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"To: BOARD OF SUPERVISORS
FROM: William Walker, M.D., Health Services Director Contra
DATE: April 7, 1998 Costa
County
SUBJECT: support for SB 2222 to Amend Section 120440 of the Health&Safety Code regarding disclosure of
information held in Immunization Registries
SPECIFIC REMESTiS)O12'RECOMMENDATK"Sl&BACKGROUND AND JUSTIFI ATION
I. RECC)M11rfEENI ATION:
To inform Governor Wilson, Senator 'Watson and Contra Costa's State legislators of our support for the
proposed legislation.
II. FISCAL INTACT:
None
III. REASONS FOR RECQN%MNDATIQNS
The current law under which our Registry operates prohibits the disclosure of a child's immunization record to
anyone other than the parent or medical provider of the child. The legislation would allow us to share
information related to a particular child with the child's school, child care provider, WIC clinic and Health Plan.
The bill limits the use for which the information may be used and provides for penalties for inappropriate
disclosure of information. By restricting the disclosure only to schools, WIC sites or Health Plans directly
serving a particular child,the legislation does not allow indiscriminate sharing of information. SB2222 balances
confidentiality concerns with the Public Health need to assure that children are fully immunized. Schools, child
care providers, WIC and Health Plans all have an important role in promoting immunizations, therefore, the
ability to share information with therm not only makes each of our roles easier to administer, but also serves the
children in a more efficient and effective way.
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1 HEREBY CERTIFY THAT M818 A TRUE
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SENATE BILL Na 2222
Introduced by Senator Watson
February 20, 1998
An act to amend Section 120440 of the Health and Safety
Code,relating to health.
LEGISLATIVE COUNSEL;S DIGEST
SB 2222, as introduced, Watson. Immunizations:
disclosure of information.
Existing law governing communicable disease prevention
and immunization authorizes local health officers to operate
immunization information systems. Existing law provides that
certain health care providers, as defined, local health
departments operating countywide immunization
information and reminder systems, •and the State Department
of Health Services may disclose o� share certain prescribed
immunization-related information concerning individual
patients, unless the patient refuses to consent to the sharing
of this information. Existing law requires the health care
provider administering immunization to provide the patient
with designated notice.
This bill would expand the definition of health care provider
for purposes of these provisions. The bill would authorize local
health departments and the State Department of Health
Services to disclose certain immunization information to
schools, child care facilities, and family child care homes,
service providers, as defined, and health care plans. The bill
would subject health care providers, local health
departments, the department, and certain persons or entities
authorized to receive the immunization information to civil
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action and criminal penalties for the wrongful disclosure of
the information. The bill would create a new crime, thereby
imposing a state-mandated local program. The bill would
revise the notice requirement of the health care provider
administering immunization under these provisions.
The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated
by the state. Statutory provisions establish procedures for
making that reimbursement.
This bill would provide that no reimbursement is required
by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
The people of the State of California do enact as follows:
1 SECTION 1. (a) The Legislature finds and declares
2 all of the following:
3 (1) Early childhood immunizations are essential to
4 protect the health of California children, yet a substantial
5 proportion of children do not receive timely standard
6 immunizations.
7 (2) In response to this problem, since fiscal year
8 199596, the Governor has proposed, and the Legislature
9 has approved, an appropriation of 3.5 million dollars
10 ($3,500;000) in ea�-.h budget year for the implementation
11 of immunization tracking systems.
12 (3) Communitywide immunization tracking systems
13 maintain current immunization records, including
14 records of severe immunization reactions, on all children.
15 This information is used to immediately provide
16 physicians with complete immunization histories of new
17 patients who come into their offices, to issue reminder
18 notifications to families when immunizations are due, and
19 to identify subpopulations of children with low
20 immunization coverage.
21 (4) Because of the importance of these systems, the
22 Legislature enacted legislation authorizing local health
23 departments and the State Department of Health
24 Services to operate communitywide immunization
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1 tracking systems and allowing physicians to regularly
2 input patient identification and immunization history
3 information to these systems, provided that the patient
4 has been notified in advance and does not object.
5 (5) Schools and child care facilities are mandated by
6 law to require certain immunizations for attendance and
7 to obtain: and maintain immunization records on their
8 pupils and clients. When a family has lost immunization
9 records, it can be difficult and time consuming for them
10 and their health care providers to obtain the necessary
11 records in order that their children may be admitted to
12 these institutions.
13 (6) Women, infants and children supplemental
14 nutrition (WIC) programs serve infants and young
15 children who are at highest risk of underimmunization.
