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STATE STATUTORY AND REGULATORY LANGUAGE REGARDING PRENATAL SYPHILIS SCREENINGS
IN THE UNITED STATES
State Statutory and Regulatory Language Regarding Prenatal Syphilis Screenings
in the United States
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EXECUTIVE SUMMARY
On This Page
* Legal Requirements
* State Navigation
* Print Version [PDF – 675 KB]
The number of reported cases of congenital syphilis (CS) has increased every
year since 2012 in the United States. From 2017 to 2021, the CS rate increased
219% from 24.4 to 77.9 cases per 100,000 live births.1 CS prevention relies on
screening and treatment of pregnant women found to have syphilis. Many states’
laws require syphilis testing of pregnant women. State policies regarding
prenatal syphilis screening may be one way to address rising CS rates through
increased screening.
This webpage includes the text of state laws requiring screening of pregnant
women for syphilis in the United States. The method for performing the legal
analysis underlying the information on this page is based on a 2018 peer
reviewed article published in the Maternal and Child Health Journal.2 This
webpage expands on that article through regularly updated legal assessments. The
most recent legal assessment was in November 2023. To better understand these
policies, you can also review the text of the laws underlying the analysis,
which are included on this page.
Disclaimer
Disclaimer: The information on this web page does not represent the official
legal positions of the U.S. Department of Health and Human Services (HHS), the
Centers for Disease Control and Prevention/HHS, or state and local governments,
and is not meant to provide specific legal advice. Users of this web page should
consult with their official state and local legal counsel for specific legal
advice and guidance.
LEGAL REQUIREMENTS FOR SYPHILIS SCREENING AMONG PREGNANT WOMEN BY TIME OF TEST
AND STATE
X = Screening Required
O = Screening Required only if at increased risk
Legal requirements for syphilis screening among pregnant women by time of test
and state, 2018 State First Visit Third Trimester Delivery Alabama X O X Alaska
X Arizona X X X Arkansas X X California X X O Colorado X Connecticut X X
Delaware X X DC X X Florida X X O Georgia X X X Hawaii Idaho X Illinois X X
Indiana X O Iowa Kansas X Kentucky X Louisiana X X O Maine Maryland X X O
Massachusetts X Michigan X X O Minnesota Mississippi Missouri X O O Montana X
Nebraska X Nevada X X O New Hampshire New Jersey X X New Mexico X New York X
North Carolina X X X North Dakota Ohio X Oklahoma X O O Oregon X Pennsylvania X
O Rhode Island X South Carolina X South Dakota X Tennessee X O Texas X X X Utah
X Vermont X Virginia X Washington X West Virginia X Wisconsin Wyoming X
STATE NAVIGATION
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ALASKA
AS § 18.15.150
§ 18.15.150. TAKING OF BLOOD SAMPLE
Each licensed physician and in the absence of a licensed physician each licensed
graduate nurse who attends a pregnant woman for conditions relating to the
pregnancy during the period of gestation or at delivery shall take, or have
taken, a sample of the blood of the woman at the time of the woman’s first
professional visit or within 10 days after the visit, unless the serological
test is contrary to the tenets or practice of the religious creed of which the
woman is an adherent. The blood specimen shall be submitted to an approved
laboratory or clinic for a standard serological test of syphilis. Any other
person permitted by law to attend pregnant women but not permitted by law to
take blood samples shall have a sample of blood taken by a licensed physician,
or on order of a licensed physician, and shall submit the sample to an approved
laboratory or clinic for a standard serological test for syphilis.
AS § 18.15.180
§ 18.15.180. PENALTY
A licensed physician or licensed nurse attending a pregnant woman during the
period of gestation or at delivery, or a representative of a laboratory or
clinic who violates AS 18.15.150 – 18.15.180 is guilty of a misdemeanor and,
upon conviction, is punishable by a fine of not more than $500. However, a
person attending a pregnant woman during the period of gestation or at delivery,
who requests the specimen in accordance with AS 18.15.150, and whose request is
refused, is not guilty of a misdemeanor.
