
4.
XI.
1
2.
3.
4.
_
Overweight and Obesity
Becoming the leading preventable cause of death in NC and US
Type II Diabetes rates climbing rapidly
NC children are 2-3 times as likely to be overweight or obese as their US counterparts
NC elementary school children are being diagnosed with high cholesterol and hypertension
Risk factors for Overweight and Obesity include:
a. Education level
b. Income
c. Ethnicity
d. Geographic location in NC (Southeastern region posing the largest threat)
Nutrition
In addition to overweight and obesity, other health risks from poor nutrition include:
a. Gall bladder disease
b. Sleep apnea
c. Osteoarthritis
d. Respiratory problems
e. Mobility problems
BRFSS 2001 Data: NHC vs NC
a. Only 14 of adults report meeting 5-A-Day goal (NHC and NC)
b. Similar percentages for 3-5 servings per day, 1-3 servings, and less than one serving per day
Physical Activity
NC girls are less active than boys
Teens are less active than younger children
African American girls are least active of all
This leads to: higher rates of overweight, obesity, CVD, stroke, and cancer
Southeastern NC has highest self-reported levels of no leisure time activity in the state
BRFSS Data: NHC has better self-reported rates than state
Tobacco Use
More NC adults smoke than US average
1999 Youth Tobacco Survey reports almost 40% of high school students use tobacco, and almost 20% of
middle school students
Men are more likely to smoke than women, but female use is increasing among youth and college age
Eastern region has highest youth use rate
Responsible Sexual Behavior
Early sexual activity leads to higher rates of STDs, HIV/AIDS, unwanted pregnancy, and cervical cancer
61% of NC youth report sexual activity, compared to 48% nationally
Of those reporting sexual activity, 20% report drinking alcohol or using drugs the last time they had sex
Teen Pregnancy and Birth
a. NC has higher rates for all age brackets, compared to US
b. NHC falls into second lowest category related to NC averages
c. Over half of NHC high school seniors report having intercourse three or more times
Strategic Plannin9 Retreat 03/22/03
Summary Report
Page 3 of 7
XII.
1
2.
XIII.
1
2.
3.
4.
5.
6.
7
8.
XIV
1
2.
3.
4.
5.
6.
XV
1
2.
3.
4
5.
Sexually Transmitted Diseases
Over 2/3 of STDs in NC occur in the 15-24 age bracket
In 1998, NC ranked 1 st in the US for primary and secondary syphilis cases, and 4th for primary and
secondary syphilis rate
3. Women are at a higher risk, due to being asymptomatic
4. African Americans and Latinos are disproportionately affected by HIV and AIDS
5. NHC falls into "1-95 and 1-40" corridor, which has the highest STD rates in NC
6. Risks higher in NHC due to transient population, tourism, and UNCW
7 STD incidence rates in NHC higher than state rates for most diseases (not total syphilis)
8. Minority death rate from AIDS higher in NHC than NC
Oral Health
Single most common health problem among children
44% of NC children have dental disease
NC has shortage of dentists and hygienists
Oral health largely dependent on SES
Untreated dental disease more common among African American and Latino children
Urban areas of NC have higher than average rates for dental visits and cleaning in the past year
Eastern areas have lower than state average rates
NHC is higher than state average for Kindergarten and 5th grade children receiving screening and being
cavity-free, and those receiving sealants
9. NHC is lower than NC rate for Kindergarten and 5th grade children with untreated decay (Dr McDaniel
noted the shortage of dentists due to a fewer number of dentist graduating. Many rural areas do not have
dentists. There are 38 dentists per 100,000 population in North Carolina. They are seeing a rise in
kindergarteners having cavities.)
Air Quality
Large portions of state are in violation of 8-hour National Ambient Air Quality Standard for ozone
Children are most at risk for exposure to ozone
Exposure can aggravate asthma, causing more hospitalizations and deaths
Other pollutants include CO, lead, N02, S02, and particulate matter
NHC usually falls into "good air quality" standards, but is not totally free of pollutants
In 1999, NHC ranked in the 10% of worst US counties for S02 emissions, and 20% worst for C02, N02,
and volatile organic compounds.
7 NHC has some of the highest state exposure levels for N02 (thanks to CP&L, Sutton, PCS Nitrogen
Fertilizer LP, and Occidental Chemical
8. Hazardous Air Pollutants can cause cancer, and neurological, respiratory, and reproductive effects.
9. NHC ranks in the 20% of worst counties in US for cancer risk from HAPs
10. The estimated cancer risk for NHC residents is 1 OOx the goal set by the Clean Air Act, due to vehicle
emissions, off-road equipment, and point sources
(A report, by Sheila Pfaender entitled "New Hanover County Environmental Assessment, " was distributed
to each participant.)
Lead Poisoning
Leading environmentally caused pediatric health problem
Lead affects almost every organ system and is very harmful to developing brain and CNS in children
Prevalence of elevated exposure in African Americans is more than double that of Whites in NC
Low income, rural, and Eastern NC communities at greatest risk for elevated blood lead levels
NHC has higher than average rate for % of 1 and 2 year olds screened and lower than average % with
elevated blood lead levels
6. In 1999, NHC was among 20% of US counties with highest number of housing units with lead hazards
7. Recent lead analyses submitted to state lab have returned significant positives from private residences and
schools or child care centers
Strategic Plannin9 Retreat 03/22/03
Summary Report
Page 4 of 7
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XVI.
1
2.
Food Safety
Food borne illness disproportionately affects young, old, chronically ill, and immuno-compromised
Determinants:
a. Sanitation, food handling practices, infected food handlers, presence of rodents and insects, cross
contamination, and sanitation of food contact surfaces
3. A number of food borne diseases are gaining increasing importance:
a. Some are rare but gaining prevalence
b. Some are spreading in geographic range
c. Some are becoming more difficult to treat
d. Examples: E. coli 0157:H7, salmonellosis, listeriosis
XVII. Water Quality
1 Surface Waters
a. NHC ranks at or slightly better than average among counties in US in % of surface waters with
impaired or threatened uses
b. There were 27 bodies of water in NHC with some level of impairment (1998), from sediment, organic
enrichment, abnormal pH, and presence of pathogens
c. Pollution from large point sources is a problem
XVIII.
1
2.
XIX.
1
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XX.
1.
2.
3.
4.
5.
6.
7
Watersheds
NHC has portions of 3 watersheds: Lower Cape Fear, NE Cape Fear, and the New.
