Chapter 22 Medical Reporting Requirements of Physicians

REQUIRED REPORTING TO THE NEVADA BOARD OF MEDICAL EXAMINERS

Change of Address/Closing Office or Practice

Physician Competence

Grounds for Initiating Licensure Disciplinary Action

PHYSICIAN REPORTING TO THE DEPARTMENT OF MOTOR VEHICLES

Blindness and Visual Impairment

Epilepsy

PHYSICIAN REPORTING TO LAW ENFORCEMENT

PHYSICIAN REQUIRED REPORTING TO STATE REGISTRAR

Birth

Hospital Births

Out of Hospital Births

Registration of Stillborn Children

Failure or Refusal to File a Certificate of Birth

Death

Cause of Death Statement

Death – Attended 22:9

Pronouncement of Death by a Registered Nurse

Autopsy on the Body of a Minor

Removal of Body to Another Registration District

Penalties

Neglect or Refusal to Execute the Medical Certificate of Death

False Certification of Cause of Death

Signature of Uncompleted Certificate of Death.

PHYSICIAN REQUIRED REPORTS TO STATE HEALTH OFFICER

Cancer Reporting

Types of Neoplasms Requiring Reporting

Exceptions for Reporting

Reporting Procedures

CONFIDENTIALITY

PHYSICIAN REQUIRED REPORTING TO THE HEALTH AUTHORITY (DISTRICT HEALTH OFFICER OR, IF NONE, STATE HEALTH OFFICER)

Incidence Reporting

Urgent Reporting Requirements

Content of Report

COMMUNICABLE DISEASES

Sexually Transmitted Diseases

Patient Instruction – Prevention and Treatment

Ensuring Adequate Treatment

Consent for Treatment of Minors

Tuberculosis

Reporting Requirements

Treatment of Patient for Control Measures

Records Inspection of a Facility

ENFORCEMENT

Grounds for Prosecution

CONFIDENTIALITY

REFERENCES

REQUIRED REPORTING TO THE NEVADA BOARD OF MEDICAL EXAMINERS

Change of Address/Closing Office or Practice

Chapter 630 of the Nevada Code addresses the licensing of physicians and physicians assistants. Licensee physicians who change their address to Nevada or within Nevada must notify the Board of Medical Examiners prior to practicing at the new location. NRS 630.254(1). Licensee physicians closing an office or a practice must notify the Board within 14 days per NRS 630.254(2)(a) and report to the Board the location of medical records. NRS 630.254(2)(b).

Physician Competence

NRS 630.307 requires the following must be reported regarding the competence of a licensee physician:

Any person, medical school or medical facility that becomes aware that a person practicing medicine in this state has, is or is about to become engaged in conduct which constitutes grounds for initiating disciplinary action shall file a written complaint with the Board.
Any hospital, clinic or other medical facility licensed in this state, or medical society, shall report to the Board any change in a physician’s privileges to practice medicine while the physician is under investigation and the outcome of any disciplinary action taken by that facility or society against the physician concerning the care of a patient or the competency of the physician.
The clerk of every court shall report to the Board any finding, judgment or other determination of the court that a physician:

(a) Is mentally ill;

(b) Is mentally incompetent;

(d) Is guilty of abuse or fraud under any state or federal program providing medical assistance; or

(e) Is liable for damages for malpractice or negligence.

A physicians current or anticipated conduct, which constitutes grounds for disciplinary action;
A change in a physicians privileges to practice medicine, or the results of disciplinary action;
Findings, judgments, or other court determinations that the physician is: mentally ill or incompetent, guilty of a felony or other crime governing controlled substances or dangerous drugs, guilty of abuse or fraud under state or federal medical assistance programs, liable for medical malpractice damages.

Grounds for Initiating Licensure Disciplinary Action

NRS 630.306, 630.3062, and 630.3067 provide for reporting requirements to the Board of Medical Examiners. The following subjects a licensee physician to licensure discipline including revocation of a physicians license to practice medicine (see NRS 630.352):

Making or filing a report which the licensee or applicant knows to be false or failing to file a record or report as required by law or regulation. NRS 630.306(8).
Failure by a licensee or applicant to report, within 30 days, the revocation, suspension, or surrender of his license to practice medicine in another jurisdiction. NRS 630.306(11).
Making or filing a report which the licensee knows to be false, failing to file a record or report as required by law, or willfully obstructing or inducing another to obstruct such filing. NRS 630.3062(3).
Failure to report any claim for malpractice or negligence filed against the licensee and the subsequent disposition thereof within 90 days after the:

Claim is filed; and

Disposition of the claim. NRS 630.3062(5).