AS § 18.15.160
§ 18.15.160. TEST FOR SYPHILIS
For the purposes of AS 18.15.150 – 18.15.180 a standard serological test is a
test for syphilis approved by the department and shall be performed in a
laboratory or clinic approved by the department. On request the laboratory test
required by AS 18.15.150 – 18.15.180 shall be performed without charge at the
laboratories of the department.
12 AAC 14.500
12 AAC 14.500. PRACTICE
a. A certified direct-entry midwife shall
1. recommend, before care or delivery of a client, that the client undergo
a physical examination performed by a physician, physician assistant, or
advanced practice registered nurse who is licensed in this state;
2. obtain informed consent from a client before onset of labor;
3. at the first prenatal visit, or not later than 10 days after the first
prenatal visit, order a serological test for syphilis;
4. provide each client with contact information for 24-hour on-call
availability by a certified direct-entry midwife throughout pregnancy,
the intrapartum period, and the postpartum period;
5. provide each client with labor support, fetal monitoring, and routine
assessment of vital signs once active labor is established;
6. supervise the delivery of infant and placenta, assess newborn and
maternal well-being in the immediate postpartum period, and perform
Apgar scores;
7. perform routine cord management and inspect for appropriate number of
vessels;
8. inspect the placenta and membranes for completeness;
9. inspect the perineum and vagina postpartum for lacerations and stabilize
or repair, as appropriate;
10. observe the mother and newborn postpartum until stable condition is
achieved;
11. instruct the mother, father, or other support persons, both verbally and
in writing, of the special care and precautions for both mother and
newborn in the immediate postpartum period;
12. reevaluate maternal and newborn wellbeing not later than 36 hours after
delivery;
13. use universal precautions with all biohazard materials;
14. ensure that a birth certificate is accurately completed and filed in
accordance with state law;
15. ensure the newborn is tested for phenylketonuria (PKU);
16. offer to one or both parents to obtain and submit a blood sample in
accordance with the recommendations for metabolic screening of the
newborn;
17. offer to one or both parents an injection of vitamin K for the newborn
in accordance with the indication, dose, and administration route set
out in 12 AAC 14.570;
18. not later than one week after delivery, refer the parents to a facility
with a newborn hearing screening program;
19. not later than two hours after the birth, offer to one or both parents
the administration of antibiotic ointment into the eyes of the newborn,
in accordance with state law on the prevention of infant blindness;
20. provide postpartum care and postpartum depression screenings and
referrals to client through the first year postpartum; and
21. maintain adequate antenatal and perinatal records of each client and
provide records to any consulting licensed physician and advanced
practice registered nurse in accordance with regulations under P.L.
104-191 (Health Insurance Portability and Accountability Act of 1996
(HIPAA)).
b. During the third trimester, the certified direct-entry midwife shall ensure
that the home-birth client is adequately prepared for a home-birth by
discussing issues such as sanitation, facilities, adequate heat,
availability of telephone and transportation, plans for emergency evacuation
to a hospital, and the skills and equipment that the midwife will bring to
the home-birth.
c. A certified direct-entry midwife shall make a home visit to the client
before delivery to assess the physical environment, to determine whether the
home-birth client has the necessary supplies, to prepare the client for the
birth, and to instruct the family in correction of problems or deficiencies.
Top of Page
ARIZONA
A.R.S. § 36-693
§ 36-693. BLOOD TESTS REQUIRED; PREGNANT WOMEN; UMBILICAL CORD AT DELIVERY;
DEFINITION
A. A physician shall at the time of the first prenatal examination, after a
diagnosis of pregnancy, take or cause to be taken a sample of the blood of
the woman and submit it to an approved laboratory for a standard serological
test for syphilis. If the woman has not had a serological test prior to
delivery, a sample of blood from the umbilical cord shall be taken at
delivery for examination.
B. Any other person permitted by law to attend pregnant women but not permitted
to take blood samples shall cause a sample of the blood of each pregnant
woman attended by him to be taken under the direction of a duly licensed
physician of medicine and surgery as required by subsection A. The physician
shall have the sample submitted to an approved laboratory for a standard
serological test for syphilis.
