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A BILL TO BE ENTITLED
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AN ACT
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relating to information submitted to, maintained in, and released |
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from the immunization registry. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 161.0001, Health and Safety Code, is |
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amended by adding Subdivision (1-c) and amending Subdivision (2) to |
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read as follows: |
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(1-c) "Individual's legally authorized |
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representative" means: |
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(A) a parent, managing conservator, or guardian |
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of an individual, if the individual is a minor; |
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(B) a guardian of the individual, if the |
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individual has been adjudicated incompetent to manage the |
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individual's personal affairs; or |
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(C) an agent of the individual authorized under a |
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durable power of attorney for health care. |
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(2) "Payor" means an insurance company, a health |
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maintenance organization, or another organization that pays a |
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health care provider to provide health care benefits, including |
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providing immunizations [to a person younger than 18 years of age]. |
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SECTION 2. Sections 161.007(a), (a-1), (b), (b-1), (c), |
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(d), (e), (f), (j), and (k), Health and Safety Code, are amended to |
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read as follows: |
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(a) The department, for the primary purpose of establishing |
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and maintaining a single repository of accurate, complete, and |
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current immunization records to be used in aiding, coordinating, |
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and promoting efficient and cost-effective [childhood] |
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communicable disease prevention and control efforts, shall |
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establish and maintain an immunization registry. The executive |
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commissioner of the Health and Human Services Commission |
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[department] by rule shall develop guidelines to: |
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(1) protect the confidentiality of patients in |
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accordance with Section 159.002, Occupations Code; |
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(2) inform the individual or the individual's legally |
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authorized representative [a parent, managing conservator, or
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guardian of each patient younger than 18 years of age] about the |
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registry and that registry information may be released under |
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Section 161.00705(g)(2) or (3) in the event of certain disasters, |
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emergencies, attacks, or actions; |
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(3) require the written consent of the individual or |
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the individual's legally authorized representative for the |
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individual's inclusion in the registry [a parent, managing
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conservator, or guardian of a patient younger than 18 years of age] |
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before any information relating to the individual [patient] is |
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disclosed to any other user of [included in] the registry except as |
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otherwise provided by this subchapter; |
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(4) permit the individual or the individual's legally |
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authorized representative [a parent, managing conservator, or
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guardian of a patient younger than 18 years of age] to withdraw |
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consent for the individual [patient] to be included in the |
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registry, except as provided by Section 161.00705(e); [and] |
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(5) determine the process by which consent is |
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verified, including affirmation by a health care provider, birth |
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registrar, regional health information exchange, or local |
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immunization registry that consent has been obtained; and |
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(6) allow the department to retain information in the |
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registry until a person's death. |
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(a-1) The written consent required by Subsection (a)(3) is |
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required to be obtained only one time. The written consent is valid |
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until the individual or the individual's legally authorized |
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representative withdraws [child becomes 18 years of age unless] the |
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consent [is withdrawn] in writing. A parent, managing conservator, |
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or guardian of a minor [child] may provide the written consent by |
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using an electronic signature on the minor's [child's] birth |
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certificate. The executive commissioner of the Health and Human |
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Services Commission by rule shall develop procedures for obtaining |
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consent from an individual who is 18 years of age or older. |
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(b) Except as provided by Section 161.0071, the [The] |
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immunization registry must contain information on the immunization |
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history that is obtained by the department under: |
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(1) this section of each individual [person who is
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younger than 18 years of age and] for whom consent has been obtained |
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in accordance with guidelines adopted under Subsection (a); |
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(2) Section 161.00705 of persons immunized to prepare |
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for or in response to a declared disaster, public health emergency, |
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terrorist attack, hostile military or paramilitary action, or |
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extraordinary law enforcement emergency in this state or another |
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state; and |
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(3) Section 161.00706 of first responders or their |
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immediate family members. |
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(b-1) The department shall remove from the registry |