Failure to report any person the licensee knows, or has reason to know, is in violation of the provisions of this chapter or the regulations of the Board. NRS 630.3062(6).
Failure to report any person the licensee knows, or has reason to know, is in violation of the provisions of this chapter or the regulations of the Board. NRS 630.3062(6).
Under the provisions of NRS 690B.045, the insurer of a physician licensed under this chapter and the physician must report to the Board any claim for malpractice or negligence and the settlement, award, judgment or other disposition thereof. NRS 630.3067.

Within NRS 630 and NAC 630 there are many more acts or omissions which subject the licensee to a disciplinary action or denial of a license. Those mentioned here only refer to those requiring licensee physicians to report to the Nevada Board of Medical Examiners. Every licensee should review the sections of NRS 630 and NAC 630 which subject licensees to disciplinary action.

PHYSICIAN REPORTING TO THE DEPARTMENT OF MOTOR VEHICLES

NAC 483.370 provides that if one or more of the following physical or mental conditions exist and there is documented evidence through medical examinations or reports in addition to appropriate DMV evaluations and examinations which indicate the disorder would severely impair the person’s ability to operate safely a motor vehicle, the department will not issue or renew the license, permit or privilege:

Lapses of consciousness, severe dizziness, fainting spells, head injuries, seizures or any other injuries or ailments resulting in lapses of consciousness, including, without limitation, epilepsy or disorders related to or associated with diabetes. A person suffering from lapses of consciousness or any other disorder as specified above will not be issued a license until he submits to the department a letter signed by his physician which states that:

(a) He has been free of seizures or has not suffered any fainting or dizzy spells or other such disorders for a period of 3 months; or

(b) The seizure or other ailment resulting in the lapse of consciousness was an isolated incident and is unlikely to reoccur.

Blindness and Visual Impairment

The Department of Motor Vehicles (DMV) must be notified of any persons who are blind, night-blind, or whose vision is severely impaired, by the following sources:

(1) Hospitals, medical clinics and similar institutions which treat persons who are blind, night-blind or whose vision is severely impaired.

The medical clinic and similar institutions must submit this information to the DMV within 30 days after learning such information and designate the person as; blind, night-blind, or severely visually impaired.

These particular categories are defined in the Nevada Revised Statute (NRS) 483.790 as:

(1) “Blind person” means any person whose visual acuity with correcting lenses does not exceed 20/200 in the better eye, or whose vision in the better eye is restricted to a field which subtends an angle of not greater than 20 degrees.

(2) “Night-blind person” means a person afflicted with Nyctalopia.

(3) “Severely visually impaired person” means any person whose visual acuity with correcting lenses does not exceed 20/70 in the better eye, or whose vision in the better eye is restricted to a field which subtends an angle of not greater than 30 degrees, or whose vision is impaired to such an extent that it materially limits, contributes to limiting or, if not corrected, will probably result in limiting the individual’s activities of functioning.

The purpose of submitting blindness or visual impairment is to establish a DMV registry of such persons. Information to be rendered is as follows:

(1) Name;

(2) Address;

(3) Birth Date;

(4) Social Security Number;

(5) Visual Acuity; and

(6) Any other information which may be required by regulation of the DMV.

If, or when, any of the sources of information learns that vision has been restored to any person whose name appears in the registry (for blind and visually impaired persons) the fact of restoration must be reported to the registry within 30 days after learning of that fact. All information learned by the department is confidential and any person who, without consent of the person concerned, reveals that information for purposes other than for DMV registry is guilty of a misdemeanor. (NRS 483.790, 483.800).

Epilepsy

NRS 439.270(2) requires physician reporting of epilepsy. Failure to do so renders the physician guilty of a criminal misdemeanor. NRS 439.270(5). The statute specifically provides:

All physicians shall report immediately to the health division, in writing, the name, age and address of every person diagnosed as a case of epilepsy. The health division shall reporting the information, in writing, to the DMV.