C. For the purpose of this section “standard serological test” means a test for
syphilis approved by the director and made at a laboratory approved by the
director to make such tests. A laboratory test required by this section
shall be made by the state laboratory without charge.
A.A.C. R9-6-381
1. Case control measures:
1. A syphilis case shall obtain serologic testing for syphilis three months,
six months, and one year after initiating treatment, unless more frequent
or longer testing is recommended by a local health agency.
2. A health care provider for a pregnant syphilis case shall order serologic
testing for syphilis at 28 to 32 weeks gestation and at delivery.
3. A local health agency shall:
1. Conduct an epidemiologic investigation, including a review of medical
records, of each reported syphilis case or suspect case, confirming
the stage of the disease;
2. For each syphilis case, submit to the Department, as specified in
Table 2.4, the information required under R9-6-206(D);
3. If the syphilis case is pregnant, ensure that the syphilis case
obtains the serologic testing for syphilis required in subsection
(A)(1) and (A)(2); and
4. Comply with the requirements specified in R9-6-1103 concerning
treatment and health education for a syphilis case.
4. The operator of a blood bank, blood center, or plasma center shall notify
a donor of a test result with significant evidence suggestive of
syphilis, as required under A.R.S. § 32-1483and 21 CFR 630.6.
2. Contact control measures: When a syphilis case has named a contact, a local
health agency shall comply with the requirements specified in R9-6-1103
concerning notification, testing, treatment, and health education for the
contact.
3. Outbreak control measures: A local health agency shall:
1. Conduct an epidemiologic investigation of each reported syphilis
outbreak; and
2. For each syphilis outbreak, submit to the Department the information
required under R9-6-206(E).
Top of Page
ARKANSAS
A.C.A. § 20-16-507
§ 20-16-507. PREGNANT WOMEN–EXAMINATION REQUIREMENTS
a. a. 1. A. Every physician and health care provider attending pregnant women
in this state for conditions relating to their pregnancy shall, in
the case of every woman so attended, take or cause to be taken a
sample of venous blood or other approved specimen of the woman as
early as reasonably possible in the pregnancy or, if not attended
prenatally, at the time of delivery, and shall submit the sample to
an approved laboratory for:
i. A standard serological test for syphilis;
ii. A standard test for human immunodeficiency virus; and
iii. A standard test for hepatitis B.
B. If for any reason the pregnant woman is not tested for syphilis,
human immunodeficiency virus, or hepatitis B, that fact shall be
recorded in the patient’s records, which, if based upon the refusal
of the patient, shall relieve the physician of any responsibility
under this subsection.
2. Every other person authorized by law to attend or to provide medical
treatment to pregnant women in this state but not permitted by law to
take blood samples shall cause a sample of blood or other approved
specimen of the pregnant woman to be taken as early as reasonably
possible in the pregnancy or, if not attended prenatally, at the time
of delivery, by or under the direction of a physician licensed to
practice medicine and surgery and have the sample submitted to an
approved laboratory for:
A. A standard serological test for syphilis;
B. A standard test for human immunodeficiency virus; and
C. A standard test for hepatitis B.
3. Every physician described in subdivision (a)(1) of this section and
every person described in subdivision (a)(2) of this section shall:
A. Inform each pregnant woman whom he or she is attending of the fact
that syphilis, human immunodeficiency virus, and hepatitis B may be
transmitted from an infected mother to the fetus or unborn child
and that these infections may be prevented if the maternal
infection is recognized and treated; and
B. Provide counseling and instruction for human immunodeficiency virus
in a manner prescribed by the Department of Health based upon
contemporary state and federal standards.
b. For the purpose of this section, a standard serological test shall be a
test for syphilis, human immunodeficiency virus, and hepatitis B,
approved or authorized by the Centers for Disease Control and Prevention,
and approved by the Director of the Department of Health and shall be
made at the division’s laboratory or at another laboratory approved to
make such tests.
c. All records, reports, data, or other information collected or maintained
under this section that identifies or could be used to identify any
individual patient, provider, or institution shall be confidential, shall
not be subject to discovery pursuant to the Arkansas Rules of Civil
Procedure or the Freedom of Information Act of 1967, § 25-19-101 et seq.