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information for any individual [person] for whom consent has been |
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withdrawn. The department may not retain individually identifiable |
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information about any individual [person]: |
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(1) for whom consent has been withdrawn; |
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(2) for whom a consent for continued inclusion in the |
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registry following the end of the declared disaster, public health |
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emergency, terrorist attack, hostile military or paramilitary |
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action, or extraordinary law enforcement emergency has not been |
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received under Section 161.00705(f); or |
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(3) for whom a request to be removed from the registry |
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has been received under Section 161.00706(e). |
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(c) A payor that receives data elements from a health care |
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provider who administers an immunization to an individual [a
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person] younger than 18 years of age shall provide the data elements |
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to the department. A payor is required to provide the department |
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with only the data elements the payor receives from a health care |
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provider. A payor that receives data elements from a health care |
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provider who administers an immunization to an individual 18 years |
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of age or older may provide the data elements to the department. |
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The data elements shall be submitted in a format prescribed by the |
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department. Except as provided by this subchapter, the [The] |
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department shall verify consent before disclosing [including] the |
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reported information to other users of [in] the immunization |
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registry. The department may [not] retain individually |
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identifiable information about an individual obtained under this |
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subsection [a person] for whom consent cannot be verified. The |
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department may not disclose the information to other users of the |
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registry until consent is verified, except that the department may |
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disclose the information to public health officials or health |
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authorities during a disaster, emergency, attack, or action |
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described by Section 161.00705(a). |
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(d) A health care provider who administers an immunization |
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to an individual [a person] younger than 18 years of age shall |
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provide data elements regarding an immunization to the department. |
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A health care provider who administers an immunization to an |
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individual 18 years of age or older may submit data elements |
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regarding an immunization to the department. The data elements |
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shall be submitted in a format prescribed by the department. Except |
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as provided by this subchapter, the [The] department shall verify |
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consent before disclosing [including] the information to other |
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users of [in] the immunization registry. The department may [not] |
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retain individually identifiable information about an individual |
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obtained under this subsection [a person] for whom consent cannot |
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be verified. The department may not disclose the information to |
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other users of the registry until consent is verified, except that |
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the department may disclose the information to public health |
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officials or health authorities during a disaster, emergency, |
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attack, or action described by Section 161.00705(a). |
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(e) The department shall provide notice to a health care |
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provider that submits an immunization history for an individual [a
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person] for whom consent cannot be verified. The notice shall |
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contain instructions for obtaining consent in accordance with |
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guidelines adopted under Subsection (a) and resubmitting the |
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immunization history to the department. |
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(f) The department and health care providers may use the |
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registry to provide notices by mail, telephone, personal contact, |
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or other means to an individual or the individual's legally |
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authorized representative [a parent, managing conservator, or
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guardian] regarding an individual [his or her child or ward] who is |
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due or overdue for a particular type of immunization according to |
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the department's immunization schedule for minors or another |
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analogous schedule recognized by the department for individuals 18 |
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years of age or older. The department shall consult with health |
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care providers to determine the most efficient and cost-effective |
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manner of using the registry to provide those notices. |
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(j) Except as provided by Sections 161.00705, 161.00706, |
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and 161.008, information obtained by the department for the |
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immunization registry is confidential and may be disclosed only |
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with the written consent of the individual or the individual's |
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legally authorized representative [, if a child, the child's
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parent, managing conservator, or guardian]. |
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(k) The executive commissioner of the Health and Human |
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Services Commission [board] shall adopt rules to implement this |
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section. |
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SECTION 3. Section 161.00705, Health and Safety Code, is |
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amended by amending Subsections (a), (c), (e), (f), and (g) and |
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adding Subsections (a-1) and (j) to read as follows: |