PHYSICIAN REQUIRED REPORTING TO LAW ENFORCEMENT

Health care providers treating an injury caused by a firearm or knife, and not appearing to be accidental in nature, must report the patients name (if known), location and extent of injury, to law enforcement personnel. NRS 629.041.

PHYSICIAN REQUIRED REPORTING TO STATE REGISTRAR

Birth

Physicians must report any birth to the State Registrar, in person, by mail, or through the local health officer if they possess the knowledge of the facts. Forms to be used for registering can be obtained from all local health officers which are prepared and issued by the State Board of Health. Use of other forms or blanks than those prepared by the Board is prohibited. The Board provides detailed instructions as required to maintain a uniform system of registration. If any birth certificate is incomplete, the local health officer will immediately contact the physician and require that missing information be supplied, if it can be obtained.

NRS 440.100, 440.130, 440.140, 440. 220.

Hospital Births

The physician in attendance is required to provide pertinent medical information requested on the birth certificate and certify to the fact of birth within 72 hours after the birth. If the physician does not certify to the birth within 72 hours, the person in charge of the hospital or a designated representative of the hospital is required to complete and sign the birth certificate.

NRS 440.280.

Out of Hospital Births

A physician in attendance at or attending immediately after a birth occurring outside a hospital must prepare and file a birth certificate. In the physicians absence any other person in attendance at or present immediately after the birth is required to file. The birth must be filed prior to 10 days after delivery if required by municipal ordinance or regulation.

NRS 440.280.

Registration of Stillborn Children

A child who is stillborn or dead at birth must be registered as a stillbirth with the local health officer and a certificate of stillbirth filed. The attending physician, if any, must sign the medical certificate which states the cause of death. The United States Public Health Service requires a standard form for the certificate of stillbirth. NRS 440.340.

Failure or Refusal to File a Certificate of Birth

Any physician in attendance of a delivery who fails or refuses to file a proper certificate of birthwith the local health officer within the required time limit will be fined not more than $250.NRS 440.740.

Death

Physicians must report any death to the State Registrar, in person, by mail, or through the local health officer, if they possess the knowledge of the facts surrounding the cause of death. Forms to be used for reporting can be obtained from all local health officers. These forms are prepared and issued by the State Board of Health. Use of other forms or blanks is prohibited. The Board provides detailed instructions for completing the forms.

The attending physician, if any, is responsible for signing the medical certificate of death (death certificate). In the absence of the attending physician, the certificate may be signed by any of the following; the attending physicians associate, the chief medical officer of the hospital or institution wherein the death occurred, or the pathologist who performed an autopsy on the deceased individual. Attendance of death by the physician is defined as having professionally seen the deceased within a 10 day period prior to the death. However, if the death was unrelated to the reason the deceased was seen by the physician, the death is not considered to be attended. A physician in charge of certifying the cause of death must complete the sections relating to the cause of death and return the certificate within 48 hours to the person acting as undertaker. The person signing the medical certificate must include:

(a) The social security of the deceased.

(b) The hour and day on which the death occurred.

(c) The cause of death, stating the cause of disease or sequence of events contributing to the death. This information shall state first the primary cause of death, or name of disease causing death, and the contributing cause, if any, with the time spans of each. Death from acts of violence must state the particular injury resulting in death and whether accidental, homicidal, or suicidal in nature.

If a certificate of death is lacking or inadequately completed, the local health officer will return the certificate, calling attention the flaws and withhold issuing the burial or removal permit until corrections are made.

NRS 440.130, 440.140, 440.220, 440.340; NAC 440.160, 440.180.

Cause of Death Statement

The cause of death statement must be legible and stated in a clear and concise manner. If the certificate is incomplete it may be returned to certifying physician to be completed or corrected. The following reasons are why a certificate might be rejected:

(a) Contains only the term “natural causes,”

(b) Explains/states only the symptoms of a disease or the resulting conditions,

(d) Includes shorthand and or personal abbreviations.

Death – Attended

For deaths occurring in hospitals, institutions, or places of non-residence, the physician may provide insight (opinion) as to where the death causative terminal disease was contracted.In cases where the physician attended the death but is unavailable 48 hours later, the certificate must be forwarded to the chief medical officer of the institution or an associate physician who can access the deceaseds medical records. This individual becomes responsible for completing the death certificate. NRS 440.380; NAC 440.160.