According to 1998 EPA Clean Water Act data, both the Lower and NE Cape Fear have "less serious"
quality issues and are rated "low" for vulnerability
3. Historically, contamination issues result from flooding due to hurricanes
Toxic Chemical Releases
In 2000, NHC ranked among 10% worst US counties in terms of major chemical releases and waste
generation
2. Majority (over 80%) of chemical releases are to the air
3. Chemical releases in NHC with highest cancer risk include arsenic and chromium compounds (CP&L,
Sutton, and Occidental)
4. Total cancer risk scores have been reduced greatly overall in recent years, especially from Sutton and
Occidental
5. Total cancer risk scores from other point sources have increased drastically recently at other point sources
(500-1275% increase)
Other Environmental Issues
Groundwater and well water
Ocean and beaches
Land contamination
Agricultural pollution
Municipal waste management
Municipal sanitation
Municipal water systems
Oraanizatlonal Levels
Mr Herzog explained Organization Levels as:
1 Strategic - Mission, goals, policy - Board of Health responsibility
2. Management - Direction, leadership, coordination - Organization Leadership
3. Operations - Day to day supervision, procedures - Line Supervisors
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Strategic Planning Retreat 03122/03
Summary Report
Page 5 of 7
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Strateaic Plannlna Process
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1 Definitions
a. Strategic Issue - Policy question or critical challenge that is:
i. Organization-wide
ii. Significant consequences if not addressed
ili. Reasonable chance of solution
b. Goal
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i. Measurable change in health status or environmental condition
ii. Mr Herzog stressed the need to pay more attention to goals rather than activity - spend
more time talking about the state or condition (what are current rates and how can we
change them?).
c. Priority
i. Relative importance (can also refer to urgency)
d. Strategic Planning - deals with important organization-wide issues that have policy implications,
setting goals, and establishing priorities
e. Management Planning - deals with managing organizational resources to meet established goals
f. Long-range planning - planning for a multi-year time frame, usually 3 to 5 years (can be at
strategic or management level)
g. Short-term planning - planning for periods up to 2 years or so (also can be strategic,
management or operational)
Review of Stratealc Priorities
Mr Herzog instructed each group to review the Health Department's current Strategic Priorities. He urged the
groups to talk more about goals that have been achieved rather than things that have been done. Talk about how
services have impacted rates in community rather than activity reports. He sited the example of "Access to Health
Care" - a major strategic issue - and the need to define goals. The bilingual signs installed at the Health
Department demonstrate an activity that helped achieve the goal. The groups need to focus on goals within _
strategic priorities. .,
Revised Stratealc Priorities
Each work group considered current Strategic Priorities and presented the following list of revisions:
1 Emerging health risks
2. Access to health care
3. Staff development and continuing education
4. Facility utilization
5. Preventive services
6. Information technology
Betsy Summey noted that communication, as it relates to Access to Health Care, can be a detriment if services are
advertised and yet clients who call are unable to obtain an appointment. Dr Speck stressed the need to evaluate
what we've done. Mr Rice reminded the group to focus on the three prongs of the Health Department Mission
Statement - promotion, prevention, and protection.
Luncheon Discussion
1 Historical or traditional markers
2. Strengths
a. Staff loyalty - low personnel turn-over
b. Commitment
c. Friendly staff
d. Strong work ethic
e. Soard of Health (SOH) members who give their time to do what's necessary for the good of the
organization
f. Well organized and structured SOH with great direction
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Strategic Planning Retreat 03122/03
Summary Report
Page 6 of 7
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3. Hidden assets
a. Development of PHRST and subsequent networking with other agencies
b. Collaborations within community with other health care provider
c. Physical asset - elevator, location
d. Staff loyalty and dedication
Goal Settina
Mr Herzog explained meaningful goals as they relate to Strategic Priorities.
1 Tests of a Meaningful Goal Statement
a. Describes a desirable state or condition to be attained, not the action required to get there
b. Is reachable, not "blue sky"
c. You can define in advance how you will know when you get there
d. The goal statement itself provides a meaningful guide to action among responsible staff
Mr Herzog then instructed the groups to develop some goals for each Strategic Priority.
Strateaic Priorities - Goals Summary
Mr Herzog recommended the BOH target one priority per meeting at its next meeting(s). He also suggested that
management turn to the division directors to find out what they feel is important. The group was hesitant to rank
the priorities fearing that may automatically put something on the back burner
1 Access to Health Care
a. Increase awareness of risk
b. Reduce death due to preventable diseases
c. Decrease language barrier - possible full-time interpreter
d. Increase communication / education
e. Increase English as Second Language (ESL) availability / access
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2. Emerging Health Risks
a. Increase capacity to respond to emerging problems, i.e., training, epidemiology, tabletop exercises,
etc.
b. Water and air quality - recreation
i. Educate HD personnel and BOH
ii. Educate general public
iii. Influence policy makers
c. Revisit Environmental Health statistics
3. Staff Development and Continuing Education
a. Cross-training - improve staff flexibility
b. Utilize experts within the department
4. Facility Utilization
a. Optimize use of NHCHD building
b. Relocation of Environmental Health Services
c. Establish a "Space Allocation Workgroup"
5. Preventive services
a. Increase rate of adult flu and pneumonia immunizations age 65 and older
i. With outreach sites
ii. Through "Open Clinic"
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6. Information Technology
a. Survey needs and abilities of staff
b. Increase staff proficiency with technology as it relates to primary job assignments
Strategic Planning Retreat 03/22/03
Summary Report
Page 7 of 7
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17TI1 STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500, FAX (910) 341-4146
_....,.,."._.
DA VJD E. RICE, M.P.B., M.A.
Health Director
LYNDA F. SMITH, M.P.A.
Assistant Health Director
March 13, 2003
Dear Physicians:
The State of North Carolina has now received the smallpox vaccine, and it has been
distributed to the seven Public Health Regional Surveillance Teams (PHRST). Stage I
pre-event vaccinations have begun.
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New Hanover County is the host county of the North Carolina Public Health Regional
Surveillance Team in Region 2 (PHRST-2). Dr. Thomas Morris has been hired as the
new physician epidemiologist for PHRST-2 and has started work at the New Hanover
County Health Department. He will give a presentation on the smallpox vaecination
indications and side effects at Coastal AHEC on March 27, 2003.
Many physicians responded to my previous correspondence and indicated a willingness
to receive the vaccination. It is anticipated that pre-event vaccinations will be
administered to a small select group of physicians and other health care providers during
Stage I. More physicians and healthcare providers will be vaccinated when Stage \I of
pre-event vaccinations is implemented.
Please make plans to join us at Coastal AHEC on March 27 to meet Dr. Morris. The
presentation will begin at 6:00 p.m. The topic will be .Vaccinia: Adverse Events and
Guidelines for Reporting, Consultation, and Treatment." Depending on demand and
space, a second presentation may be scheduled at a later time.
Contact Alene Mabry at 910-343-6760 or amabrvtfilnhcaov.com to reserve your seat.
Maximum seating at AHEC is approximately 120.
