CHAPTER He-P 3000
MATERNAL AND CHILD HEALTH
PART He-P 3001 – 3007 – EXPIRED
Source. #2407, eff 6-30-83, EXPIRED: 6-30-85
PART He-P 3008
NEWBORN DRIED BLOOD SPOT SCREENING, CRITICAL CONGENITAL HEART DISORDER
SCREENING AND NEWBORN HEARING SCREENING
He-P
3008.01 Purpose. The purpose of this part is to describe the
requirements for the screening of all newborns pursuant to RSA 132:10-a, RSA
132:10-aa and for newborn hearing screening pursuant to RSA 132:10-b, V.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18
He-P
3008.02 Scope. This part shall apply to:
(a) Birth facilities and laboratories performing
newborn dried blood spot screening;
(b) Birth facilities performing newborn hearing
screening;
(c) Birth facilities performing newborn critical
congenital heart disorder screening;
(d) Providers, certified midwives, and nurse
midwives performing newborn dried blood spot screening, newborn hearing
screening, and critical congenital heart disorder screening;
(e) Audiologists providing pediatric diagnostic
audiology services; and
(f) Organizations and agencies providing
intervention and early supports and services to children between the ages of
birth and 3 years with hearing conditions.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18
He-P
3008.03 Definitions.
(a) “Birth facility” means the hospital or
birthing center where the infant was
born.
(b) “Commissioner” means the commissioner of the
New Hampshire department of health and human services, or his or her designee.
(c) “Critical Congenital Heart Disorder (CCHD)
screening” means screening for 7 different heart disorders that can be detected
via pulse oximetry.
(d) “Department” means the department of health
and human services, State of New Hampshire.
(e) “Diagnostic hearing evaluation” means
comprehensive testing of infants to determine type and classification of
hearing loss.
(f) “Dried blood spot (DBS)” means a specimen of
blood obtained from an infant through the heel stick procedure, which is then
applied to a filter paper and dried.
(g) “Early hearing detection and intervention
(EHDI) program” means a department program, which oversees the newborn hearing
screening process in New Hampshire.
(h) “EHDI database” means the information
collection system used by the department for the reporting of newborn hearing
screening, diagnosis, and treatment information.
(i) “Filter paper”
means the department-approved specimen collection card which is made
specifically for the purpose of collecting an infant’s blood, and which is used
by the laboratory for testing.
(j) “Infant’s healthcare provider” means the
licensed medical doctor, licensed doctor of osteopathy, licensed advanced
practice nurse, licensed physician’s assistant, or certified midwife, responsible for the care of the newly born
infant.
(k) “Informed dissent” means the written refusal
by an infant’s parent or guardian to participate in newborn screening as
defined in this rule.
(l) “Laboratory” means the testing facility
authorized by the State of New Hampshire to conduct DBS testing on its behalf.
(m) “Newborn hearing screening” means evaluating
the hearing status of infants.
(n) “Newborn screening” means the DBS testing of
infants.
(o) “Newborn screening program (NSP)” means the
department program which has responsibility for managing all aspects of infant
DBS screening pursuant to RSA 132:10-a.
(p) “Out of range (OOR) result” means a DBS test
result that is inconclusive.
(q) “Pediatric audiologist” means a person who
specializes in the assessment and rehabilitation of hearing loss in infants and
children.
(r) “Unsatisfactory specimen” means a DBS
specimen which is unacceptable for testing.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18
He-P
3008.04 Newborn DBS Screening.
(a) Newborn screening shall be required for all
infants born in the State of New Hampshire, in accordance with RSA 132:10-a,
unless the parent(s) or guardian(s) object.
(b) The infant’s health care provider shall
inform the infant’s parent or guardian of their right to opt out of the
performance of the DBS testing per RSA 132:10-c.
(c) If the infant’s
parent or guardian objects to the performance of DBS testing, he or she shall
provide informed dissent to the infant’s healthcare provider or
designee, subject to the following:
(1) A statement
of dissent for testing shall be signed and dated by the infant’s parent or
guardian;
(2) The
statement of dissent shall be included in the infant’s medical record;
(3) The
infant’s healthcare provider or designee shall submit a copy of the statement
of dissent to the NSP; and
(4) A copy of
the statement of dissent shall be provided to the parent or guardian.
(d) Newborn screening tests shall be conducted as
follows:
(1) The DBS
shall be collected from the infant through the heel stick procedure and
directly applied to an unexpired filter paper obtained from the NSP; and
(2) If the
newborn screening tests are performed by a laboratory other than that used by
the NSP, the infant’s healthcare provider shall request all tests required by
the NSP and provide a copy of these test results to the NSP.
(e) For homebirths, the attending physician, advanced
practice registered nurse, certified midwife, or designee shall be responsible
for conducting newborn screening, as described in (a) through (d) above, and
the collection of the DBS specimen, as described in He-P 3008.05(a)-(i) below.
(f) The department shall restrict the quantity of
filter papers made available to birth facilities during periods when changes to
the program are being made.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18
He-P
3008.05 DBS Collection Procedures.
(a) Except as allowed by (b)-(i)
below, the infant’s healthcare provider or designee shall collect the DBS
between 24 and 48 hours after birth.
(b) The infant’s healthcare provider or designee
shall obtain an initial DBS at time of discharge from a birth facility for
infants discharged prior to the first 24 hours of life.
(c) When the initial DBS is obtained prior to the
first 24 hours of life due to early discharge, the infant’s healthcare provider
or designee shall obtain a second DBS within 48 hours of discharge.
(d) When the infant’s birth weight is less than
1500 grams, the infant’s healthcare provider or designee shall obtain
additional DBS for repeat testing at 2, 6, and 10 weeks of age, and monthly
thereafter, until the infant reaches 1500 grams
body weight.
(e) For infants who are sick, premature, or in an
intensive care unit, the infant’s healthcare provider or designee shall obtain:
(1) An initial
DBS between 24 and 48 hours of the infant’s life; and
(2) A second
DBS at 2 weeks of age or at birth facility discharge, whichever is earlier.
(f) Except as allowed by (g) below, the infant’s
healthcare provider shall ensure that a DBS is obtained prior to transfer to
another medical facility.
(g) If an infant’s medical condition prohibits
DBS collection prior to transfer to another medical facility, the transferring
birth facility shall:
(1) Notify the
receiving medical facility that a DBS has not been obtained; and
(2) Submit a
completed filter paper form without the blood specimen and with a comment
explaining the circumstances preventing the collection of blood.