Howerer,1 this subsection shall not affect the reports required to be
submitted to the department under other laws and rules and regulations.
ARK. ADMIN. CODE 007.35.7-XXI
FORMERLY CITED AS AR ADC 007.15.2-XXI
007.35.7-XXI. SEXUALLY TRANSMITTED DISEASE (SYPHILIS, GONORRHEA, CHLAMYDIA, HIV
(HUMAN IMMUNODEFICIENCY VIRUS), CHANCROID, LYMPHOGRANULOMA VENEREUM, GRANULOMA
INGUINALE) AND OPHTHALMIA NEONATURUM (GONORRHEAL OPHTHALMIA)
a. 1. Testing of pregnant women.
1. Every physician attending a pregnant woman shall take, or cause to be
taken, a sample of venous blood at the time of first examination and
during the third trimester, ideally at 28 to 32 weeks gestation, and
submit such sample to an approved laboratory for a standard serologic
test for Syphilis; a standard test for Human Immunodeficiency virus;
and a standard test for Hepatitis B. Any person other than a physician
permitted by law to attend pregnant women but not permitted by law to
take blood samples, shall cause a specimen of blood to be taken by, or
under the direction of a physician duly licensed to practice medicine
and surgery, and have such specimen submitted to an approved
laboratory for testing.
2. Any person reporting a birth or stillbirth shall state on the
certificate whether a blood test for Syphilis had been made upon a
specimen of blood taken from the woman who bore the child for which a
birth or stillbirth certificate is filed and the approximate date when
the specimen was taken.
2. Ophthalmia Neonatorum (Gonorrhea Ophthalmia)
1. Ophthalmia Neonatorum is to be reported to the Epidemiology Program,
Arkansas Department of Health, as soon as the disease is suspected.
2. It shall be the duty of the local health authority in whose
jurisdiction the case occurs to investigate the case to confirm the
diagnosis by bacteriological examination and, if of Gonococcal origin,
to determine if the attendant at delivery used prophylactic medication
in the eyes of the infant.
3. Due to the nature of the infection and its communicability, and
inasmuch as Gonorrheal Ophthalmia is amenable to penicillin therapy;
it shall be the duty of every physician to administer adequate
penicillin therapy at once. It shall be the duty of every midwife
attending such cases, or suspected cases, to refer all such cases to a
licensed physician for treatment.
3. It shall be the duty of every physician to report, as soon as diagnosed,
every case of sexually transmitted disease on the Confidential Case
Report, as provided by the Department, or by utilizing the Toll Free
Communicable Disease Reporting System, to the Sexually Transmitted
Disease Program, Arkansas Department of Health. Physicians shall report
the patient by name, address, age, sex, race and date of birth within
twenty-four (24) hours of the diagnosis in case of primary, secondary and
congenital Syphilis and Syphilis in pregnant women.
4. Whenever the Director has reasonable grounds to believe that any person
is suffering from Syphilis, Gonorrhea, Chancroid, Lymphogranuloma
Venereum or Granuloma Inguinale in a communicable state, he is authorized
to cause such person to be apprehended and detained for the necessary
tests and examination, including an approved blood serologic test and
other approved laboratory tests, to ascertain the existence of said
disease or diseases: provided, that any evidence so acquired shall not be
used against such person in any criminal prosecution.
5. The Director may, when in the exercise of his discretion he believes that
the public health requires it, commit any commercial prostitute, or other
persons apprehended and examined and found afflicted with said diseases,
or either of them who refuses or fails to take treatment adequate for the
protection of the public health, to a hospital or other place in the
State of Arkansas for such treatment even over the objection of the
person so diseased and treated provided the commitment can be done
without endangering the life of the patient.
6. It shall be the duty of a physician on the occasion of the first visit to
or by a person suffering from Syphilis, Gonorrhea, Chancroid,
Lymphogranuloma Venereum or Granuloma Inguinale to instruct said person
in the precautions to be taken to prevent communication of the disease to
others, and to inform him of the necessity of continued uninterrupted
treatment until such adequate treatment has been administered.