Sincerely yours,
~ ~ p--~W1iO. ~
Janelle A. Rhyne, M.D., FACP
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RESOLUTION URGING THE STATE OF NORTH
CAROLINA TO INCREASE THE TAX ON CIGAREnES
WHEREAS, the New Hanover County Board of Health is delegated the responsibility to protect
and promote the public health; and
WHEREAS, the New Hanover County Board of Health upholds the mission of the New Hanover
County Health Department to preserve, protect and enhance the general health and
environment of the community; and
WHEREAS, the general goals of the New Hanover County Health Department include the
promotion of "healthy and safe lifestyles" and "identification and reduction of health risks in the
community"; and
WHEREAS, a goal of Healthy People 2010 is to "reduce illness, disability, and death related to
tobacco use and exposure to secondhand smoke"; and
WHEREAS, death rates from heart disease and cancer, the leading causes of clealh in North
Carolina and New Hanover County, are partially attributable to smoking and tobacco use; and
WHEREAS, the current tax on cigarettes in North Carolina is 'Nell below the national average
and only higher than two other states; and
WHEREAS, seventy percent of the 638 participants, in a current North Carolina Public Health
Awareness Survey, favorably responded to a cigarette tax increase of $0.25 to more than $1.00
(provided that the money is used to fund tobacco use prevention programs for youth); and
WHEREAS, each year 24,200 children in North Carolina become regular daily smokers and 1/3
of those will die prematurely; and
WHEREAS, studies show that a 10 percent increase in the prica of cigarettes can lead to a 6 to
10 percent decrease in the smoking rate of youth and a 3 to 5 percent rate for adults; and
WHEREAS, the Centers for Disease Control reported that tobacco use cost North Carolina
$4.75 billion annually in health care expenses and lost productivity; and
WHEREAS, North Carolina can collect significant additional revenue that would help to ease the
financial crisis it currently faces;
THEREFORE, BE IT RESOLVED that the New Hanover County Board of Health determines
that a tax increase to at least the national average needs to be applied to the real prica of a
pack of cigarettes. Only then will an overall reduction in youth and adult consumption be
realized as well as the added benefit of a significant increase in revenue generated for the State
of North Carolina.
Gela N. Hunter, RN, FNP, Chairman
Adopted by the New Hanover County Board of Health
August 7, 2002
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0311212003 05:06 PM
To: NHCBH
cc:
Subject: [Lhd) FW: NEWS: Locals lobby for tobacco tax hike
fyi
Thanks,
David E. Rica, Health Director
New Hanover County Health Department
2029 South 17th street
Wilmington, NC 28401
Phone (910)343-6591 Fax (910)341-4148
drice@nhcgov.com
htlp:Jlwww.nhchd.OItI
- Forwarded by David E Rice/NHC on 0311212003 05:06 PM -
a.i
VI
"Debor8h RoweR
<ncpha14lmlndeprlng.
com>
Sent by:
Ihd-admin@dBhnet.net
0311212003 04:00 PM
To: "Local Health Dirsclors" <lhd@dBhnet,nel>
cc: (bee: archive)
Subject: [Lhd) FW: NEWS: Locals lobby for tobacco tax hike
Many thanks to the following health directors who made the trip to Raleigh to show the support of the NC
Association of Local Health Directors and the NC Public Health Association for House Bill 254: Mimi
Cooper, Randolph County; Wayne Raynor, Harnett County, Don Yousey, Brunswick County, David Rice,
New Hanover County; and Jerry Parks, Albemarte Health District, There were 14 legislators present for
the Press Conference and that many organizations present in providing support.
The message was simple: This bill is a public health bill, This bill provides the potential to have the
greatest impact on the public's health in many decades, Increasing the cost of cigarettes will cause a
decline in consumption, especially for teens and pregnant women, and will save lives and medical care
costs, Pediatricians treat children for diseases and illnesses caused from the mother's use of tobacco
products or by second hand smoke, As Dr Olson Huff so eloquently said, these children go from the
"smoke filled womb to the smoke filled room" He said that it was not unusual for 10-12 year old children
who are already smoking a pack of cigarettes a day to be treated for smoke related illnesses. Our kids
deserve better
If you have not gotten involved, please do so. This may be our generation's public health legacy to the
children of North Carolina.
deb
--o;ginal M~!ge
From: Ann Houston [mailto:ncs1395@mindspring.com)
Sent: Wednesday, Marth 12, 2003 8:14 AM
To: Tim M<:GIoin; Suzanne Depalma; Sheryl Scott; Scott Proescholdbell; Sarah Carl2r; Sandra Colt; Sally
Malek; Robert Brown; Richard Rosen; Renee Douglas; Rebecca S. Williams; Phlllsa Parker; Paul Savery;
Pam Kohl; Melva Fager Okun; Mary McBrath; Margaret Watkins; Margaret Brake; Lynette Tolson; Trad
Oark; Terry Quinn; Teri VanDyke; Sun Choe; Steve Johnson; Mary Gillett; Jennifer Woodward; Ebony
Randall; Deborah cemto; Chandra Green; Bronwyn Glenn; Karen Caldwell; Jeanne Dalraghl; laurie
Mettam-Rude; Larry Gourdine; Kenny Ray; Kathy Blue; Kathleen McCann Webster; Katherine Hampton;
.
.
.
.
,~
,
Julia Garnett; John Thompson; Jim Martin; Jim Catlin; 'Gary Miner'; Donna Dinkin; Donna Borowski;
Dianne May; Delmonte Jefferson; Deborah Rowe; David Altman; Charlotte Ranz; Anne Butzen; Anna
Wood; Ann Houston; Amy Ward; Amy Dixon; Austin, William D.
Subject: NEWS: Locals lobby for tobacco tax hike
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Last changed: March 11. 2003 12:00AM
Locals lobby for tobacco tax hike-Wilmington Star
Health directors heading to legislature
By Millard K. lves
Staff WHter
millard.ivesallwilminatonstar.com
Smokers may have to cough up more money if local health offidals succeed in
persuading the legislature to raise the state dgarette tax by at least 75 cents a pack.
Health department directors from Brunswick and New Hanover counties will head to
Raleigh on Wednesday in hopes of influendng state legislators to raise the current tax
from 5 cents to at least 80 cents a pack.
They will be part of a group from across the state that will rally for support of a
resolution by the N.C. Alliance for Health that calls for the increase.
'We look at it as a user fee - charging smokers up front for the health care they will
eventually need," said Don Yousey, director of the Brunswick County Health
Department.
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David Rice of the New Hanover County Health Department will join him on the trip.
North Carolina's 5-cent tax is the nation's third lowest.
According to the resolution, the use of tobacco products cost the state $4.75 billion in
medical costs and lost productivity each year.