16 Reviewing client immunization status at 'WIC service
17 sites and referring behind schedule infants and children
18 to their physicians for immunization has been shown to
19 substantially increase immunization coverage, without
20 restricting any WIC program benefits to families. Several
21 WIC service sites in California perform this activity, using
22 state or federal funds. However, WIC staff cannot assess
23 immunization records if clients fail to provide them, or if
24 the records they provide are incomplete.
25 (7) Health care plans are required to provide standard
26 childhood immunizations as benefits. These plans ne6d
27 updated information on immunizations received by
28 beneficiaries both to facilitate payments to health care
29 providers and to assess how well their clients are
30 immunized. Lack of ready access to complete current
31 immunization records of their clients impedes these
32 functions.
33 (8) Schools, child care facilities, WIC service sites, and
34 health care plans in California all have well established
35 procedures for maintaining the confidentiality of client
36 immunization histories and are liable for civil and
37 criminal penalties for their inappropriate disclosure.
38 (b) In light of all the findings set forth in subdivision
39 (a), in enacting this legislation, it is the intent of the
40 Legislature to help infants and children receive
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I immunizations in a more timely manner through
2 immunization tracking systems providing appropriate
3 information to specified agencies and entities serving
4 these clients.
5 SEC. 2. Section 120440 of the Health and Safety Code
6 is amended to read:
7 120440. (a) For the purposes of this chapter, -=heir
8 the fallowing definitions shall apply:
9 (1) "Health care provider" means any person licensed
10 pursuant to Division 2 (commencing with Section 500) of
11 the Business and Professions Code or a clinic or health
12 facility licensed pursuant to Division 2 (commencing
13 with Section 1200). "Health care provider" also means
14 schools, child care facilities, family child care homes,
15 women, infants, and children nutrition service providers,
16 as defined in paragraph (3), and health care plans that
17 provide immunization to patients. ` +
18 (2) "Schools, child care facilities, and family child care V,
19 homes" means those institutions referred to in V-
20 subdivision(b)of Section 120335.
(3) "Women, infants, and children service provider"
22 means any public or private nonprofit agency contracting
23 with the department to provide supplemental nutrition
24 program services to women, infants, and children.
:. 25 (4) "Health care plan" means a health care service �, 1
26 plan as defined in subdivision (f of Section 1345 or an 1 tk
27 insurer as described in Sections 10123.5 and 10123.55 of
28 the Insurance Code.
29 (b) Local health officers may operate immunization
30 information systems pursuant to their authority under
31 Section 120175, in conjunction with the Immunization
32 Branch of the State Department of Health Services.
33 (c) Notwithstanding any other provision of law, unless
34 a refusal to ,permit recordsharing is made pursuant to
35 subdivision (e), health care providers may disclose the
36 information set forth in paragraphs (1) to (9), inclusive,
37 from the patient's medical record to local health
38 departments operating countywide immunization
39 information and reminder systems and the State
40 Department of Health Services. Local health
--s-- SB 2222
1 departments and the State Department of Health
2 Services may disclose the information set forth in
3 paragraphs (1) to (9), inclusive, to other local health.
4 departments and health care providers taking care of the
5 patient, schools, child care ,facilities, and family child care
6 homes to which the person is being admitted or in
7 attendance, and women, infants, and children service
8 providers and health care plans providing services, upon
9 request r for information pertaining to a specific person.
10 All of the following information shall be subject to this
11 subdivision;
12 (1) The name of the patient and names of the patient's
13 parents or guardians.
14 (2) Date of girth of the patient.
15 (3) Types and dates of immunizations received by the
16 patient
17 (4) Manufacturer and lot number for each
18 immunization received.
19 (5) Adverse reaction to immunizations received.
20 (6) Cather nonmedical information necessary to
21 establish the patient's unique identity and record.
22 (7) Current address and telephone number of the
23 patient and the patient's parents or guardians.
24 (8) Patient's gender.
25 (9) Patient's place of birth.
26 (d) (1) Health care ;providers, local health
27 departments, and the State Department of Health
28 Ser=vices shall maintain the confidentiality of information
29 listed in subdivision (c) in the same manner as other
30 medical record information with patient identification
31 that they possess;ate. 77tey shall be subject to civil action
32 and criminal penalties for the wrongful disclosure of the
33 information listed in subdivision (c) as described in
34 Sections 56.35 and 56.36 of the Civil Code. They shall use
35 the information listed in subdivision (c) only for the
36 following purposes.