7. It shall be the duty of every physician to administer appropriate and
adequate treatment to any individual regardless of age, sex, or race whom
he has reasonable grounds to believe is suffering from Syphilis,
Gonorrhea, Chancroid, Lymphogranuloma Venereum or Granuloma Inguinale in
a communicable state, to render the disease non-communicable to others
for the protection of the public health. Likewise, it shall be the duty
of every physician to treat, prophylactically or therapeutically, any
individual regardless of age, sex or race whom he has reasonable grounds
to believe has been exposed to a communicable case of Syphilis,
Gonorrhea, Chancroid, Lymphogranuloma Venereum or Granuloma Inguinale for
the protection of the public health. Consent to the provision of medical
and surgical care or services by a physician licensed to practice
medicine in this State, when executed by a minor who is or believes
himself to be afflicted with a sexually transmitted disease, shall be
valid and binding as if the minor had achieved his majority.
Top of Page
CALIFORNIA
WEST’S ANN.CAL.HEALTH & SAFETY CODE § 120685
§ 120685. REQUIRED PROVISION OF SYPHILIS SCREENING AND TESTING
1. Every licensed health care professional engaged in providing prenatal care
or attending a birthing patient at the time of delivery, shall provide
syphilis screening and testing as outlined in the most recent guidelines
published by the State Department of Public Health.
2. This section does not limit a local health jurisdiction’s ability to provide
additional recommendations or guidelines for syphilis screening and testing,
nor does it limit the ability of a health care professional to follow other
existing clinical guidelines for syphilis screening and testing
recommendations, including guidelines issued by local health authorities, as
long as, at minimum, the health care professional complies with subdivision
(a).
WEST’S ANN.CAL.HEALTH & SAFETY CODE § 120690
§ 120690. SUBMISSION OF SPECIMEN FOR TEST
The blood specimen thus obtained shall be submitted to an approved laboratory
for a standard laboratory test for syphilis.
WEST’S ANN.CAL.HEALTH & SAFETY CODE § 120715
§ 120715. VIOLATION; OFFENSE
Any licensed physician and surgeon, or other person engaged in attendance upon a
pregnant woman or a recently delivered woman, or any representative of a
laboratory who violates any provision of this chapter, is guilty of a
misdemeanor. However, a licensed physician and surgeon, or other person engaged
in attendance upon a pregnant or recently delivered woman, whose request for a
specimen is refused, is not guilty of a misdemeanor for failure to obtain it.
WEST’S ANN.CAL.HEALTH & SAFETY CODE § 125110
§ 125110. OBJECTIONS TO TEST ON RELIGIOUS GROUNDS; INAPPLICABILITY OF MATERNAL
AND CHILD HEALTH PROGRAM ACT
The Maternal and Child Health Program Act (Section 27) shall not apply if the
pregnant woman objects to the test required by that act on the ground that the
test conflicts with her religious beliefs or practices.
Top of Page
COLORADO
C.R.S.A. § 25-4-201
§ 25-4-201. PREGNANT WOMAN TO TAKE BLOOD TEST
1. Every licensed health care provider authorized to provide care to a pregnant
woman in this state for conditions relating to her pregnancy during the
period of gestation or at delivery shall take or cause to be taken a sample
of blood of the woman at the time of the first professional visit or during
the first trimester for testing pursuant to this section. The blood specimen
obtained shall be submitted to an approved laboratory for a standard
serological test for syphilis and HIV. Every other person permitted by law
to attend pregnant women in this state but not permitted by law to take
blood samples shall cause a sample of blood of each pregnant woman to be
taken by a licensed health care provider authorized to take blood samples
and shall have the sample submitted to an approved laboratory for a standard
serological test for syphilis and HIV. A pregnant woman may decline to be
tested as specified in this subsection (1), in which case the licensed
health care provider shall document that fact in her medical record.