Mr. Yousey said in a presentation to his Board of Health Monday night that the extra
tax would generate $553 million for the state during the next fiscal year. It would
trickle down to help pay for local smoking-prevention programs, health insurance for
children and other programs such as Medicaid, he said.
''Sixty-six children start smoking each day across the state," Mr. Yousey said. 'This can
save our children's lives."
The resolution will help support House Bill 254, which was filed this month and aims to
decrease smoking among children by raising the tax.
About 26 percent of the state's residents smoke. Mr. Yousey said that every 10 percent
increase in dgarette price results in a 3 percent to 5 percent decrease in overall
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,
.
.
.
smoking.
"lhe tax increase would lead to a decline in smoking that would help save the county
thousands of dollars used to treat smoking-related illnesses," he said.
He's not just blowing smoke.
According to resolutions passed by the two counties' boards of health recently, heart
disease and cancer are the leading causes of death in the New Hanover and Brunswick
counties, a statistic partially attributed to smoking and toba(:co use.
In the two counties, which faced a combined cut in state reimbursements of almost $6
million this fiscal year, health offidals said they have no problem taxing what has
been the leading cash crop in Southern states since colonial times.
"Our mission is to promote health and prevent disease," Mr. Rice said.
Millard K. Ives: 343-2075
millard. ives@wilmingtonstar.com
,
"
North Ca~ina AI~ance for Health
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NEWS IIU,E4SE
Wednesday, MarclII2, 2003
CONTACI': Melva Fager Oknn
To Coordinator
919-624-4382
MOMENTUM GROWS FOR PASSAGE OF CIGARETTE TAX INCREASE IN NC
RALEIGH - Today, North Carolina joined a growing number of tobacco producing states
pushing for a substautial increase in the cigarette excise tax. Legislators and advocates ftom
around the state joined fon:es to urge passage ofHB 254, newly introduced legislation that would
raise North Carolina's tax to 75 calls. Cum:utly, the cigarette excise in North Carolina is :live
. ceIIIs, the third lowest in the COUDtry.
"House Bill 254. is a bill about prof-'ll the health of our childreo," said Representative Jwuifta
Weiss (Wake-D), the bill's primaJy spoosor. "We know that for every 10 pen:ent we increase the
price of a pack of cigarettes, seven pen:ent fewer children begin to smoke. Bringing our tax up to
75 cents will preveut, over time, close to 106,000 of our children ftom startiDg to smoke and will
save 33,750 of them ftom premature smoking-related deMhq." she said.
Flanked by a room full of supporters, Weiss and primary bill co-sponsors Reps. Rick Glazier
(Cumberland-D), Verla Insko (Orange-D) and Martha Alexander (Mecklenburg-D) indicated that
support fur increasing the cigarette tax is growing, daily. "This bill cunent1y has 13 spoDSOrs
represeDling all parts of North Carolina, " said Weiss. "Clearly my colleagues an: listening to the
fulks at home and our constituents are telling us that we need to increase the cigarette tax-both
for health reasons and for financial reasons," she stated.
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Rep. Glazier, a first term legislator from Fayetteville, echoed Weiss' sentiments. "Tbe 75 cent tax
would IS............ close to $450 million in critical new revenue, a......ally,. he said "It will n:duce
teenage smoking. defray health care costs as~"'M with smoking, and help generate fimds to
close the budget deficit. I n:cognize that adults have choices and they have the right to make a
choice to smoke. But that doesn't mean we have to economically support their choice. This bill is
about saving lives and ensuring futures-it's a win-win for North Carolina, . stated Glazier.
Dr. Olson Huff: a pediatrician from Asheville, emphasized the positive impact a tax increase will
have on the health of children. '"These members of the General Assembly have eloquently stated
what we, as pediatricians, see in our pnu:tice every day. We see children as }'01ID8 as 10 and 11
beginning to smoke. In North Carolina, 17 pen:ent of our middle school students and 36 percent
of our high school students are regu1ar users of tobacco products. lncIeasing the price of
cigarettes, by increasing this tax, is OIIC of the fiIstest, most effective ways to stem the tide of this
dilldhood epidemic." .
"There is growing momentum for substantially increasing the cigarette tax in North Carolina,"
said Pam g...""''''l. Executive Director of the North Carolina Alliance for Hea1tb, a coalition of
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Page 2
North Carolina Alliance fur Health
News Conference
March 12, 2003
OTgllni:nltions and individuals dedicated to smoking prevention and supporting a 75 cent increase
in the tax,. ''Daily, new organizations, representing thousands of North Carolinians ftom across
the state, announce support for increasing this tax. These people feel we have a responsibility to
protect the health of our children and to provide them with a healthy financial future," she said.
''We applaud Representatives Weiss, Glazier, Insko, Alexander and the other bill co-sponsors for
their leadership on this tough issue. Each has demonstrated COUJlIge and a commitment to a
healthier North Carolina," said Seamans.
Seamans also noted that every state in the Southeast is looking at increasing this tax. ''South
. Carolina is actively considering several tax bills to fund Medicaid and Georgia's new Republican
governor has included a substantial tax increase as part of his proposed budget. On March 6, West
Virginia's tax was increased to 55 cents," she said.
"At the beginning of the year, the national average for the cigarette tax was 62 cents. So fill" this
year, three states have had cigarette tax increases now the average is closer to 65 cents. North
Carolina should not be left behind-either in the health of our children or in our financial
security," she concluded.
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IM.- David E Rice
q n.. 03/1712003 08:01 AM
To: bjones@nhcgov,com@NHC, dharvell@nhcgov,com@NHC,Janet
McCumbee/NHC@NHC, Lynda SmithlNHC@NHC, Thomas
MorrislNHC@NHC
ce:
Subject CDC Advisory 00118 - Atypical Pneumonia
fyi
_m_ Forwarded by David E Rice/NHC on 03/17/2003 08:00 AM _m_
.