(h) Upon notice of non-collection from the birth
facility, the receiving medical facility shall obtain a DBS for screening in
accordance with He-P 3008.05.
(i) Infants receiving
a blood transfusion shall have DBS collection performed in the following
manner:
(1) For infants
receiving blood transfusions, the infant’s healthcare provider or designee
shall obtain a DBS prior to transfusion, regardless of the infant’s age;
(2) If the
first DBS is obtained prior to 48 hours after transfusion, then a second DBS
shall be obtained 48 hours after transfusion; and
(3) A final DBS
shall be collected by the infant’s healthcare provider 60 days after the final
transfusion.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18
He-P
3008.06 Disposition of the DBS.
(a) The DBS shall be processed by the infant’s
healthcare provider or designee as follows:
(1) The
infant’s healthcare provider shall note in the infant’s medical record the date
and time the DBS is obtained;
(2) The filter
paper shall be filled out completely, including the following information:
a. Whether the
DBS is an initial or repeat sample;
b. The name of
the birth facility where the infant was born;
c. The infant’s
medical record number;
d. The name of
the hospital to which the infant has been transferred, if applicable;
e. The infant’s
mother’s name, date of birth, address, and telephone number;
f. The name,
address, and telephone number of the infant’s healthcare provider;
g. The infant’s
first and last name;
h. The infant’s
sex;
i. Whether the
infant’s birth was a single birth or multiple birth, and if multiple, the
infant’s birth order;
j. The date and
time of infant’s birth;
k. The date and time of DBS collection;
l. The infant’s
birth weight and current weight;
m. Whether the
infant was less than 24 hours old at the time the DBS was obtained;
n. Whether the
infant has undergone transfusion preceding DBS collection, and, if so, the date
of the most recent transfusion;
o. Whether the
infant is a patient in a neonatal intensive care unit/special care unit;
p. The infant’s
feeding method; and
q. Whether the
submitter is the birth facility, the transfer hospital, or the infant’s
healthcare provider; and
(3) The filter
paper shall be sent within 24 hours of collection to the laboratory providing
analysis of the DBS.
(b) The DBS shall be transported to the
laboratory by:
(1) Courier
service provided by the laboratory, or
(2)
Posted by overnight mail, in accordance with U.S. Postal Service
regulations, within 24 hours of collection.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18
He-P
3008.07 DBS Analysis. The laboratory conducting analysis of the DBS
shall provide such analysis with respect to the following disorders:
(a) Phenylketonuria (PKU);
(b) Maple syrup urine disease (MSUD);
(c) Homocystinuria (HCY);
(d) Galactosemia (GALT);
(e) Congenital hypothyroidism;
(f) Toxoplasmosis;
(g) Hemoglobinopathies;
(h) Biotinidase
deficiency (BIOT);
(i) Congenital
adrenal hyperplasia (CAH);
(j) Medium chain acyl CoA dehydrogenase
deficiency (MCAD);
(k) Cystic fibrosis (CF);
(l) Argininosuccinic
aciduria (ASA);
(m) Argininemia (ARG);
(n) Carnitine uptake defect (CUD);
(o) Carnitine palmitoyltransferase
II deficiency (CPTII);
(p) Citrullinemia I, (ASA synthetase def) (CIT);
(q) Cobalamin A,B (Cbl
A,B);
(r) Glutaric aciduria type I (GAI);
(s) 3-hydroxy-3-methylglutaryl-CoA Lysase deficiency (HMG);
(t) Hyperornithinemia hyperammoninemia,
homocitrullinemia syndrome (HHH);
(u) Isovaleric acidemia (IVA);
(v) Long chain 3-hydroxyacyl-CoA dehydrogenase
deficiency (LCHAD);
(w) 3-Methylcrotonyl-CoA carboxylase deficiency
(3MCC);
(x) Methylmalonic acidemia (MUT);
(y) Mitochondrial acetoacetyl-CoA
thiolase deficiency (BKT);
(z) Multiple acyl-CoA dehydrogenase deficiency
(GA2);
(aa) Multiple carboxylase deficiency (MCD);
(ab) Propionic acidemia (PROP);
(ac) Severe combined immunodeficiency disorder
(SCID)
(ad) Trifunctional protein deficiency (TFP);
(ae) Tyrosinemia; and
(af) Very long chain
acyl-CoA dehydrogenase deficiency (VLCAD).
Source. #8529, eff
12-23-05; ss by #8875, eff 4-25-07; ss by #9725, eff 7-1-10; ss by #12632, eff
9-28-18
He-P
3008.08 Procedures for Unsatisfactory
and OOR DBS Screening Results.
(a) A DBS for re-screening shall be collected by
the infant’s healthcare provider or birth facility of record in the following
cases:
(1) When an
infant’s DBS was obtained prior to the first 24 hours of life;
(2) When an
infant was transfused before an initial DBS could be collected; or
(3) When the
laboratory deems any specimen as unsatisfactory or any result as OOR.
(b) Upon notification by the NSP, the infant’s
healthcare provider shall:
(1) Arrange for
the repeat DBS collection or additional testing as requested by the NSP; or
(2) Verify that
another provider performs the requested testing.
(c) If the infant’s healthcare provider elects to
utilize a laboratory service other than that utilized by the NSP to perform the
retesting, the infant’s healthcare provider shall be responsible for providing
the results of this testing to the NSP.
(d) If a requested repeat DBS is not received by
the NSP within 4 weeks of the notice in (b) above, the department shall issue a
certified letter to the infant’s healthcare provider and birth facility of
record indicating that newborn screening testing is incomplete.
(e) The NSP shall cease attempts to obtain the
repeat DBS and close its file indicating the DBS was not received after
follow-up.
Source. #8529,
eff 12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18
He-P
3008.09 Reporting of Results. Upon receipt of a completed newborn screening
report from the department, the birth facility shall include a copy of the
report in the infant’s medical record.
Source. #9725, eff 7-1-10;
ss by #12632, eff 9-28-18
He-P
3008.10 Disposal of DBS Residual.
(a) The testing
laboratory shall store DBS specimens in sealed bags of low gas permeability
containing a desiccant and humidity indicator at -20 degrees Celsius.