2. If a pregnant woman entering a hospital for delivery has not been tested for
HIV during her pregnancy, the hospital shall notify the woman that she will
be tested for HIV unless she objects and declines the test. If the woman
declines to be tested, the hospital shall document that fact in the pregnant
woman’s medical record.
C.R.S.A. § 25-4-204
§ 25-4-204. PENALTY
Any licensed physician and surgeon or other person engaged in attendance upon a
pregnant woman during the period of gestation or at delivery or any
representative of a laboratory who violates the provisions of this part 2 is
guilty of a misdemeanor and, upon conviction thereof, shall be punished by a
fine of not more than three hundred dollars. Every licensed physician and
surgeon or other person engaged in attendance upon a pregnant woman during the
period of gestation or at delivery who requests such specimen in accordance with
the provisions of section 25-4-201 and whose request is refused is not guilty of
a misdemeanor.
Top of Page
CONNECTICUT
C.G.S.A. § 19A-90
§ 19A-90. BLOOD TESTING OF PREGNANT WOMEN FOR SYPHILIS AND HIV
a. A health care provider giving prenatal care to a pregnant woman in this
state during gestation shall order a blood sample of such woman for each of
the following serological tests: (1) Not later than thirty days after the
date of the first prenatal examination, a serological test for HIV and
syphilis; (2) not later than twenty-eight to thirty-two weeks of gestation,
a serological test for syphilis; (3) not later than thirty-two to thirty-six
weeks of gestation, a serological test for HIV; and (4) at the time of
delivery, a serological test for HIV and syphilis, provided the woman
presents to labor and delivery without documentation of the required
serological testing prescribed under subdivisions (2) and (3) of this
subsection. No pregnant woman shall be subject to serological testing more
than once during each of the time frames outlined in subdivisions (1) to
(4), inclusive. A pregnant woman’s consent to the HIV-related test, as
defined in section 19a-581, shall be consistent with the consent given for
the HIV-related test prescribed under section 19a-582. The laboratory tests
required by this section shall be made on request without charge by the
Department of Public Health. For purposes of this subsection, “health care
provider” means a physician licensed pursuant to chapter 370,1 advanced
practice registered nurse licensed pursuant to chapter 378,2 physician
assistant licensed pursuant to chapter 370 or nurse midwife licensed
pursuant to chapter 377.3
b. The provisions of this section shall not apply to any woman who objects to a
blood test as being in conflict with her religious tenets and practices.
Top of Page
DELAWARE
24 DEL. ADMIN. CODE 1795-6.0
1795-6.0. PRENATAL CARE
6.1 During prenatal care, the midwife or other licensed health care provider
shall follow a regular schedule of prenatal care with increasing frequency
towards term. The responsibilities of the midwife during this time include:
6.1.1 Initial Prenatal Visit:
6.1.1.1 History and assessment of general health;
6.1.1.2 History and assessment of obstetric and psychosocial status;
6.1.1.3 Discussion of current CDC recommendations for immunization during
pregnancy;
6.1.1.4 Physical Exam, including:
6.1.1.4.1 Height;
6.1.1.4.2 Weight;
6.1.1.4.3 Blood pressure;
6.1.1.4.4 Pulse;
6.1.1.4.5 Breast exam;
6.1.1.4.6 Abdomen, to include fundal height, fetal heart tones, fetal lie, and
presentation;
6.1.1.4.7 Estimation of gestational age;
6.1.1.4.8 Assessment of varicosities, edema, and reflexes.
6.1.1.5 The midwife must complete the following laboratory tests at the initial
prenatal visit:
6.1.1.5.1 Hemoglobin or hematocrit or CBC;
6.1.1.5.2 Urinalysis for protein and glucose;
6.1.1.5.3 Syphilis serology;
6.1.1.5.4 Blood group, Rh type, and antibody screen;
6.1.1.5.5 Hepatitis B surface antigen;
6.1.1.5.6 Rubella screen;
6.1.1.5.7 Gonorrhea test;
6.1.1.5.8 Chlamydia test;
6.1.1.5.9 HIV test;
6.1.1.5.10 Urine culture.
6.1.1.6 The midwife must provide appropriate prophylactic antibiotic therapy for
GBS positive clients pursuant to CDC guidelines.