Health Alert Network
<health alert @cdc.goY>
03115/2003 08:51 PM
To: Health Alert Network <healthalert@cdc,gov>
cc: (bcc: archive)
Subject CDC Advisory 00118 - Atypical,pneumonia
This is an official
CDC Health Advisory
Distributed via Health Alert Network
March 15, 2003, 20:45 EDT (8:45 PM EDT)
CDCHAN-000118-03-03-15-ADV-N
FOllowing is information regarding the current WHO investigation of atypical pneumonia, Included
are: a news release from the CDC, interim information and recommendations for health care
providers, and text of a travelers' health alert card which will be distributed to targeted international
travelers returning to the U,S,
COC Issues Health Alert About Atypical Pneumonia
Atlanta: In response to reports of increasing numbers of cases of an atypical pneumonia that the
World Health Organization (WHO) has called Severe Acute Respiratory Syndrome (SARS), the
Centers for Disease Control and Prevention (CDC) today announced several steps to alert US
health authorities at local and state levels,
CDC activated its emergency operations center on Friday, March 14, upon learning of several
cases reported in Canada among travelers recently returned from Southeast Asia and their family
members, The federal public health agency:
. Issued a health alert to hospitals and clinicians on Saturday, March 15,
. Briefed state health officials on Saturday, March 15,
. Is investigating illness among travelers who may have passed through the United States
after having potential exposure to the virus,
. Is preparing health alert cards to give to travelers returning from Southeast Asia,
. Is preparing guidance to assist public health departments, health care facilities and
clinicians in monitoring and identifying potential cases,
. Deployed eight CDC scientists to assist the WHO in the global investigation,
. Is analyzing specimens to identify a cause for the illness,
CDC has been working with the World Health Organization (WHO) since late February to
investigate and confirm outbreaks of this severe form of pneumonia in Viet Nam, Hong Kong, and
.
l
4.
parts of China. No cases have been identified to date in the United States.
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"The emergence of two clusters of this illness on the North American continent indicates the
potential for travelers who have been in the affected areas of Southeast Asia to have been
exposed to this serious syndrome," said Dr Julie L. Gerberding, CDC Director "The World
Health Organization has been leading a global effort, in which CDC is participating, to understand
the cause of this illness and how to prevent its spread. We do know that ~ may progress rapidly
and can be fatal. Therefore, we are instituting measures aimed at identifying potential cases
among travelers returning to the United States and protecting the people with whom they may
come into contact."
The WHO issued a global alert about the outbreak on March 12, cautioning that the severe
respiratory illness may spread to hospital staff. No link has been made between this illness and
any known influenza, including the "bird flu" (A[H5N1]) outbreak reported in Hong Kong on
February 19.
###
Severe Acute Respiratory Syndrome (SARS)
Interim Information and Recommendations for Health Care Providers
3/15/20036:00 pm Eastern Standard Time
The Centers for Disease Control and Prevention (CDC) and the World Health Organization have
received reports of patients with severe acute respiratory syndrome (SARS) from Canada, China,
Hong Kong Special Administrative Region of China, Indonesia, Philippines, Singapore, Thailand,
and Vietnam. The cause of these illnesses is unknown and is being investigated. Early e
manifestations in these patients have included influenza-like symptoms such as fever, myalgias,
headache, sore throat, dry cough, shortness of breath, or difficulty breathing. In some cases
these symptoms are followed by hypoxia, pneumonia, and occasionally acute respiratory distress
requiring mechanical ventilation and death. Laboratory findings may include thrombocytopenia
and leukopenia. Some close contacts, including healthcare workers, have developed similar
illnesses. In response to these developments, CDC is initiating surveillance for cases of SARS
among recent travelers or their close contacts.
Case Finding
Clinicians should be alert for persons with onset of illness after February 1, 2003 with:
. Fever (>380 C)
ANO
. One or more signs or symptoms of respiratory illness including cough, shortness of
breath, difficulty breathing, hypoxia, radiographic findings of pneumonia, or respiratory
distress
ANO
One or more of the following:
. History of travel to Hong Kong or Guangdong Province in People's Republic of China, or
Hanoi, Vietnam, within seven days of symptom onset
. Close contact with persons with respiratory illness having the above travel history. Close
contact includes having cared for, having lived with, or having had direct contact with
respiratory secretions and body fluids of a person with SARS.
Oiagnostic Evaluation
Initial diagnostic testing should include chest radiograph, pulse oximetry, blood cultures, sputum
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Gram's stain and culture, and testing for viral respiratory pathogens, notably influenza A and B
and respiratory syncytial virus. Clinicians should save any available clinical specimens
(respiratory, blood, and serum) for additional testing until a specific diagnosis is made. Clinicians
should evaluate persons meeting the above description and, if indicated, admit them to the
hospital. Close contacts and healthcare workers should seek medical care for symptoms of
respiratory illness.
Infection Control
If the patient is admitted to the hospital, clinicians should notify infection control personnel
immediately. Until the etiology and route of transmission are known, in addition to standard
precautions(l), infection control measures for inpatients should include:
. Airborne precautions (including an isolation room with negative pressure relative to the
surrounding area and use of an N-95 respirator for persons entering the room)
. Contact precautions (including use of gown and gloves for contact with the patient or their
environment)
Standard precautions routinely include careful attention to hand hygiene. When caring for
patients with SARS, clinicians should wear eye protection for all patient contact.
To minimize the potential of transmission outside the hospital, case patients as described above
should limit interactions outside the home until the epidemiology of illness transmission is better
understood. Placing a surgical mask on case patients in ambulatory healthcare settings, during
transport, and during contact with others at home is prudent.
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Treatment
Because the etiology of these illnesses has not yet been determined, no specific treatment
recommendations can be made at this time. Empiric therapy should include coverage for
organisms associated with any community-acquired pneumonia of unclear etiology, including
agents with activity against both typical and atypical respiratory pathogens (2). Treatment choices
may be influenced by severity of the illness. Infectious disease consultation is recommended.
Reporting
Healthcare providers and public health personnel should report cases of SARS as described
above to their state or local health departments.
For more information contact your state or local health department or the CDC Emergency
Operations Center 770-488-7100. Updated information will be available at htto:llwww.cdc.aov
References
1 Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation
precautions in hospitals. Infect Control Hosp EpidemioI1996;17:53-80, and Am J Infect Control
1996;24:24-52. htto:llwww.cdc.aov/ncidod/hio/ISOLAT/lsolat.htm
2. Bartlett JG, Dowell SF, Mandell LA, File Jr, TM, Musher DM, and Fine MJ. Practice
Guidelines for the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis
2000;31 :347-82.
htto:llwww.iournals.uchicaao.edu/CID/iou rnal/issues/v31 n2/000441 1000441 . web.odf
###
Text of a travelers' health alert card:
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HEALTH ALERT NOTICE
FOR INTERNATIONAL TRAVELERS ARRIVING IN OR RETURNING TO THE USA FROM
HONG KONG AND GUANGDONG PROVINCE, PEOPLE'S REPUBLIC OF CHINA, AND
HANOI, VIETNAM
TO THE TRAVELER: During your recent travel, you may have been exposed to cases of severe
acute respiratory disease syndrome. You should monitor your health for at least 7 days. If you
become ill with fever accompanied by cough or difficulty in breathing, you should consult a
physician. To help your physician make a diagnosis, tell him or her about your recent travel to
these regions and whether you were in contact with someone who had these symptoms. Please
save this card and give it to your physician if you become ill.