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(a) The department shall maintain a registry of persons who |
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receive an immunization, antiviral, and other medication |
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administered to prepare for a potential disaster, public health |
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emergency, terrorist attack, hostile military or paramilitary |
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action, or extraordinary law enforcement emergency in this state or |
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another state or in response to a declared disaster, public health |
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emergency, terrorist attack, hostile military or paramilitary |
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action, or extraordinary law enforcement emergency in this state or |
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in another state. A health care provider who administers an |
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immunization, antiviral, or other medication to a resident of this |
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state or to a resident of another state that has relocated or |
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evacuated to this state shall provide the data elements to the |
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department. |
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(a-1) The department may accept from a health authority in |
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another state or a local health authority in another state |
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immunization information for inclusion in the registry under this |
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section if the department determines that: |
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(1) residents of that state have evacuated or |
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relocated to this state in response to a declared disaster, public |
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health emergency, terrorist attack, hostile military or |
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paramilitary action, or extraordinary law enforcement emergency in |
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that state; or |
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(2) residents of this state have evacuated or |
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relocated to that state in response to a declared disaster, public |
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health emergency, terrorist attack, hostile military or |
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paramilitary action, or extraordinary law enforcement emergency in |
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this state. |
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(c) The department shall track adverse reactions to an |
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immunization, antiviral, and other medication administered to |
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prepare for a potential disaster, public health emergency, |
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terrorist attack, hostile military or paramilitary action, or |
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extraordinary law enforcement emergency in this state or another |
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state or in response to a declared disaster, public health |
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emergency, terrorist attack, hostile military or paramilitary |
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action, or extraordinary law enforcement emergency in this state or |
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another state. A health care provider who administers an |
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immunization, antiviral, or other medication to a resident of this |
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state or to a resident of another state that has relocated or |
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evacuated to this state may provide data related to adverse |
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reactions to the department. |
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(e) The executive commissioner of the Health and Human |
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Services Commission by rule shall determine the period during which |
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the information collected under this section must remain in the |
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immunization registry following the end of the disaster, public |
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health emergency, terrorist attack, hostile military or |
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paramilitary action, or extraordinary law enforcement emergency in |
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this state or another state. |
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(f) Unless an individual or, if a minor [child], the minor's |
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[child's] parent, managing conservator, or guardian consents in |
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writing to continued inclusion of the minor's [child's] or other |
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individual's information in the registry, the department shall |
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remove the immunization records collected under this section from |
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the registry on expiration of the period prescribed under |
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Subsection (e). |
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(g) The immunization information of a minor [child] or other |
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individual received by the department under this section, including |
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individually identifiable information, may be released only: |
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(1) on consent of the individual or, if a minor |
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[child], the minor's [child's] parent, managing conservator, or |
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guardian; [or] |
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(2) to a state agency or health care provider in this |
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state consistent with the purposes of this subchapter or the |
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purposes of aiding or coordinating communicable disease prevention |
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and control efforts during a declared disaster, public health |
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emergency, terrorist attack, hostile military or paramilitary |
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action, or extraordinary law enforcement emergency in this state or |
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another state; or |
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(3) to an appropriate health authority or local health |
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authority of another state to which residents of this state have |
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evacuated or relocated in response to a declared disaster, public |
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health emergency, terrorist attack, hostile military or |
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paramilitary action, or extraordinary law enforcement emergency |
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consistent with the purposes of this subchapter or the purposes of |
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aiding or coordinating communicable disease prevention and control |
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efforts during a declared disaster, public health emergency, |
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terrorist attack, hostile military or paramilitary action, or |
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extraordinary law enforcement emergency. |
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(j) The executive commissioner of the Health and Human |
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Services Commission may enter into a memorandum of agreement with |