(b) The testing laboratory shall destroy DBS
specimens 6 months after the collection date, in a manner consistent with
applicable federal requirements relating to the disposal of human blood and
body fluids per OSHA regulations 29 CFR 1910.1030.
(c) If the storage environment of any DBS
specimen is found to have deviated from the required conditions described in
(a) above, such that the stability of the specimen is likely to have been
affected, the testing laboratory shall first notify the NSP and shall then
destroy the DBS specimen.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.09); ss by #12632, eff
9-28-18
He-P
3008.11 Requests for DBS or Related
Records. Residual DBS specimens and related records may be retrieved for
other purposes only with the written authorization of a parent or guardian.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.10); ss by #12632, eff
9-28-18
He-P
3008.12 Training of Persons
Collecting a DBS. All persons
performing DBS collection for newborn screening shall comply with the proper
collection, handling, short-term storage, and transport of DBS in accordance
with the Clinical and Laboratory Standards Institute (CLSI) “NBS 01-A6, Blood
Collection on Filter Paper for Newborn Screening Programs, Approved
Standard-Sixth Edition,” (July 2013) available as noted in Appendix A.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.11); ss by #12632, eff
9-28-18
He-P
3008.13 Newborn Screening Advisory
Committee.
(a) The commissioner shall appoint members to a
newborn screening advisory committee (NSAC), pursuant to RSA 132:10-a, III.
(b) The NSAC shall be comprised of at least one
individual from each of the following:
(1)
Health care sub-specialists with expertise relative to newborn
screening. including, but not limited to, such specialties as:
a.
Endocrinology;
b. Pediatric
neurology;
c. Genetics;
d. Hematology;
e. Metabolics;
f. Obstetrics;
and
g. Neonatology;
(2) A
member of the health and human services oversight committee, as established by
RSA 126-A:13, appointed by the chair of that committee;
(3) A
genetic counselor;
(4) A
parent of a child affected by a disorder for which there is a nationally
recommended newborn screening test;
(5) A
midwife practicing outside the hospital setting;
(6) A
representative from the New Hampshire Pediatric Society;
(7) A
nurse with child health experience;
(8) A
representative from the New Hampshire Chapter of the March of Dimes;
(9) A
representative from the New Hampshire Hospital Association;
(10) A
representative from the department’s public health laboratory;
(11)
The department’s medical director or designee;
(12) A
representative from the department’s maternal and child health program;
(13) A
representative from the department’s children with special health care needs
program;
(14) A
representative from the department’s medicaid
program;
(15) A
representative from a health insurance provider; and
(16) A
representative from the New Hampshire Academy of Family Practitioners.
(c) Additional
staff from the department may participate in the NSAC, but shall not be voting
members.
(d) The NSAC shall meet at least once annually
to:
(1)
Advise the department on clinical, educational, and operational aspects
of the NSP;
(2)
Advise the department on the inclusion of additional disorders in the
current newborn screening panel based upon the criteria set forth by RSA
132:10-a, I; and
(3) Offer other
advice as requested by the commissioner.
(e) Each member of the NSAC shall have one vote.
(f) The NSAC shall choose, by majority vote, 2
members to serve as co-chairs, including:
(1) One
co-chair employed by the department; and
(2) One
co-chair not employed by the department.
(g) A quorum shall consist of a majority of all
voting members.
(h) A quorum
shall be present for a vote to take place.
(i) A majority vote shall be necessary to pass a
motion.
(j) Recommendations by the NSAC shall be
advisory, but not binding.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.12); ss by #12632, eff
9-28-18
He-P 3008.14 Newborn
Screening Test Fees.
(a) The department shall establish and impose
fees upon hospitals for the newborn screening tests performed.
(b) Fees for the testing, analysis, and ancillary
costs of the newborn screening program shall be determined by calculating the
total yearly costs for program services divided by the state-wide annual
projection of births.
(c) The department shall re-calculate fee amounts
upon commissioner approval of new or changed newborn screening tests.
(d) Any change in the fee amount as a result of
adding or changing newborn screening tests shall take effect upon approval by
the commissioner.
(e) The department shall notify hospitals of any
new or increased fee at least 30 days prior to the fee’s effective date.
Source. #8529, eff
12-23-05; amd by #8875, eff 4-25-07; ss by #9725, eff 7-1-10 (from He-P
3008.13); ss by #12632, eff 9-28-18
He-P 3008.15 Reporting of Newborn Hearing Screening
Information to EHDI Program.
(a)
Within 2 weeks of testing, individuals conducting newborn hearing
screening and diagnostic hearing evaluation shall report the following
information to the EHDI program via the EHDI database:
(1)
Demographic information, including:
a. The infant’s
name;
b. The infant’s
sex;
c. The infant’s
race;
d. The family
of the infant’s preferred language for communication;
e. The infant’s
date of birth;
f. The infant’s
medical record number;
g. The infant’s
birth facility;
h. Family
contact information; and
i. The infant’s
health care provider; and
(2)
Results from testing, including:
a. Birth
facility;
b. Testing
date;
c. Type of
testing;
d. Testing
results;
e. Diagnosis;
and
f. Risk factors
for progressive hearing loss.
(b) Birth facilities shall fax to the EHDI
program within 48 hours the hearing screening and diagnostic hearing in (a)
above for any infant who does not pass the final newborn hearing screening.
(c) Newborn screen and diagnostic hearing
information shall be faxed via secure fax line at 603 271 4519.
(d) In
addition to the information in (a), above, New Hampshire audiologists providing
diagnostic hearing evaluation shall submit to the department the following
information:
(1) Referral
information for medical, genetic, and early support services; and
(2)
Hearing follow-up information, such as post-referral disposition.
(e) In
addition to the information in (a) above, New Hampshire organizations and
agencies providing intervention and early supports and services to children
between the ages of birth and 3 years with hearing conditions shall submit to
the department the following information:
(1)
Early supports and services, individual family service plan, start date
and discharge date; and
(2) Nature of
the services provided and post referral disposition date.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.14); ss by #12632, eff
9-28-18
He-P 3008.16 Critical
Congenital Heart Disorder (CCHD) Screening.
(a) Newborn CCHD screening shall be required for
all infants born in the State of New Hampshire in accordance with RSA 132.10-aa.