TO THE PHYSICIAN: The patient presenting this card may have recently traveled to Hong Kong
or Guangdong Province in the People's Republic of China or Hanoi, Vietnam, where cases of
atypical pneumonia have been identified. If you suspect atypical pneumonia (also being called
severe acute respiratory disease syndrome [SARS]), please contact your city, county, or state
health officer (see htto:llwww.cdc.aov or call the CDC Emergency Operations Center
770-488-7100).
For public inquiries, call Centers for Disease Control and Prevention (CDC) hotline: English
888-246-2675, EspanoI888-246-2857, TTY 866-874-2646.
Categories of Health Alert messages:
Health Alert: conveys the highest level of importance; warrants immediate action or attention.
Health Advisory: provides important information for a specific incident or situation; may not require immediate action.
Health Update: provides updated information regarding an incident or situation; unlikely to require immediate actjon.
---------------------------------------
---------------------------------------
You have received this message based upon the information contained within our emergency notification data base. If
you have a different or additional e-mail or fax address that you would like us to use please notify us as soon as possible
bye-mail at healthalertllllcdc.oov.
---------------------------------------
---------------------------------------
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'"-
MIKE MciNTYRE
71rl DISTRICT, NORTH CAFlOLlNA
/''Rllt!:!!m-?u',"'NG
WASHINGTON. DC 20515-3307
(2021225-2731
FAX: (202) 225-5773
,
COMMITTEE ON AGRICULTURE
_MITTEE ON ARMED SERVICES
SPECIAL OVERSIGHT PANEl
ON TERRORISM
~HAIRMAN
RURAL HEALTH CARE COALITION
(lCongrtgg of tlJt mntttb ~tattg
1!)ouse of l'epresentattbtS
'Ballbington,1.BQC 205\5-3307
OISTRlCTOFACES;
301 GREEN STREET. ROOM 218
FAYUTEVlUE, NC 28301-5088
(910)323-0260
701 NoRTH ELM STREET
LUMBERTON. NC 28358-4895
(9101671-6223
WEB PAGE:
www.house.gov/mcintyre
152 NORTH fflONT STREET, ROOM 208
WILMINGTON, NC 28401-3957
(910) 815-4959
FROM: KatberineTbompson & Katby Price
~J
if; 03
TO: Team Members
DATE: February 6, 2003
RE: Homeland Security Advisory Team Meeting
'.
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As a member of the newly-created Homeland Security Advisory Team for the Seventh
Congressional District, I would appreciate your attendance at a meeting on Tuesday,
March 18, 2003, which will be held on the campus of the N.C. Justice Academy. I have
provided directions to the facility for your reference. We will hold the meeting in
Classroom 13, which is located in the Classroom Building.
Our meeting will begin at 10:00 a.m. and will conclude at 11:30 a.m. Uyou would like
to arrive early, light refreshments will be available at 9:30 a.m.
Please contact Katherine Thompson, District Special Projects Coordinator, at 910-815-
4959 to confirm your attendance. Thank you for your commitment, and I look forward to
seeing you on the 18th.
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PRINTED ON RECYCU:O PAPER
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HELPFUL WEBSITES
www.readY.e:oY
This is the Department of Homeland Security's (DHS) official website. It
contains information on emergency kits, potential emergency situations,
contact numbers and constituent handouts.
www.citizencorDs.e:OY
This website is a grassroots approach toward community preparedness. It
provides guidance for communities that wish to set up volunteer homeland
security councils.
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www.ed/e:oy/emereenCVDlan
This website will provide a template crisis plan for schools. This site will
give examples of schools that have implemented effective emergency
response plans, examples of possible threats and a bomb threat guide.
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Department of Homeland Security
DH8 has Five Major Divisions, or "Directorates":
I. Border and Transportation Security (BTS): BTS will be led by Under Secretary Asa
Hutchinson, and is responsible for maintaining the security of our nation's borders and
transportation systems. The largest of the Directorates, it will become home to agencies
such as the Transportation Security Administration, U.S. Customs Service, the border
security functions of the Immigration and Naturalization Service, Animal & Plant Health
Inspection Service, and the Federal Law Enforcement Training Center.
II. Emerl!:encv Preparedness and Response (EPR): This Directorate, which will be
headed up by Under Secretary Designate Mike Brown, ensures that our nation is prepared
for, and able to recover from, terrorist attacks and natural disasters.
III. Science and Technolol!:V (8 & T): Under the direction of Under Secretary Designate
Dr. Charles McQueary, this Directorate will coordinate the Department's efforts in
research and development, including preparing for and responding to the full range of
terrorist threats involving weapons of mass destruction.
IV. Information Analvsis and Infrastructure Protection (IAIP): lAIP merges the
capability to identify and assess a broad range of intelligence information concerning
threats to the homeland under one roof, issue timely warnings, and take appropriate
preventive and protective action.
V. Manal!:ement: The Under Secretary of Management Designate, Janet Hale, will be
responsible for budget, management and personnel issues in DHS.
Besides the five }2irectorates ofDHS, several other critical agencies are folding into the
new departmerii or being newly created:
. United States Coast Guard: The Commandant of the Coast Guard will report
directly to the Secretary of Homeland Security However, the USCG will also
work closely with the Under Secretary of Border and Transportation Security as
well as maintain its existing independent identity as a military service. Upon
declaration of war or when the President so directs, the Coast Guard would
operate as an element of the Department of Defense, consistent with existing law.
. United States Secret Service: The primary mission of the Secret Service is the
protection of the President and other government leaders, as well as security for
designated national events. The Secret Service is also the primary agency
responsible for protecting U.S. currency from counterfeiters and safeguarding
Amencans trom credlt card traud.
. Bureau of Citizenship and Immil!:ration Services: While BTS will be
responsible for enforcement of our nation's immigration laws, the Bureau of
Citizenship and Immigration Services will dedicate its full energies to providing
efficient immigration services and easing the transition to American citizenship.
.
The Director of Citizenship and Immigration Services will report directly to the
Deputy Secretary of Homeland Security
. Office of State and Local Government Coordination: A truly secure homeland
requires close coordination between local, state and federal governments. This
office will ensure that close coordination takes place with state and local first
responders, emergency services and governments.
. Office of Private Sector Liaison: The Office of Private Sector Liaison will
provide America's business community a direct line of communication to the
Department of Homeland Security The office will work directly with individual
businesses and through trade associations and other non-governmental
organizations to foster dialogue between the Private Sector and the Department of
Homeland Security on the full range of issues and challenges faced by America's
business sector in the post 9-11 world.
.1
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March 2003
New Hanover County Health Department
AIDS Cases Increase
in North Carolina
The number of new AIDS
cases reported in North
Carolina increased dramatically
in 2002, according to the North
Carolina HIV/STD Prevention
and Care Branch. There were
1,014 new cases reported
last year, 16 percent more
than in 200 I when there
were 871 new cases.