37 fl-)-
38 (A) To provide immunization services to the patient,
39 including issuing reminder notifications to patients or
40 their parents or guardians when immunizations are due.
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2 (B) To provide or facilitate provision of third-party
3 payer payments for immunizations.
4 (-}
5 (C) To compile and disseminate statistical information
6 of immunization status on groups of patients or
7 populations in California, without patient identifying
8 information for these patients included in these groups or
9 populations.
10 (2) Schools, child care facilities, family child cure
11 homes, women, infants, and children service providers,
12 and health cure plans shall maintain the confidentiality dentiality of
13 information listed in subdivision (c) in the same manner
14 as other client and pupil information that they possess.
15 They shall be subject to civil action and criminal penalties
16 for the wrongful disclosure of the information listed in
17 subdivision (c) as described in Sections .1798:53 and
18 1798.57 of the Civil Code. They shall use the information
19 listed in subdivision (c) only for those purposes provided
20 in subparagraphs (A) to (C), inclusive, of paragraph (1)
21 and as follows:
22 (A) In the case of schools, child care facilities, and
23 family child care homes, to carry out their responsibilities
24 regarding required immunization for attendance, as
25 described in Chapter 1 (commencing with Section
26 120325).
27 (B) In the case of women, infants, and children service
28 providers, to perform immunization status assessments of
29 clients and to refer those clients found to be due or
30 overdue for immunizations to healthcare providers.
31 (e) A patient or a patient's parent or guardian may
32 refuse to permit recordsharing. The health care provider
33 administering immunization shall inform the patient or
34 the patient's parent or guardian of the following:
35 (1) The information listed in subdivision (c) may be
36 shared with local health departments, and the State
37 Department of Health Services. 'The health care provider
38 shall provide the name and address of the department or
39 departments with which the provider will share the
40 information.
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1 (2) Any of the information shared wiR with local
2 health departments and the State Department of Health
3 Services shall be treated as confidential medical
4 information and shall be used only to share with health
5 care providers, schools, child care facilities, family child
6 care homes, women, infants, and children service
7 providers, and health care plans, upon request. These
8 providers, agencies, and institutions shall, in turn, treat
9 the shared information as confidential, and shall use it
10 only to help provide immunization services to the
11 patient, er to issue reminder notifications to the patient
12 or patient's parent or guardian if immunizations are due
13 or overdue, or, in the case of schools, child care facilities,
14 and family child care homes, to help children document
15 receipt of immunizations _ required by state law for
16 attendance
17 (3) The patient or patient's parent or guardian has the
18 right to examine any immunization-related information
19 shared in this manner and to correct any errors in it.
20 (4) The patient or the patient's parent or guardian
21 may refuse to allow this information to be shared in the
22 manner described, or to receive immunization reminder
23 notifications at any time, or both.
24 ,(f) if the patient or patient's parent or guardian
25 refuses to allow the information to be shared, pursuant to
26 paragraph (4) of subdivision (e), the health care provider
27 shall not share this information in the manner described
28 in subdivision(c).
29 (g) Upon request of the patient or the patient's parent
30 or guardian, in writing or by other means acceptable to
31 the recipient, a local health department or the State
32 Department of Health Services that has received
33 information about a person pursuant to subdivision (c)
34 shall do all of the following:
35 (1) Provide the name and address of other persons or
36 agencies with whom the recipient has shared the
37 information.
38 (2) Stop sharing the information in its possession after
39 the date of the receipt of the request.
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I (h) Upon notification, in writing or by other means
2 acceptable to the rbcipient, of an error in the information,
3 a local health department or the State Department of
4 Health Services that has information about a person
5 pursuant to subdivision (c) shall correct the error. If the
6 recipient is aware of a disagreement about whether an
7 error exists, information to that effect may be included.
8 (i) Section 120330 shall not apply to this section.
9 SEC. 3. No reimbursement is required by this act
10 pursuant to Section 6 of Article XIII B of the California
1I Constitution because the only costs that may be incurred
12 by a local agency or school district will be incurred
13 because this act creates a new crime or infraction,
14 eliminates a crime or infraction, or changes the penalty
15 for a crime or infraction, within the meaning of Section
16 17556 of the Government Code, or changes the definition
17 of a crime within the meaning of Section 6 of Article
18 XIII B of the California Constitution.
19 Notwithstanding Section 17580 of the Government
20 Code, unless otherwise specified, the provisions of this act
21 shall became operative on the same date that the act
22 takes effect pursuant to the California Constitution.
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