Pronouncement of Death by a Registered Nurse

A physician who expects the death of a patient from a particular illness, malady or disease may give permission to a specific registered nurse or the registered nurses employed by a particular medical facility, to make a pronouncement of death. The nurse must be actually present at the time of the patients death. An authorization of this type is only valid for 120 days if a specific nurse is identified. There is no time limitation if the physician has authorized the registered nurses employed by the facility to make pronouncements of death. Authorizations made by physicians for registered nurses must include;

(a) A written order within the patients medical chart;

(b) The name(s) of a registered nurse or nurses who are able to make a death pronouncement;

If a registered nurse makes a death pronouncement under authorization of the attending physician, the physician is required to sign the death certificate within 24 hours. Pending the completion of the death certificate, a registered nurse may release the patients body to a licensed funeral director if the physician, medical director, or chief of the medical staff has authorized the release. NRS 440.415.

Autopsy on the Body of a Minor

If a physician orders an autopsy on the body of a minor, he must make a persistent effort

(in person, by telephone, or by mail) to give the parents or guardian of the minor notice of the autopsy. NRS 440.433.

Removal of Body to Another Registration District

With the approval of the physician who certifies the cause of death, a body can be transported from the place of death to another registration district to be fixed for final disposition. NRS 440.540.

Penalties

Neglect or Refusal to Execute the Medical Certificate of Death

Physicians in medical attendance at the time of death who neglect or refuse to complete a death certificate and deliver it to the funeral director, or person in charge of disposition of the body will not be fined more than $250. NRS 440.720.

False Certification of Cause of Death

A physician who knowingly falsifies a certification of the cause of death will be fined not more than $250. NRS 440.730.

Signature of Uncompleted Certificate of Death

It is unlawful for any physician to apply his signature to an uncompleted certificate of death. NRS 440.735.

PHYSICIAN REQUIRED REPORTS TO STATE HEALTH OFFICER

Cancer Reporting

Cancer means all malignant neoplasms, regardless of the tissue of origin, including malignant lymphoma and leukemia. Any physician who diagnoses or provides treatment for cancer, excluding cases of direct referrals or previous admits to a hospital, medical laboratory or other facility admissions, are required to report information on cases of cancer to the State Health Offier who is responsible for maintaining an accurate system for reporting various cancer information. The State Board of Health sets the guidelines for form and manner of the reporting. A physician who is a chief administrative officer for a health care facility shall make known every case of malignant neoplasms to the State Health Officer. Any person who falsely represents any device, substance or treatment, as effective to arrest or cure cancer is also guilty of a misdemeanor. NRS 457.020, 457.160, 457.210, 457.230, 457.240, 457.250.

Types of Neoplasms Requiring Report

The types of malignant neoplasms requiring reports are listed under the Nevada Administrative Code at NAC 457.040. This administrative code can be accessed via on-line at: http://leg.state.nv.us/

Exceptions for Reporting

Common carcinomas not requiring a report are:

Carcinoma in situ of the cervix

Noninvasive basal cell carcinomas of the skin

Noninvasive squamous cell carcinomas of the skin

(NAC 457.045).

Reporting Procedures

A physician diagnosing a patient with cancer, or treating a patient with cancer, must provide information to the State Health Officer on the State Board of Healths forms within 10 working days after the date of the diagnosis or the date of the first treatment. A physician may also provide this information by electronic means to either the State Health Officer or designee. The information required includes:

(a) The name, address, date of birth, gender, race or ethnicity, and social security number of the patient;

(b) The name and the address or telephone number of the physician making the report;

(d) Any other relevant information from the pathology report, including, without limitation:

(1) The anatomical site of the lesion;

(2) The size of the lesion;

(3) The stage of the disease and the grade of tumor;

(4) The lesion margin status, if available; and

(5) Lymphatic involvement, if available.

The above information is not required to be reported by the physician if the patient is directly referred to or has been previously admitted to a hospital, medical laboratory or other facility which is required to report similar information. (NAC 457.057)

CONFIDENTIALITY

Any physician who has access to confidential information of the registry must comply with the following procedures for maintaining the confidentiality of that information:

(1) All files containing confidential information, including, without limitation, the indexes for access to other files, must be locked when not in use.