(b) CCHD screening shall be accomplished by pulse
oximetry following the American Academy of Pediatrics (AAP) guidelines and
screening algorithm “Strategies for Implementing Screening for Critical
Congenital Heart Disease,” (November
2011) available as noted in Appendix A.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.15); ss by #12632, eff
9-28-18
He-P 3008.17 Reporting of CCHD Screening Results. Within 24 hours of screening completion,
facilities and individuals performing the screening shall report the results to
the NSP via secure fax line at 603 271 4519 the following demographic
information:
(a) The infant’s name;
(b) The infant’s sex;
(c) The infant’s date of birth;
(d) The infant’s medical record number;
(e) The infant’s birth facility;
(f) Mother’s name and address;
(g) Screening date;
(h) Screening results following AAP guidelines
“Strategies for Implementing Screening for Critical Congenital Heart Disease,”
(November 2011) available as noted in Appendix A;
(i) Further testing
completed for infants with positive screening results; and
(j) Referral and transfer information.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.16); ss by #12632, eff
9-28-18
He-P 3008.18
Complaints and Non-Compliance. Upon receiving a complaint that an
individual or facility listed in He-P 3008.02(a)-(e) is not practicing in
accordance with this part, the department shall:
(a) Investigate the complaint; and
(b) If founded, refer the complaint to a relevant
disciplinary body, such as the New Hampshire board of medicine.
Source. #8529, eff
12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.17); ss by #12632, eff
9-28-18 (formerly He-P 3008.16)
He-P 3008.19
Confidentiality and Security of Records.
(a) All records maintained by the NSP and EHDI or
its contractors, including paper files, facsimile transmissions, or electronic
data transfers, shall be strictly confidential.
(b) All confidential information shall be kept in
a secured area at all times as follows:
(1) Paper
records and external electronic storage media shall be kept in locked file
cabinets;
(2)
All electronic files shall be password protected; and
(3) All confidential notes or other materials that do
not require storage shall be shredded immediately after use.
Source. #12632, eff
9-28-18 (formerly He-P 3008.17)
He-P 3008.20 Quality
Assurance.
(a)
Birth facilities shall allow periodic reviews of their newborn
screening, CCHD, and newborn hearing screening activities by department staff
for quality assurance purposes.
(b)
Reviews shall include, but not be limited to:
(1) The review of policies and procedures
regarding newborn screening, CCHD, newborn hearing screening, and
diagnostic hearing evaluation;
(2)
Interviews with staff performing any aspect of newborn screening, CCHD,
and newborn hearing screening; and
(3)
The on-site review of medical records.
(c)
The NSP shall provide upon request:
(1) Information
regarding acceptable procedures for the collection, handling, short-term
storage and transport of a DBS;
(2) Information
regarding newborn screening that shall be given to and reviewed with the parent
or guardian of each infant prior to testing; and
(3)
Text to be used in statements of informed dissent.
(d)
The NSP and the EHDI program shall compare the data sets of infants
screened with New Hampshire birth certificate files, in order to ensure that
every infant born in New Hampshire is screened, or had the opportunity to be
screened, for hearing, CCHD, and for those conditions that are determined by
DBS testing.
Source. #12632, eff
9-28-18 (formerly He-P 3008.18)
PART He-P 3009 – 3010 – EXPIRED
Source.
#2407, eff 6-30-83, EXPIRED: 6-30-85
PART He-P 3011 BICYCLE PROTECTIVE HEADGEAR REGULATIONS
Statutory Authority – RSA 126-A:5, XIII
He-P
3011.01 Purpose. The purpose of this part is to set forth
rules relative to approved protective headgear as required by RSA 126-A:5,
XIII.
Source. #8524, eff
1-1-06; ss by #10529, eff 2-27-14
He-P
3011.02 Definitions.
(a) “Label” means a sticker with information
identifying the protective headgear as compliant with 16 Code of Federal
Regulations (C.F.R.) Part 1203 by the Consumer Product Safety Commission
(CPSC).
(b) “Protective headgear” means a bicycle helmet
that adheres to the appropriate safety standard set forth in 16 C.F.R. Part
1203 by the CPSC.
Source. #8524, eff
1-1-06; ss by #10529, eff 2-27-14
He-P
3011.03 Safety Standards for
Protective Headgear. All protective
headgear shall have a label as required by the CPSC safety standards.
Source. #8524, eff
1-1-06; ss by #10529, eff 2-27-14
He-P
3011.04 Wear of Protective Headgear. All individuals under the age of 16 shall
wear protective headgear pursuant to RSA 265:144, X.
Source. #8524, eff
1-1-06; ss by #10529, eff 2-27-14
PART He-P
3012 BIRTH CONDITIONS PROGRAM
Statutory
Authority RSA 141-J:9
He-P
3012.01 Purpose. The purpose of this part is to establish the
requirements of a statewide population-based public health surveillance program
on birth conditions. The surveillance
program shall carry out the provisions established in RSA 141-J.
Source. #9404, eff
3-5-09, EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
He-P
3012.02 Definitions.
(a) “Birth condition” means “birth condition” as
defined in RSA 141-J:2, I namely, “one or more of the birth conditions
recommended by the National Birth Defects Prevention Network and/or the Centers
for Disease Control and Prevention.”
(b) “Commissioner” means the commissioner of the
New Hampshire department of health and human services, or his or her designee.
(c) “Confirmed case” means confirmation by a
medical record abstractor that an individual with a birth condition meets the
criteria for case definition as defined by the National Birth Defects
Prevention Network or Centers for Disease Control and Prevention, or both.
(d) “Department” means the New Hampshire
department of health and human services.
(e) “Facilities” means health care facilities,
clinics, imaging centers, laboratories, medical records departments, and
state offices, agencies, and departments, which have information relating to
the occurrence of birth conditions in children, infants, or stillborn fetuses.
(f) “Health care professional” means a:
(1) Medical
doctor;
(2) Doctor of
osteopathy;
(3) Doctor of
naturopathic medicine;
(4) Advanced
registered nurse practitioner;
(5) Registered
nurse;
(6) Physician’s
assistant;
(7) New
Hampshire certified midwife;
(8) Doctor of
audiology or licensed audiologist; or
(9) Optometrist
or orthopist.
(g) “Health information” means “health
information” as defined in RSA 141-J:2, IV.
(h) “Individually identifiable health
information” means “individually identifiable health information” as defined in
RSA 141-J:2, V.
(i) “Medical records
abstractor” means a staff person from the New Hampshire birth conditions
program, its contractor, or designee who reviews medical information to confirm
the presence of a birth condition.