More New Cases
This is the first year since 1994
that more than 1000 new cases
have been recorded for a single
year, and the second year in a
row the state has recorded an
increase in new AIDS cases.
This is also the sec-
ond year there has
been an increase in
new individuals re-
ported to the pub-
lic health system-
49 percent having not been re-
ported previously as HIV posi-
tive.
Why the Increase?
Several possible reasons have
been cited for the increase.
Many persons do not have
ready access to care, allowing
HIV infection to go undetected
and untreated. The disparity in
health status between minority
communities and the general
population is greatest for HIVI
AIDS. The closure of North
Carolina's AIDS Drug Assis-
tance Program may likely have
contributed to this disparity.
The program, which provides
HIV/AIDS drugs to people who
are otherwise unable to obtain
treatment, was closed to new
enrollees in December 200 I.
Although some 600+ people
on the waiting list have
been moved to active status
as funds have become avail-
able, the program is still
closed to new enrollees
with a waiting list of over
175 people. In addition,
North Carolina's eligibility level
makes it harder to qualify than
in any other state.
Other possible reasons for the
increase include the expected
progression of disease for the
high number of individuals in-
fected during the mid-I 990s,
changes in HIV treatment effec-
tiveness, and enhanced surveil-
lance efforts to better capture
report information.
CDC Requests Enhanced
Surveillance for Human
Cases of Avian Flu
The Centers for Disease
Control and Prevention
(CDC) has issued an alert re-
questing enhanced surveillance
for human cases of avian flu
type A (HSN I) in the United
States, pursuant to cases and
deaths diagnosed in China in
mid-February. The World
Betsy Summey, FNP, 343-6531
Health Organiza-
tion reported no
human flu genes
in the avian flu
virus that caused
the deaths in
China. Therefore person-to-
person transmission is not ex-
pected.
Medical providers are
reminded to:
1 Obtain viral cultures on cases
of severe atypical pneumonia,
2. Obtain a travel history to Asia
in the 10 days prior to disease
onset, and
3. Immediately report unex-
pected deaths due to respira-
tory infection.
Questions may be directed
to Lynnette Brammer
(Ibrammer@cdc.gov) or
Alicia Postema
(apostema@cdc.gov) at
404-639-3747.
Vaccinia Now a
Reportable Disease
A temporary rule, NCAC
19A .0208, became effec-
tive February 13, 2003, making
vaccinia a reportable disease in
North Carolina. Smallpox vac-
cine contains live vaccinia virus
that is communicable to unvac-
cinated people by direct
contact.
continued
This rule states the attending phy- Morbidity and Mortality Weekly inadvertent exposure for
sician of a person vaccinated Report of the CDC. household members and oth- e
against smallpox shall report to ers, including patients.
the local health department the The State Health Director or a
existence of any of the following. local health director may use iso- Vaccine Information
lation authority pursuant to GS CDC vaccine information distrib-
Report to Health Dept. 130A-14S when necessary to pre- uted by the state will be mailed to
vent the spread of smallpox or physicians. This information con-
vaccinia virus. tains phone numbers at the state
. Autoinnoculation level to contact for medical con-
. Generalized vaccinia Smallpox Vaccination sultation. Included in the infor-
. Eczema vaccinatum Begins mation for vaccinees is a Physician
. Progressive vaccinia Consultation Card. which they
. Post vaccination
encephal~is SmallPOX vaccine administra- are to carry with them should
tion began at New Hanover they seek medical care.
The attending physician shall County Health Department Surveillance
(NHCHD) on February 25, 2003.
make the report to the local There were 17 Aside from being prepared to
health department within 24 =;~""', .d,;~ 11J deal with adverse events. physi-
hours. The local health depart- istered. primarily ) cians should be alert and report
ment shall notify the Division of to staff who will be to the Health Department any
Public Health within 24 hours. vaccinators. Of unusual illnesses that might be a
the 17. 16 were result of terrorist activity. Effec-
The physician responsible for revaccinations. There were two tive surveillance begins with
vaccinating a person against no-takes and no adverse reac- suspicion, early detection,
smallpox and the physician tions. NHCHD was extremely and reporting for investiga- -
diagnosing a person with vac- cautious in determining medical tion. It requires cooperation
cinia disease shall instruct the contraindications for pre-event and communication among
patient to follow CDC guide- vaccine and ruling out any ques- providers of medical care.
lines for the prevention of tionable vaccinees. Staff was
the spread of vaccinia. These trained in appropriate site
guidelines can be found in The care to avoid unnecessary or
Communicable Disease Statistics
New Hanover County
July 1, 2002 - February 28, 2003
AIDS ...................................... 24
Campylobacter .....................13
Chlamydia ........................... 395
Gonorrhea........................... 123
Hepatitis A.............................. 2
Hepatitis B (acute).................. 8
Hepatitis B (carrier) ................6
Hepatitis C (acute).................. 0
HIV Infection ......................... 35
Leglonellosls .......................... 1
Listeriosis ............................... 1
Lyme Disease ......................... 3
Meningitis Pneumococcal...... 1
Meningococcal Disease ......... 1
Pertussis .................................... 1
Rky. Mtn. Spotted Fever............ 4
Salmonellosis .......................... 70
Shiga-Toxin Producing Infection
(formerly E. coli 0157:H7) ......2
Shigellosis ................................. 3
Strep, Group A Invasive............ 1
Syphilis ...................................... 3
Toxic Shock Syndrome............. 1
Tuberculosis.............................. 3
Typhoid (acute).......................... 0
Vancomycin Resistant
Enterococcus......................... 9
-
SANITATION TIPS FOR FOOD WORKERS
SPRING 2003
"
Ice: The Forgotten Food
c
Don't Reuse
Water Bottles
Disposable
Page 3
Most people think that the cold temperature of ice kills bacteria. Actually,
bacteria in ice are preserved, not destroyed, so they're often just
waiting around until they get a chance to grow.
Handlin~ ice with dirty hands or utensils is often a source of
contamination. If someone uses a utensil or ice scoop and re-
turns it to the ice, instead of storing the scoop outside the ice
bin, contaminants can get on the ice and spread to beverages or
foods through contact with the ice, explains Mike Milliorn, CEO
of Daydots, a food safety products manufacturer.
In the summer of 1999, an outbreak of E. coli 0157:H7 at a
drill team camp in Denton, Texas, infected 58 individuals and caused severe
gastrointestinal illnesses in 41 of them, Milliorn says. Investigators believe the
outbreak occurred when campers used their hands to scoop ice out of an ice-
machine and contaminated the ice.
In another incident in 1999, 400 people in Anchorage, Alaska, were infected
and one elderly man was killed by an outbreak linked to contaminated ice. A
juice company had been hauling a truckload of unpasteurized orange juice from
Mexico chilled with contaminated ice.