(2) All files on a computer containing confidential information, including, without limitation, the indexes for access to other files, must be closed and protected by password when not in use.

(3) Passwords created must be changed every 30 days.

(4) All documents containing confidential information must be out of sight when an employee is away from his desk.

(5) Keys to the office of the registry may be issued to and used only by employees so authorized by the State Health Officer.

(6) The doors to the registry must be locked at all times when the office is vacant.

(NAC 457.070).

PHYSICIAN REQUIRED REPORTING TO THE HEALTH AUTHORITY (DISTRICT HEALTH OFFICER OR, IF NONE, STATE HEALTH OFFICER)

Incidence Reporting

A physician who knows of, or provides services to, a person who has or is suspected of having a communicable disease must report that fact to the health authority (District Health Officer or his designee, or if none, the State Health Officer or his designee) and in the manner required by the State Board of Health. A “suspected case” means a person who, based on clinical signs and symptoms or on laboratory evidence, is considered by a health care provider (physician, nurse, or physician’s assistant) to possibly have:

Food-borne botulism;
Diphtheria;
Extraordinary occurrence of illness;
Measles;
Plague
Rabies (human or animal)
Rubella; or
Tuberculosis,

or is considered to be part of a foodborne disease outbreak. If a physician is in charge of a medical facility knows of or suspects the presence of a communicable disease within the facility, the physician must notify the proper health authority.

NRS 441A.150, NRS 441A.190; NAC 441A.110, 441A.180.

Report Requirements – Urgent

The urgent reporting requirements include of a case, suspected case, or carrier of animal rabies, or an animal bite by a rabies-susceptible animal, and:

(1) Cases must be reported to the health authority:

(a) Within 24 hours after identifying the case, suspected case, or carrier; or

(b) During the regular business hours of the health authority on the first working day following the identification of the case, suspected case, or carrier.

(2) Upon discovering a case having:

(a) An animal bite by a rabies-susceptible animal;

(b) Food-borne botulism;

(d) Meningococcal disease;

(e) Plague;

(f) Rabies; or

(3) Upon discovering a suspected case considered possibly to have:

(a) Food-borne botulism;

(b) Extraordinary occurrence of illness;

(d) Rabies,

or that is part of a foodborne outbreak.

The report must be made to the health authority (who has jurisdiction where the office of the health care provider is located) within 24 hours after identifying the case, using the after-hours reporting system if the report is made at a time other than during the regular business hours of the health authority. A report to the health authority must be made either by telephone, electronic communication, or on an official report form furnished by the division. If a report involves a rabies animal or an animal bite by a rabies-susceptible animal, the report must also be made to the rabies control authority. (NAC 441A.225).

For specific requirements concerning miscellaneous communicable diseases, information can be found via the Internet at: http://www.leg.state.nv.us/NAC/NAC-441A.html

under sections 441A.450 thru 441A.725.

Content of Report

The report must include:

(1) The communicable disease or suspected communicable disease.

(2) The name and the address or telephone number of the case or suspected case.

(3) The name and the address or telephone number of the health care provider making the report.

(4) The occupation, employer, age, sex, race, and date of birth of the case or suspected case, if available.

(5) The date of onset and the date of diagnosis of the communicable disease.

(6) Any other information requested by the health authority, if available.

NAC 441A.225.

COMMUNICABLE DISEASES

A communicable disease is considered to be any of the following diseases:

Acquired immune deficiency syndrome (AIDs).
Amebiasis
Animal bite from a rabies-susceptible species
Anthrax
Botulism (food-borne, infant, wound, other)
Brucellosis
Camphylobacterosis
Chancroid
Chlamydia trachomatis infection of the genital tract
Cholera
Coccidioidomycosis
Cryptosporidiosis
Diphtheria
E. coli 0157:H7
Encephalitis
Extraordinary occurrence of illness
Foodborne disease outbreak
Giardiasis
Gonococcal infection
Granuloma inguinale
Haemophilus influenzae type b invasive disease
Hansen’s disease (leprosy)
Hantavirus
Hemolytic-uremic syndrome (HUS)
Hepatitis (A, B, C, delta, and unspecified)
Human immunodeficiency virus infection (HIV)
Influenza
Legionellosis
Leptospirosis
Listeriosis
Lyme disease
Lymphogranuloma venereum
Malaria
Measles (rubeola)
Meningitis
Meningococcal disease
Mumps
Pertussis
Plague
Poliomyelitis
Psittacosis
Q Fever
Rabies (human or animal)
Relapsing fever
Respiratory syncytial virus infection
Rocky mountain spotted fever
Rotavirus infection
Rubella (including congenital rubella syndrome)
Salmonellosis
Severe reaction to immunization
Shigellosis
Syphilis (including congenital syphilis)
Tetanus
Toxic shock syndrome
Trichinosis
Tuberculosis
Tularemia
Typhoid fever
Yersiniosis