(j) “New Hampshire birth conditions program
(NHBCP)” means the entity assigned the responsibility for managing the program
pursuant to RSA 141-J under the supervision of the department.
(k) “Opt-out” means the procedure an individual
follows to elect not to participate in the NHBCP program, pursuant to RSA
141-J:5 and RSA 141-J:6.
Source. #9404, eff
3-5-09, EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
He-P
3012.03 Program Access to Health
Information.
(a) In accordance with RSA 141-J:3 and this
section, health care providers and facilities shall allow the NHBCP access to
health information and individually identifiable health information relating to
the occurrence of birth conditions in children, infants, and stillborn fetuses.
(b) At least annually, the NHBCP shall direct
health care providers and facilities to generate a list of presumed cases of
birth conditions. This list shall
include only the information allowed by (d)(1) below.
(c) The NHBCP medical records abstractor shall be
allowed to conduct on-site reviews of medical records to determine which cases
identified in (b) above are confirmed cases as recommended by the National
Birth Defects Prevention Network or the Centers for Disease Control and
Prevention or both.
(d) For confirmed cases determined in accordance
with (c) above, the medical records abstractor shall collect:
(1) The diagnosis, the health care provider’s name and
address, and only the following individually identifiable information about the
child, infant, or stillborn fetus:
a. Name; and
b. Address,
including town or city, state, and postal code at the time of birth; and
(2) Additional
non-individually identifiable health information about the child, infant, or
stillborn fetus as recommended by the National Birth Defects Prevention Network
or the Centers for Disease Control and Prevention or both.
(e) If the NHBCP has not received a completed
opt-out form “Birth Conditions Program Registry Form” (12/2017) form from the
individual in accordance with He-P 3012.04, the medical records abstractor
shall return to the health care provider or facility to conduct a second
on-site visit and perform on-site medical record abstraction to collect only
that information described in (f) through (i) below. This visit shall be conducted no earlier than
60 days after the opt-out packet was mailed.
(f) For those cases allowed under (e) above, the
following additional individually identifiable health information shall be
collected for the child, infant, or stillborn fetus:
(1) Date of
birth and death, if applicable;
(2) Results of
any genetic testing related to the birth condition; and
(3) Medical
record number.
(g) For those cases allowed under (e) above, the
following individually identifiable information shall be collected for the
mother:
(1) First,
middle, and last name; and
(2) Date of
birth.
(h) For those cases allowed under (e) above, the
following individually identifiable health information shall be collected for the father:
(1) First,
middle, and last name; and
(2) Date of
birth.
(i) If the pregnancy
was voluntarily terminated:
(1) No opt-out
package shall be sent;
(2) No
individually identifiable health information shall be collected; and
(3)
Non-individually identifiable health information may be collected except
that the following shall not be collected:
a. Physician or
other health care provider; and
b. Health care
facility.
(j) The NHBCP shall collect health information
and individually identifiable health
information relating to New
Hampshire residents who meet the criteria for confirmed cases as defined in
He-P 3012.02(c) only from those health care facilities, birth conditions
surveillance programs, or other sources in other states with which the
department has entered into an interstate memorandum of agreement in accordance
with RSA 141-J:3.
(k) The NHBCP shall collect individually
identifiable health information for confirmed cases of birth conditions defined
by He-P 3012.02(c). When a child meets
the criteria for a confirmed case, but a specialist is evaluating the birth
condition further, the program shall maintain the child’s information for up to
2 years while monitoring the outcome of the specialist evaluation. If the
outcome of the specialist evaluation indicates the child no longer meets the
criteria for a confirmed case, all information on the child shall be expunged.
Source. #9404, eff
3-5-09, EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
He-P 3012.04 Election Not to Participate in the NHBCP.
(a) If an individual, or the parent or guardian
of a minor or an individual who is
legally incompetent, objects to
the collection of individually identifiable health information by the
NHBCP, the individual, or a parent or guardian of a minor or an individual who
is legally incompetent, may elect not to participate in the NHBCP program, by
completing and submitting an opt-out form “Birth Conditions Program Registry
Form” (12/2017) , as defined by He-P 3012.03(e) in accordance with RSA 141-J:5
and RSA 141-J:6, I.
(b) Within 7 business days of case confirmation
per He-P 3012.03(d), the NHBCP shall send an opt-out information packet which
shall include:
(1) A letter to
the individual, or the parent or guardian of a minor or an individual who is legally incompetent, explaining
the collection of the birth condition data by the NHBCP under RSA 141:J;
(2) A NHBCP
fact sheet about the nature and purpose of the program including the telephone
number, fax number, mailing address, and email address of the NHBCP;
(3) Information
about state-supported early intervention and prevention services; and
(4) An opt-out
form “Birth Conditions Program Registry Form”
(12/2017) with:
a. A statement
that the failure to complete and return the opt-out form “Birth Conditions
Program Registry Form” (12/2017) within 60 calendar days of the date of the
letter means that their individually identifiable health information as listed
in He-P 3012.03 shall be collected by the NHBCP;
b. A statement
that the individual, or the parent or guardian of a minor or an individual who is legally incompetent, may
elect not to participate at any time in the future in accordance with RSA
141-J:6, I and He-P 3012.06(a);
c. Information
on what will occur as a result of opting out of the program; and
d. Information
on the possible risks and benefits of participating in the program.
(c) If information packets described in (b) above
are returned to the NHBCP as undeliverable, the program shall contact the
individual’s health care provider for the individual’s most current address.
The provider shall disclose that information solely for the purpose of the
NHBCP contacting the individual regarding the opt-out procedures. Should the information packets described in
(b) above be returned undeliverable a second time, the NHBCP shall not retain
any information other than that allowed by (e) below.
(d) The NHBCP shall send letters to acknowledge
the individual’s decision to opt-out of the NHBCP within 7 business days of
receipt of the completed opt-out form.
(e) The NHBCP shall develop a list of individuals
who have confirmed birth conditions but who have elected to opt-out of the
program, including the dates of such elections, which shall be used only as a
means of verifying that the individual or the parent, or guardian of a minor or
an individual who is legally incompetent, has opted out in the event that
individual’s record is encountered again through routine case finding. This list shall not be disclosed to any
entity or individual outside of the NHBCP and shall be purged after 2 years
from the date the case was confirmed.
Source. #9404, eff
3-5-09, EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
He-P
3012.05 Confidentiality and Security
of Records.