Many times, ice contamination is a result of mishandling ice and the products
that store the ice, Milliorn says.
So, for example, it's important not to place one bucket inside another, be-
cause the bottoms of buckets that have come in contact with a contaminated
surface-such as the floor-can spread the contami-
nant to the inside of other containers.
Also in this issue ...
About Hand Hygiene, Rubs and
Gloves Page 2
Salmonella Linked to Raw,
U ndercooked Eggs Page 3
Test Yourself
Temperatures
on Holding
Page 4
Copyright 2003
Pike & Fischer, Inc.
1-800-255-8131
Keeping Ice Safe
Here are some tips for keeping ice safe:
. Use ice-only containers for transporting ice.
. Avoid using containers that also are used for stor-
ing food or chemicals.
. Hang ice containers upside down to keep them
dry and off the floor to prevent "nesting," which of-
ten causes buckets to become unsanitary.
. Use an ice scoop for dispensing ice.
. Store the scoop outside the ice bin and not in the ice.
. Clean and sanitize every utensil used in ice frequently.
. Wear clean clothing and wash and sanitize your hands before scooping.
bagging or touching ice.
. Never eat, drink or smoke around ice-making equipment.
. Clean all ice-making machines once a week. Slime and mold can build up
inside them, allowing bacteria to grow.
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50
FOOD TALK
SPRING 2003
Test Yourself on
Holding Temperatures!
4. The number one contributing factor
leading to food borne illness in food
establishments is:
r.~
All foods that are to be held cold must be
held at or below.
a. improper cooling of foods.
b. cross contamination.
c. poor personal hygiene.
d. inadequate cooking of foods.
a. 410 F
b. 500 F
c. 320 F
d. 00 F
5. All potentially hazardous foods that have
been cooked and cooled need to be
reheated to an internal temperature of
within two hours to be safe.
2. All foods that are to be held hot must be
held at or above:
a. 700 F
b. 980 F
c. 1200 F
d. 1400 F
a. 1400 F
b. 1450 F
c. 1550 F
d. 1650 F
3. Most of the bacteria that cause food borne
illness grow.
6. Bacteria grow best within a temperature
range called the "danger zone" which is
between:
a. with or without oxygen at an ideal
temperature of 98.60 F.
b. only without oxygen at an ideal
temperature of 1100 F
c. only with oxygen at an ideal
temperature of 1100 F.
d. only without oxygen at an ideal
temperature of 98.60 F.
a. 0 and 2200 F
b. 0 and 1400 F
c. 41 and 1400 F
d. 41 and 2200 F
Source: "Essentials of Food Safety and Sanitation:
Prentice Hall, Inc., 2000
(3)9 '(p)s '(0)" '(O)"f (P)"l; (oh :SJ"MSUIf
jU::lUljIlld::lO 41111::lH
lOj:l::lI!O 411P-::lH
::l:J!'l:I. P!AP-O 10tU IN 'NOI9NIWlIM
mll1s HU I HInOS 6~0~
NOISIAIO HIlV3H lYIN3WNOIIAN?
IN3WI1Yd30 HI1Y3H ,UNnOl 13AONYH M3h
National Association of Local Boards of Health
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United 1Ve Stand
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Publishedfor Members of Local Boards of Health
Februmy 2003
President's Message
Ken Hartke
As we start a new year, let us first reflect back on the previous
year NALBOH has had another successful year I would like to
thank Phil Lyons, the Board, and the members for the success
we had during the last twelve months. This year is going to be
another challenge, but I believe that we can do great things
together
I' I~'\~.. The Board has just completed an update of the NALBOH
II strategic plan. We are currently developing goals and action
III 'I plans to address the main strategic focuses for the next few
'. . I \ 'I L years. I would like to take a moment to describe the strategic
plan to you. I believe that you, the members, need to know the strategic plan, the goals and the
action plans that have been developed. You can become involved in the plan by giving us feedback
about our actions or becoming involved in some of the committees or activities. I believe we must
support, involve and listen to our members.
There are five priority issues NALBOH is planning to work on during this year I do not believe that
these will be completed within this year but progress will be made. These issues are:
Education
NALBOH is committed to developing more educational products for its members. These educational
products include videos, training programs, distance learning broadcasts, and the annual meeting.
These products are aimed at local board of health members. NALBOH believes that you can become
a more effective board member if you have information about public health issues and your role in
the public health system.
Continued on Page 2
Good News for Children
Submitted by Martin Wasserman, MD, JD
Medical Director, Immunization Practices and Scientific Affairs, GlaxoSmithKline
One of the major responsibilities of local boards of health is to assure and protect the health of their
community members. Maintaining a high level of protection against communicable diseases is one of
the single most important achievements a governing body can proVide to its constituents. Perhaps
the most effective way of accomplishing this is to work with the local health officer and local health
department to optimize the level of childhood immunizations. In fact, the United States Surgeon
General has stated that immunizations save more lives and prevent more illnesses than any other
medical treatment. Preventable infectious illnesses in this country are at an all-time low. This is
largely because of the quality, safety, and effectiveness of vaccines and the strong policy
commitment to achieve 90% immunization levels for our children. Today, children in the United
States receive nearly 20 injections in the first two years of life in order to protect against 12 diseases
including diphtheria; pertussis (whooping cough) and tetanus (OPT); hepatitis B; hepatitis A, polio;
mumps, measles, and rubella (MMR); chicken pox; pneumococcal disease, and hemophilus influenza B
bacterial infections. Many of these infections cause life-threatening illness. More than half of
vaccinations are recommended during the primary immunization series. This occurs at 2, 4, and 6
months for infants during visits to their health care providers in both public and private health care
settings. Young infants, being held by their parents, may endure up to 5 individual injections at a
single session causing pain to the child, anxiety to the parent, and administrative stress to the
Continued on Page 3
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I [NALBOH'S 11th Annual Conference~
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Boards of Health: Stewards of Local Public Health
July 16-19, 2003
Wyndham Baltimore Inner Harbor
Baltimore, Maryland
For more information contact the NALBOH office by phone: (419) 353-7714; fax: (419) 352-6278
e-mail: <nalboh@nalboh,org>, or visit our website at <www.nalboh.org>
For a virtual tour of the Wyndham Inner Harbor Hotel, visit <www.wyndham.com/hotels/BWIIH/main.wnt#>
I
('
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1
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,
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National Association of Local Boards of Health
1840 East Gypsy Lane Road
Bowling Green, OH 43402
E-mail: <nalboh@nalboh,org>
Website: <www.nalboh.org>
NON PROm ORG,
u.s. Postage
PAID
Bowling Green, OH
Permit No.4 7
/^)
"---./