(NAC 441A.040).

SEXUALLY TRANSMITTED DISEASES

Sexually transmitted disease means any bacterial, viral, fungal, or parasitic disease which may be transmitted through sexual contact. These diseases include but are not limited to the following list:

(1) Acquired immune deficiency syndrome (AIDS)

(2) Acute pelvic inflammatory disease

(3) Chancroid

(4) Chlamydia trachomatis infection of the genital tract

(5) Genital herpes simplex

(6) Genital human papilloma virus infection

(7) Gonorrhea

(8) Granuloma inguinale

(9) Hepatitis B infection

(10) Human immunodeficiency virus infection (HIV)

(11) Lymphogranuloma venereum

(12) Nongonococcal urethritis

(13) Syphilis

(NAC 441A.775).

Patient Instruction – Prevention and Treatment

A physician who provides treatment to a person who has a sexually transmitted disease shall instruct him in the methods of preventing the spread of the disease and any necessity for systematic and prolonged treatment. NRS 441A.270, 202.240.

Ensuring Adequate Treatment

A physician who determines that a person has a sexually transmitted disease should encourage that person to submit to medical treatment. In cases where the infected person does not submit to treatment or does not complete the prescribed course of therapy, the physician must notify the health authority (District Health Officer or his designee, or if none, the State Health Officer or his designee). The health authority is then responsible for taking action to ensure that the person receives adequate treatment for the disease. NRS 441A.280.

Consent for Treatment of Minors

A licensed physician, clinic, or local/State Health Officer is not required to obtain a consent or authorization from a parent(s) or legal guardian for examination and treatment of any minor who is suspected of being infected or is actually infected with a sexually transmitted disease. NRS 129.060.

TUBERCULOSIS

Reporting Requirements

A physician must notify the health authority within 24 hours of discovery of any case having active tuberculosis or any suspected case considered to have active tuberculosis who fails to submit to medical treatment or who discontinues or fails to complete an effective course of medical treatment. Active tuberculosis is defined as unhealed pathological changes in the tissues of the body demonstrated by the recovery of tubercle bacilli from the tissues.

NAC 441A.015, 441A.350.

Treatment of Patient for Control Measures

A person who has tuberculosis and is confined to a hospital or other institution must be treated for the disease and any other related condition which the health division (the department of human resources of the health division) determines is detrimental to his health. Physicians must treat both active tuberculosis and suspected tuberculosis cases with a chemotherapeutic regimen approved by the health authority. Exceptions to this rule can be found via on-line at:

http://www.leg.state.nv.us/NRS/CH_441A.html

Under NRS 441A.210, regarding persons whom depend solely on prayer for healing, a person with tuberculosis or suspected of having tuberculosis can only be discharged from medical supervision after a determination by the health authority that the person is cured.

NRS 441A.380; NAC 441A.360, NAC 441A.390.

Records Inspection of a Facility

The health division may inspect and must be given access to all records of every institution and clinic, both public and private, where patients who have tuberculosis are treated at public expense. NRS 441A.400.

ENFORCEMENT

Grounds for Prosecution

Any physician or medical facility that willfully fails, neglects, or refuses to comply with any regulation of the State Board of Health in relation to the reporting of a communicable disease is guilty of a misdemeanor and may be subject to a fine of $1,000 for each violation. If an individual has a communicable disease and fails to:

(a) Comply with any regulation of the Board relating to the control of a communicable disease;

(b) Comply with any provision of chapter Nevada Revised Statute (NRS) 441A

(d) Provide any information required by NRS 441A; or

(e) Perform any duty required under NRS 441A,

the person may be prosecuted by the district attorney in the county where the violation occurred. may be warned by a court of competent jurisdiction.