(a) All records maintained by the NHBCP,
including paper files, facsimile transmissions, or electronic data transfers,
shall be strictly confidential except as allowed by RSA 91-A.
(b) All confidential information shall be kept in
a secured area or safely stored electronically at all times as follows:
(1) Paper
records and computer discs shall be kept in locked, cabinets or a medical
record room;
(2) All
individually identifiable health information stored in electronic files shall
be password protected; and
(3) All
confidential notes or other materials entered into the NHBCP database, which
are not required to be stored, shall be shredded immediately after use.
(c) All staff members of NHBCP and any other
persons given access to individually identifiable health information in the
records maintained by the NHBCP shall sign a confidentiality agreement
specified by the department requiring adherence to this part and the provisions
pursuant to RSA 141-J:8, I.
(d) In accordance with RSA 141-J:8, II, the
department shall maintain a list of any persons other than NHBCP staff given
access to individually identifiable health information.
Source. #9404, eff
3-5-09, EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
He-P
3012.06 Rights of Individuals.
(a) Requests to exercise any or all of the rights
listed in RSA 141-J:6 shall be put in writing and sent to:
Department of Health and Human Services
Division of Public Health Services
Maternal and Child Health Section
29 Hazen Dr.
Concord, NH 03301
(b) The department shall respond to those
requests within 10 business days from the receipt of the written request.
Source. #9404, eff 3-5-09,
EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
He-P
3012.07 Program Ability to Share Data.
(a) Health information, including individually
identifiable health information available to the NHBCP under He-P 3012.03,
shall be used to determine the prevalence and trends of birth conditions, to
develop and assess prevention strategies, and to promote scientific
collaboration through analyses, investigations, and epidemiological studies on
the public health impact and possible causes of birth conditions.
(b) Pursuant to RSA 141-J:3, I, the NHBCP shall
not provide individually identifiable health information relating to New
Hampshire residents to any similar program operated by any other state or the
federal government.
(c) The NHBCP shall maintain the confidentiality
of all individually identifiable health information collected, except as
allowed pursuant to RSA 141-J:4 and RSA 141-J:7 and in accordance with (d)
below.
(d) Health information and individually
identifiable health information that is made available to the NHBCP concerning
an individual, and any other information maintained by the NHBCP, which,
because of a personal identifier, can be readily associated with an individual,
shall only be released:
(1) To the
individual upon receipt of:
a. A written
request which shall be signed by the individual;
b. A certified
copy of the birth certificate of the individual; and
c. A copy of
the individual’s identification, such as a driver’s license;
(2) If the
individual is a minor, to a parent of the individual upon receipt of:
a. A written
request, which shall be signed by the parent;
b. A certified
copy of the birth certificate of the individual; and
c. A copy of
the parent’s identification, such as a driver’s license by the parent;
(3) If the
individual has a court-appointed guardian or if the individual is deceased, to
the court-appointed guardian or to the executor or administrator of the
individual’s estate upon receipt of:
a. A written
request, which shall be signed by the court-appointed guardian, executor, or
administrator of the estate;
b. A certified
copy of the order or decree which appoints the guardian, executor, or
administrator; and
c. A copy of
identification, such as a driver’s license, of the guardian, executor, or
administrator;
(4) To an
attorney or other person designated by the individual upon receipt of a written
medical release request which shall be signed by the individual;
(5) Pursuant to
RSA 141-J:7, relative to a legal proceeding upon receipt of a written
authorization from the person about whom the information relates; and
(6) To persons
conducting health related research upon receipt and approval of a written
request to the department pursuant to He-P 3012.08, which shall be signed by
the requestor and include:
a. The
following information about the principal investigator:
1. Name,
address, and phone number;
2.
Organizational affiliation;
3. Professional
qualification; and
4. Name and
phone number of principal investigator’s contact person, if any;
b. The
following information about the data or record copies being requested:
1. Type of
event or record copies;
2. Time period
of the data or record copies;
3. Specific
data items required, if applicable;
4. Medium in
which the data or record copies are to be supplied; and
5. Any special
format or layout of data required by the principal investigator;
c. A research
protocol containing the following:
1. A summary of
the background and origin of the research;
2. A statement
of the health-related problem or issue to be addressed by the research;
3. The primary
research hypothesis to be tested;
4. The research
design, which shall include:
(i) Case definition;
(ii) Method of
case selection; and
(iii) Method of
data analysis;
5. The research
methodology, including:
(i) The way in which the requested data will be
used; and
(ii) The
procedures for follow-back to any persons or facilities named in records, if
applicable;
6. Procedures
to obtain informed consent from the research participants, if applicable;
7. The
procedures that will be followed to maintain the confidentiality and security
of any data or copies of records provided to the requester; and
8. The intended
completion date;
d. A written
statement signed by the principal investigator agreeing to the following:
1. “I am the
person in charge of the health-related research project, as described in the
written request. I am the custodian of
the data responsible for the observance of all conditions of use and for
establishment and maintenance of security arrangements to prevent unauthorized
use of the data and copies of records obtained”;
2. “I
acknowledge that the department is the source of the data in any and all public
reports, publications, or presentations generated by me or the written research
request from this data”;
3. “I acknowledge and specify that the analyses,
conclusions, and recommendations drawn from the data are solely my own or those
developed as part of the health related research and are not necessarily those
of the department”;
4. “I agree that any copies of data or records
provided during the health related research shall not be used for any purpose
other than that described in the written request”;
5. “I shall not disclose the identity of
individuals revealed in the data or record copies to any persons except as is
necessary to perform the research described in the written request”;
6. “I agree to
have a procedure in place to require research staff to agree not to disclose
the identity of individuals revealed in the data or record copies to any
persons except as is necessary to perform the research described in the written
request”;
7. “I agree
that the data record shall not be further released to any other person or
organization without the written consent of and under the terms specified by
the commissioner or his designee”; and
8. “I agree
that no form of information derived from the data or record copies that identifies
any individuals shall be made public.”;
e. A written
statement signed by the principal investigator stating: “I agree to indemnify
the department accepting all responsibility on behalf of the research project
if I or a member of the research staff cause an unauthorized disclosure of
individually identifiable health information”; and
f.
Documentation of Institutional Review Board (IRB) approval for the study
by an IRB formed in accordance with the requirements of the U.S. Department of
Health and Human Services Code of Federal Regulations for Protection of Human
Subjects, 45 CFR 46.
