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  1. Learning About the Law... Interpreting North Carolina’s Immunization Laws and Rules

  2. Where Are NC Immunization Laws Found? • In the General Statutes of North Carolina • Chapter 130A - Public Health • Article 6 - Communicable Diseases • Part 2 - Immunization - 130A - 152 • You can access them online at www.ncleg.net or through the Immunization Branch website immunizenc.com

  3. How About Immunization Rules? • Located in North Carolina Administrative Code (NCAC) • Section .0400 - Immunization • 15A NCAC 19A.0401-0503 • http://ncrules.state.nc.us/ncadministrativ_/default.htm

  4. Why do we have public health laws? • The General Assembly recognizes that unified purpose and direction of the public health system is necessary to ensure that all citizens in the State have equal access to essential public health services. • “Essential public health services” means those services that the State shall ensure because they are essential to promoting and contributing to the highest level of health possible for the citizens of NC. - Immunization

  5. What is a Rule? “Rule” means any agency regulation, standard, or statement of general applicability that implements or interprets an enactment of the General Assembly or Congress or a regulation adopted by a federal agency or that describes the procedure or practice requirements of an agency.

  6. Laws Introduced and Voted on by NC General Assembly Signed by the Governor Adopted & Enforced Rules Agency is petitioned to adopt a rule Rule change is presented to the Commission for Health Services Submitted for public comment Adopt Temporary Rule Approved by Commission Permanent Rule Adoption Process for Laws and Rules

  7. Commission for Health Services • The Commission is created with the authority and duty to adopt rules to protect and promote the public health. • The Commission is authorized to adopt rules necessary to implement the public health programs administered by the Department.

  8. State Immunization Law Enforcement • State - Immunization Branch • Reporting of Vaccines Administered • Vaccine Accountability • Restitution for wasted vaccine • County • School Principal, Registrar • Child Care Operator • Local Health Director

  9. Who do I call for help interpreting immunization laws? Your Regional Immunization Consultant Immunization Branch - Central Office Your Local Health Director Your Local County Attorney

  10. diphtheria tetanus pertussis poliomyelitis red measles hepatitis B haemophilus influenzae type b varicella rubella mumps Every child present in NC shall be immunized against...

  11. Who is responsible for ensuring children are immunized on time? • Parent • Guardian • Person in loco parentis • Person or agency - governmental or private - with legal custody (e.g. Social Services)

  12. Where can state-supplied vaccines be obtained? • Local health department • Licensed physicians office participating in NCIP • State-supplied vaccines must be administered at no cost to the patient. Private providers may charge the administration fee allowed by law.

  13. Who is Allowed Access to Immunization Information • State and Local health departments • Patient’s physician • Schools K-12, public and private • Licensed childcare facilities • Colleges and universities - public and private • Health Maintenance Organizations • State and local health departments outside NC

  14. Immunizing Minors • With consent • parent • guardian • person standing in loco parentis • adult who signs statement they are authorized by parent or guardian to obtain immunizations for minor • Emancipated minors

  15. Name of child Name of child’s parent, etc. Address of child Address of parent Date of child’s birth Sex of child Number of doses given Date doses given Physician’s name Physician’s or local health department’s address What Should Appear on a Certificate of Immunization?

  16. Enforcement of Immunization Laws • Required of • Licensed child care facilities, schools, colleges and universities • By • 30 calendar days from 1st day of attendance • Responsible party • principal, registrar or operator

  17. What type of exemptions are allowed in N.C.? G.S. 130A - 156 & 157 15A NCAC 19A .0403 15A NCAC 19A .0404

  18. Medical Exemption • A N.C.licensed physician must certify that an immunization would be detrimental to a person’s health due to a contraindication adopted by the Commission (Medical Exemption Form) • Exceptions can be made by the State Health Director to grant a medical exemption for a non listed contraindication (physician must request this)

  19. Religious Exemption • Bona fide religious objection to required immunizations • Written statement of the bona fide religious beliefs and opposition to the immunization requirements must be submitted to the facility requesting a certificate of immunization • There is no required “Form” • Special Religious Exemption for Hep B, MMR and Varicella

  20. Is a signature required by law for childhood immunizations?

  21. Hepatitis B vaccine--three doses: one dose by age three months, a second dose before age five months and a third dose by age 19 months. However: (A) The last dose of the hepatitis B vaccine series shall not be administered prior to 24 weeks of age; (B) Individuals born before July 1, 1994 are not required to be vaccinated against hepatitis B. 15A NCAC 19A .0401 Dosage and age requirements of immunizations (7)

  22. In what situations does the 4 day rule apply? 15A NCAC 19A .0401 Dosage and age requirements for immunization (9)

  23. What are the varicella requirements? 15A NCAC 19A .0401 Dosage and age requirements for immunization (8)

  24. What is the principal’s or child care operator’s responsibility if a child doesn’t present a certificate of immunization within 30 days? G.S. 130A - 155

  25. Why are schools, child care centers and colleges required to keep a file of immunization on each attendee?

  26. What is a providers’ responsibility in providing a certificate of immunization to a patient? G.S. 130A - 154

  27. Who may bring a child in for immunizations? G.S. 130A - 152 G.S. 130A - 153 (d)

  28. How does HIPPA affect immunization record sharing? G.S. 130A - 153 15A NCAC 19A .0406

  29. Immunization Branch Experts in the Law • Charles Philbeck: Western Half of the State: Phone 704-480-5439 (email) charles.philbeck@dhhs.nc.gov • Vicki Ransom: Eastern Half of the State: Phone 919-218-5545 (email) vicki.ransom@dhhs.nc.gov • Isabel Reynolds: (Regional Immunization Consultant Supervisor) Phone 919-218-3877 (email) isabel.reynolds@dhhs.nc.gov