CONFIDENTIALITY

Communication within the doctor patient relationship is “confidential” and must not be disclosed to third persons other than:

Those present to further the interest of the patient in the consultation, examination or interview;
Persons reasonably necessary for the transmission of the communication; or
Persons who are participating in the diagnosis and treatment under the direction of the doctor, including members of the patient’s family.

The patient has the privilege to refuse to disclose and to prevent any other person from disclosing confidential communications among himself, his doctor or persons who are participating in the diagnosis or treatment under the doctor’s direction.

NRS 49.215, 49.225.

REFERENCES

The following recommendations, guidelines, and definitions are adopted by reference:

The standard procedures to prevent transmission of disease by contact with blood or other body fluids as recommended by the Centers for Disease Control set forth in “Morbidity and Mortality Weekly Report” [37(24):378-88, June 24, 1988], published by the Department of Health and Human Services and available for purchase, a the cost of $1, from Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402-9325.
“Centers for Disease Control Guidelines for Isolation Precautions in Hospitals,” published by the Department of Health and Human Services and available for purchase, at the cost of $18.95, from National Technical Information Service, United States Department of Commerce, 5285 Port Royal Road, Springfield, Virginia 22161.
The recommended guidelines for the investigation, prevention, suppression, and control of communicable disease of the Centers for Disease Control’s Advisory Committee on Immunization Practices, set forth in “Morbidity and Mortality Weekly Report” [38(13):205-214 & 219-227, April 7, 1989], as revised or supplemented in:

(a) “Morbidity and Mortality Weekly Report” [38(22):388-392 &397-400, June 9, 1989]

(b) “Morbidity and Mortality Weekly Report” [38(S-9), December 29, 1989]

(d) “Morbidity and Mortality Weekly Report” [39(RR-15):1-18, November 23, 1990]

(e) “Morbidity and Mortality Weekly Report” [40(RR-1):1-7, January 11, 1991]

(f) “Morbidity and Mortality Weekly Report” [40(RR-3):1-19, March 22, 1991]

(g) “Morbidity and Mortality Weekly Report” [40(RR-6):1-15, May 24, 1991]

(h) “Morbidity and Mortality Weekly Report” [40(RR-10), August 8, 1991],

each of which is published by the Department of Health and Human Services and available for purchase, at the cost of $1, from Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402-9325.

The recommended guidelines for the investigation, prevention, suppression, and control of communicable diseases contained in “Control of Communicable Disease in Man,” published by the American Public Health Association and available for purchase, at the cost of $15 plus $2 postage and handling, from American Public Health Association, 1015 Fifteenth Street, Washington, D.C. 20005.
The recommended guidelines for the investigation, prevention, suppression, and control of communicable diseases contained in “The report of the Committee on Infectious Diseases of the American Academy of Pediatrics (Red Book),” published by the American Academy of Pediatrics and available for purchase, at the cost of $50 plus $7.95 postage and handling, from American Academy of Pediatrics, Publications Division, 141 Northwest Point Boulevard, P.O. Box 927, Elk Grove Village, Illinois 90009-0927.
The recommendations for the testing, treatment, prevention, suppression and control of chancroid, Chlamydia trachomatis, gonococcal infection, granuloma inguinale, lymphogranuloma venereum, and infectious syphilis as are specified in “Sexually Transmitted Diseases Treatment Guidelines,” set forth in “Morbidity and Mortality Weekly Report” [38(S-8), September 1, 1989], and available for purchase, at the cost of $1, from Superintendent of documents, U.S. Government Printing Office, Washington, D.C. 20402-9325.
The recommendations for the counseling of and effective therapy for a person having active tuberculosis or tuberculosis infection of the American Thoracic Society and the American Lung Association set forth in “Tuberculosis: What the Physician Should Know,” and available, free of charge, from American Lung Association of Nevada, P.O. Box 7058, Reno, Nevada 89510.
The recommendations of the Centers for Disease Control for preventing the transmission of tuberculosis in facilities providing health care set forth in “Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Settings, with Special Focus on HIV-Related Issues,” and available for purchase, at the cost of $1, from Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402-9325. (NAC 441A.200).

STATUTES AND REGULATIONS