(e) Persons who fraudulently request data shall
be subject to the penalty for unsworn falsifications in accordance with RSA
641:3.
Source. #9404, eff
3-5-09, EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
He-P
3012.08 Approval Criteria for Release
of Confidential Data for Research Purposes.
(a) The commissioner shall review and approve
requests for the use of confidential NHBCP data, based on the following
criteria:
(1)
Completeness of written request, pursuant to He-P 3012.07(d)(6);
(2)
Documentation of adequate measures to insure confidentiality of
patients, and security of data pursuant to He-P 3012.07(d)(6);
(3)
Determination of whether the study, if carried out according to the
written request submitted pursuant to He-P 3012.07(d)(6) will be able to answer
the research hypothesis as stated in the written request; and
(4)
Qualifications of principal investigator(s) and research staff, as
indicated by submission of:
a.
Documentation of training and previous research, such as peer reviewed
publications, in the proposed or related area; and
b.
Documentation of an affiliation with a university, medical center or
other institution, which will provide sufficient research resources.
(b) The commissioner shall deny a written request
in accordance with RSA 541-A:29, II(a), when it has been determined that one or
more of the requirements of He-P
3012.07(d)(6) or any of the criteria in (a) above have not been met.
(c) Upon
approval by the commissioner, the principal investigator or responsible party
shall execute an “NHDHHS Division of Public Health Services Data Use Agreement”
(11/1/17) which describes the permitted uses of the data.
Source. #9404, eff
3-5-09, EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
He-P
3012.09 Release of Aggregate Data.
(a) Statistics derived from the NHBCP data shall
be considered to be aggregate data if published by towns with a population of
5,500 or more.
(b) Population estimates shall be derived from
the most recent decennial census.
(c) If there are 4 or fewer confirmed cases in
towns with populations of less than 5,500, then the data at the town level
shall not be released, to prevent constructive identification of individuals.
(d) The age-adjusted rates and age-specific rates
shall:
(1) Not be calculated for cases fewer than 10;
and
(2) Be provided with confidence intervals.
Source. #9404, eff
3-5-09, EXPIRED: 3-5-17
New. #12333, INTERIM, eff 7-22-17, EXPIRES:
1-18-18; ss by #12448, eff 1-9-18
PART He-P
3013 MATERNAL MORTALITY REVIEW PANEL
Statutory
Authority: RSA 132:30, VII
He-P
3013.01 Purpose. The purpose of this part is to establish the
requirements of a maternal mortality review panel in order to carry out the
provisions established in RSA 132:30, VII.
Source. #10287, eff
3-16-13
He-P
3013.02 Definitions.
(a) “Abstraction team” means a team of
professionals designated by the Northern New England Perinatal Quality
Improvement Network (NNEPQIN), which abstracts medical information to review
and analyze the public health implications of a maternal death.
(b) “Commissioner” means the commissioner of the
(c) “Department” means the
(d) “Individually identifiable information” means
information relating to the occurrence of a maternal death, as described in RSA
132:31, II.
(e) “Maternal death” means any of the following,
as defined in RSA 132:29, I–III:
(1)
“Pregnancy-associated death” means the death of a woman while pregnant
or within one year of the end of pregnancy, irrespective of cause;
(2) “Pregnancy-associated,
but not pregnancy-related” means the death of a woman while pregnant or within
one year of the end of pregnancy due to a cause unrelated to pregnancy; and
(3)
“Pregnancy-related death” means the death of a woman while pregnant or
within one year of the end of pregnancy, irrespective of the duration and site
of the pregnancy, from any cause related to or aggravated by her pregnancy or
its management, but not from accidental or incidental causes.
(f) “Medical records” means any related
healthcare and mental health record of the mother, including, but not be
limited to, audio and video recordings, vital records, hospital discharge data,
prenatal, fetal, pediatric, or infant medical records, hospital, medical
office, or clinic records, laboratory reports, records of fetal deaths or
induced termination of pregnancies, autopsy reports, and emergency response
records.
(g) “Northern New England Perinatal Quality
Improvement Network (NNEPQIN)” means the entity designated by the department,
through a business associates agreement, to oversee the review and abstraction
of medical information to review and analyze the public health implications of
a maternal death.
(h) “Panel” means the maternal mortality review
panel as established and described in RSA 132:30.
Source. #10287, eff
3-16-13
He-P
3013.03 Identification and Reporting
of Maternal Deaths.
(a)
Facilities, as described in RSA 132:31, II, shall identify and report maternal deaths to
the department.
(b) Maternal deaths may be identified and
reported to the department through the following sources:
(1) Direct
report from a hospital, non-emergency walk-in care center, ambulatory surgical
center, or birthing center;
(2) Data
linkage through a death certificate;
(3) Case
finding from a panel member and reported to the department;
(4) Medical
examiner’s report; and
(5) Other
source.
(c) For maternal deaths identified and reported
in (b)(1) above, the hospital, non-emergency walk-in care center, ambulatory
surgical center, or birthing center shall complete and send a “Maternal
Mortality Initial Report” form (2/2013) to the department either by secure fax,
electronic, or paper format within 10 business days of a maternal death.
(d) Upon receipt of the initial report form in
(c) above, the department shall send the CEO of the hospital or birthing
center:
(1) A “Maternal
Mortality Case Information Sheet” which includes the identified patient’s name
and date of birth; and
(2) A data collection letter which shall include
information on the review process to be conducted by the abstraction team.
(e) For deaths identified in (b)(2)–(5) the
department shall complete the “Maternal Mortality Initial Report” form (2/2013)
and send it and the following to the CEO of the appropriate hospital,
non-emergency walk-in care center, ambulatory surgical center, or birthing
center where the patient received care:
(1) A “Maternal
Mortality Case Information Sheet” which includes the identified patient’s name
and date of birth; and
(2) A data
collection letter which shall include information on the review process to be
conducted by the abstraction team.
(f) Reporting under this part shall not preclude
the requirement for a hospital or ambulatory surgical center to report an
adverse event under RSA 151:37–40 and He-P 802 and He-P 812, respectively, and
for a birthing center to report an unusual incident under He-P 810.
Source. #10287, eff
3-16-13
He-P
3013.04 Program Access to Health
Information.