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another state on: |
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(1) the release and use of registry information under |
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this section to the appropriate health authority or local health |
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authority of that state; or |
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(2) the receipt and use of information submitted by |
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the health authority or local health authority of that state for |
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inclusion in the registry under this section. |
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SECTION 4. Sections 161.00706(c) and (d), Health and Safety |
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Code, are amended to read as follows: |
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(c) The executive commissioner of the Health and Human |
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Services Commission shall: |
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(1) develop rules to ensure that immunization history |
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submitted under Subsection (a)(2) is medically verified |
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immunization information; |
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(2) develop guidelines for use by the department in |
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informing first responders about the registry and that registry |
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information may be released under Section 161.00705 in the event of |
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certain disasters, emergencies, attacks, or actions; and |
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(3) adopt rules necessary for the implementation of |
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this section. |
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(d) Except as provided by Section 161.00705, in the event of |
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certain disasters, emergencies, attacks, or actions, a [A] person's |
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immunization history or data received by the department under this |
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section may be released only: |
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(1) on consent of the person; or |
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(2) to any health care provider licensed or otherwise |
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authorized to administer vaccines. |
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SECTION 5. Section 161.0071, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 161.0071. NOTICE OF RECEIPT OF REGISTRY DATA; |
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EXCLUSION FROM REGISTRY. (a) The first time the department |
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receives registry data for an individual [a child] for whom the |
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department has received consent to be included in the registry, |
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[from a person other than the child's parent, managing conservator,
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or guardian,] the department shall send a written notice to the |
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individual or the individual's legally authorized representative |
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[child's parent, managing conservator, or guardian] disclosing: |
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(1) that providers and payors may be sending the |
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individual's [child's] immunization information to the department; |
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(2) the information that is included in the registry; |
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(3) the persons to whom the information may be |
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released under Section 161.00705(g)(2) or (3) and Section |
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161.008(d); |
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(4) the purpose and use of the registry; |
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(5) the procedure to exclude an individual [a child] |
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from the registry; and |
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(6) the procedure to report a violation if an |
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individual [a parent, managing conservator, or guardian discovers a
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child] is included in the registry after exclusion has been |
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requested or consent has been withdrawn. |
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(b) On discovering that consent to be included in the |
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registry has not been granted or has been withdrawn, the department |
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shall exclude the individual's [child's] immunization records from |
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the registry and any other registry-related department record that |
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individually identifies the individual [child]. |
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(c) On receipt of a written request to exclude an |
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individual's [a child's] immunization records from the registry, |
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the department shall send to the individual or the individual's |
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legally authorized representative [a parent, managing conservator,
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or guardian] who makes the request a written confirmation of |
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receipt of the request for exclusion and shall exclude the |
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individual's [child's] records from the registry. |
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(d) The department commits a violation if the department |
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fails to exclude an individual's [a child's] immunization |
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information from the registry as required by Subsection (b) or (c). |
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(e) The department shall accept a written statement from an |
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individual or the individual's legally authorized representative |
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[a parent, managing conservator, or guardian] communicating to the |
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department that an individual's information [a child] should be |
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excluded from the registry, including a statement on a minor's [the
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child's] birth certificate, as a request for exclusion under |
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Subsection (c). The written statement may include the electronic |
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signature on the minor's [child's] birth certificate. |
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SECTION 6. Section 161.0072, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 161.0072. PROVIDING IMMUNIZATION INFORMATION TO |
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DEPARTMENT. (a) If the individual or the individual's legally |
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authorized representative [parent, managing conservator, or
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guardian of a child] has reasonable concern that the individual's |
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[child's] health care provider is not submitting the immunization |
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history to the department [and the parent, managing conservator, or
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guardian wants the child included in the registry], the individual |
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or the individual's legally authorized representative [parent,