(a) In accordance with RSA 132:31, II, the
commissioner through NNEPQIN shall have access to individually identifiable
health information relating to the occurrence of a maternal death on a
case-by-case basis where public health is at risk, as follows:
(1) Upon
receipt of the “Maternal Mortality Initial Report” form (2/2013) from the
department, NNEPQIN shall assign an abstraction team to the hospital,
non-emergency walk-in care center, ambulatory surgical center, or birthing center
to conduct a review of medical records within 60 days of receipt of the initial
report; and
(2) The
hospital, non-emergency walk-in care center, ambulatory surgical center, or
birthing center shall make available all medical records relating to the maternal
death to NNEPQIN by a secure fax, electronic, or paper method within 60 days of
contact by NNEPQIN.
(b) After the completion of the abstraction
process, NNEPQIN shall send the analysis to the department, no later than one
week prior to the semiannual maternal mortality review panel meeting, by
completing and sending the following forms:
(1) “Maternal
Mortality Review Panel Case Abstraction” form (2/2013);
(2) “Maternal
Mortality Review Panel Staffing Questions” form (2/2013); and
(3) “Maternal
Mortality Review Panel Submission Checklist” (2/2013).
Source. #10287, eff
3-16-13
He-P 3013.05 Contact with Families.
(a) The department shall contact families after the death
of the mother to invite them to participate in an interview except when the
department determines such an interview would not assist in the root cause
analysis of a maternal mortality event.
The results and findings of the interview may be included in the case
summary presented to the panel per He-P 3013.06.
(b) Initial family contact shall occur through a
letter from the department to include the following information:
(1) An
invitation for the family to participate in a home interview through a
voluntary process;
(2) The
information obtained shall be used to determine and understand the significant
social, economic, cultural, safety, and health care delivery system factors
that are associated with maternal mortality;
(3) The
information obtained shall be confidential, and the name of the deceased mother
and her family and any other individually identifying information shall not be
released; and
(4) A family
may refuse participation in the home interview
(c) In the event of documented family refusal to
participate, or indication of unwillingness to participate, in an interview,
the department shall not conduct the interview.
Source. #10287, eff
3-16-13
He-P
3013.06 Panel Access to Health
Information.
(a) The department
shall prepare and present to the panel a de-identified case summary of each
maternal death reported or identified based on the following:
(1) NNEPQIN review;
(2) Family interview as applicable; and
(3) The facility’s root cause analysis of the
event if one has been completed.
(c) All members of the panel shall sign a
confidentiality agreement regarding case review conduct and assurances of
confidentiality.
(d) After each case has been reviewed, the
department shall collect all summaries from panel members and shred them
immediately after the meeting.
(e) The panel shall provide the hospital,
non-emergency walk-in care center, ambulatory surgical center, or birthing
center a written copy of the maternal mortality review panel’s general
recommendations and conclusions.
Source. #10287, eff
3-16-13
Appendix
A: Incorporation by Reference Information
|
Rule |
Title |
Obtain
at: |
|
He-P 3008.12 |
NBS 01-A6 “Blood Collection on Filter Paper for
Newborn Screening Programs; Approved Standard” – Sixth Edition (July 2013) |
Available Clinical and Laboratory Standards
Institute (CLSI) 950 West Valley Road, Suite 2500, Wayne, PA 19087 at
a cost of $140. |
|
He-P 3008.16(b) and He-P 3008.17(h) |
American Academy of Pediatrics (AAP) Strategies for Implementing Critical
Congenital Heart Disease (November 2011) |
Available free of charge from the American Academy
of Pediatrics website at www.pediatrics.aapublications.org/content/128/5/e1259. |
APPENDIX B
|
RULE |
STATUTE |
|
|
|
|
He-P 3008.01 |
RSA 132:10-a, III; RSA
132:10-b, V |
|
He-P 3008.02 |
RSA 132:1; RSA 132:10-a |
|
He-P 3008.03 |
RSA 132:1 |
|
He-P 3008.04 |
RSA 132:10-a, I;
RSA132:10-c |
|
He-P 3008.05 |
RSA 132:10-a |
|
He-P 3008.06 |
RSA 132:10-a |
|
He-P 3008.07 |
RSA 132:10-a |
|
He-P 3008.08 |
RSA 132:10-a |
|
He-P 3008.09 |
RSA 132:10-a |
|
He-P 3008.10 |
29 CFR 1910.1030 |
|
He-P 3008.11 |
45 CFR 164.524 |
|
He-P 3008.12 |
RSA 132:10-a, I(c) |
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He-P 3008.13 |
RSA 132:10-a, III |
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He-P 3008.14 |
RSA 132:10-a, II; RSA 541-A |
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He-P 3008.15 |
RSA 132:10-b, V; RSA 132:12 |
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He-P 3008.16 and He-P
3008.17 |
RSA 132:10-aa |
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He-P 3008.18 |
RSA 132:3 |
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He-P 3008.19 |
45 CFR 164.524 |
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He-P 3008.20 |
RSA 132:3 |
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He-P 3011.01 - He-P 3011.04 |
RSA
126-A:5; RSA 265:144, X |
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He-P 3012.01 |
RSA 141-J:1; RSA 141-J:9 |
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He-P 3012.02 |
RSA 141-J:2; RSA 141-J:9 |
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He-P 3012.03 |
RSA 141-J:3; RSA 141:J-5; RSA 141:J-9. |
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He-P 3012.04 |
RSA 141-J:5: RSA 141:J-6; RSA 141:J-9. |
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He-P 3012.05 |
RSA 141-J:7; RSA 141:J-8; RSA 141:J-9 |
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He-P 3012.06 |
RSA 141-J:6; RSA 141:J-9 |
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He-P 3012.07 |
RSA 141-J:3; RSA 141:J-4; RSA 141:J-8; RSA 141:J-9. |
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He-P 3012.08 |
RSA 141-J:4; RSA 141:J-8; RSA 141:J-9 |
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He-P 3012.09 |
RSA 141-J:4; RSA 141:J-8; RSA 141:J-9 |
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He-P 3013.01 |
RSA 132:29-31 |
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He-P 3013.02 |
RSA 132:29-31 |
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He-P 3013.03 |
RSA 132:31 |
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He-P 3013.04 |
RSA 132:30, IV; RSA 132:31 |
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He-P 3013.05 |
RSA 132:30, VII(c) |
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He-P 3013.06 |
RSA 132:30, VII(d); RSA 132:31 |