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managing conservator, or guardian] may provide the individual's |
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[child's] immunization history directly to the department to be |
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included in the immunization registry. |
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(b) The individual or the individual's legally authorized |
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representative [parent, managing conservator, or guardian of a
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child] may send evidence of the individual's [child's] immunization |
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history to the department by facsimile transmission or by mail. The |
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evidence may include a copy of: |
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(1) the individual's [child's] medical record |
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indicating the immunization history; |
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(2) an invoice from a health care provider for the |
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immunization; or |
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(3) documentation showing that a claim for the |
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immunization was paid by a payor. |
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(c) The board shall develop rules to ensure that the |
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immunization history submitted by an individual or the individual's |
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legally authorized representative [a parent, managing conservator,
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or guardian] is medically verified immunization information. |
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SECTION 7. Sections 161.0073(a), (b), and (c), Health and |
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Safety Code, are amended to read as follows: |
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(a) Except as provided by Section 161.00705, information |
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that individually identifies an [a child or other] individual that |
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is received by the department for the immunization registry is |
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confidential and may be used by the department for registry |
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purposes only. |
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(b) Unless specifically authorized under this subchapter, |
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the department may not release registry information to any |
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individual or entity without the consent of the individual or the |
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individual's legally authorized representative [person or, if a
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minor, the parent, managing conservator, or guardian of the child]. |
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(c) A person required to report information to the |
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department for registry purposes or authorized to receive |
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information from the registry may not disclose the individually |
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identifiable information of an [a child or other] individual to any |
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other person without written consent of the individual or the |
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individual's legally authorized representative [, if a child, the
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parent, managing conservator, or guardian of the child], except as |
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provided by this subchapter, Chapter 159, Occupations Code, or |
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Section 602.053, Insurance Code. |
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SECTION 8. Sections 161.008(c), (d), (e), (g), and (h), |
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Health and Safety Code, are amended to read as follows: |
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(c) The department may obtain the data constituting an |
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immunization record for an individual [a child] from a public |
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health district, a local health department, the individual or the |
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individual's legally authorized representative [child's parent,
|
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managing conservator, or guardian], a physician to the individual |
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[child], a payor, or any health care provider licensed or otherwise |
|
authorized to administer vaccines. Except as provided by this |
|
subchapter, the [The] department shall verify consent before |
|
disclosing [including] the reported information in the |
|
immunization registry. The department may [not] retain |
|
individually identifiable information about an individual obtained |
|
under this subsection [a person] for whom consent cannot be |
|
verified. The department may not disclose the information to other |
|
users of the registry until consent is verified, except that the |
|
department may disclose the information to public health officials |
|
or health authorities during a disaster, emergency, attack, or |
|
action described by Section 161.00705 in accordance with that |
|
section. |
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(d) The department may release the data constituting an |
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immunization record for the individual [child] to: |
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(1) any entity that is described by Subsection (c); |
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(2) [, to] a school or child care facility in which the |
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individual [child] is enrolled; |
|
(3) [, or to] a state agency having legal custody of |
|
the individual; or |
|
(4) any entity as necessary to verify an immunization |
|
required for: |
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(A) admittance in a professional school, |
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college, or university; |
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(B) certification in a health care profession; |
|
(C) enlistment in the United States armed forces; |
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or |
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(D) any other purpose at the request of the |
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individual [child]. |
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(e) An individual or the individual's legally authorized |
|
representative [A parent, managing conservator, or legal guardian] |
|
may obtain and on request to the department shall be provided with |
|
all individually identifiable immunization registry information |
|
concerning the individual [his or her child or ward]. |
|
(g) The department may release nonidentifying summary |
|
statistics related to the registry that do not individually |
|
identify an individual [a child]. |
|
(h) The executive commissioner of the Health and Human |
|
Services Commission [board] shall adopt rules to implement this |
|
section. |
|
SECTION 9. Section 161.009(a), Health and Safety Code, is |
|
amended to read as follows: |
|
(a) A person commits an offense if the person: |
|
(1) negligently releases or discloses immunization |
|
registry information in violation of Section 161.007, 161.0071, |
|
161.0073, or 161.008; |
|
(2) fails to exclude an individual's [a child's] |
|
immunization information in violation of Section 161.0071; |
|
(3) fails to remove a person's immunization |
|
information in violation of Section 161.00705 or 161.00706; or |
|
(4) negligently uses information in the immunization |
|
registry to solicit new patients or clients or for other purposes |
|
that are not associated with immunization or quality-of-care |
|
purposes, unless authorized under this section. |
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SECTION 10. This Act takes effect September 1, 2009. |