6.1.1.7 The midwife should consider genetic testing, urine drug screen, and
Hepatitis C testing as indicated.
6.1.2 On-going Prenatal Care:
6.1.2.1 Assessment of general health;
6.1.2.2 Assessment of psychosocial health;
6.1.2.3 Nutritional counseling;
6.1.2.4 Physical Exam to include, but not limited to:
6.1.2.4.1 Blood pressure;
6.1.2.4.2 Weight;
6.1.2.4.3 Abdomen, to include fundal height, fetal heart tones, fetal lie, and
presentation;
6.1.2.4.4 Estimation of gestational age by physical findings;
6.1.2.4.5 Assessment of varicosities, edema and reflexes.
6.1.2.5 The midwife must offer the following laboratory tests:
6.1.2.5.1 Hemoglobin, hematocrit, or CBC between 28 and 32 weeks;
6.1.2.5.2 Gross urinalysis for protein and glucose at each visit;
6.1.2.5.3 Glucose Tolerance Test;
6.1.2.5.4 Group Beta Strep (GBS) cultures, according to CDC guidelines. If
penicillin allergic, determine antibiotics to which the strain of GBS carried by
the client is sensitive and treat appropriately during labor;
6.1.2.5.5 Herpes (HSV 1 or HSV 2) cultures, if indicated;
6.1.2.5.6 Prophylactic Rh-immune globulin information for Rh negative clients;
6.1.2.5.7 Urine Drug Screen.
16 DEL.C. § 708
§ 708. PRENATAL STANDARD TESTS FOR SYPHILIS, GONORRHEA, CHLAMYDIA AND OTHER STDS
a. Every health-care professional qualified to attend a pregnant woman in this
State during gestation shall take or cause to be taken suitable specimens of
such woman and submit such specimens to an approved laboratory for standard
tests for syphilis and gonorrhea, chlamydia and other such tests for STDs as
may be designated by the Department of Health and Social Services. Every
other person permitted by law to attend upon pregnant women in the State but
not permitted by law to take such specimens shall cause such specimens of
such pregnant woman to be taken by a qualified health care professional and
submitted to an approved laboratory for standard tests for gonorrhea,
syphilis and chlamydia and other such tests for STDs as may be designated by
the Department of Health and Social Services. The specimens shall be taken
at the time of the first examination relating to the current pregnancy and a
second specimen during the third trimester of pregnancy which is in addition
to or exclusive of the test taken at delivery.Every pregnant woman shall
permit the specimens to be taken by a qualified health care professional as
herein provided. However, the Director or the Director’s authorized deputy
within the county wherein any person affected by this section resides may
waive the requirements of this section if the Director or deputy is
satisfied by written affidavit or other notarized written proof that the
tests required by this section are contrary to the tenets and practices of
the religious teachings of which the applicant is an adherent, and that the
public health and welfare would not be injuriously affected by such waiver.
b. The term “approved laboratory” means a laboratory approved for this purpose
by the Department of Health and Social Services. Standard tests for
syphilis, chlamydia and gonorrhea are ones recognized as such by the
Department of Health and Social Services.
c. The laboratory tests required by this section shall be made on request
without charge by the Department of Health and Social Services.
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DISTRICT OF COLUMBIA
22-B DCMR § 205
D.C. MUN. REGS. SUBT. 22-B, § 205
205. TESTS FOR SYPHILIS AND GONORRHEA REQUIRED DURING PREGNANCY
205.1 Unless the person in charge of a case of pregnancy includes in the
patient’s case history a written statement giving the medical reasons why a
serological test for syphilis and a laboratory test for gonorrhea performed at
the times specified in this section would be harmful to the patient, that person
shall include both of these tests in the management of the case at the first
visit of that patient’s pregnancy is established as a certainty.
205.2 When it is determined that tests for syphilis and gonorrhea have been
performed within thirty (30) days before the visit at which pregnancy is
established, the serological test need not be performed at that time.
205.3 Any person in charge of a case of pregnancy during the last trimester
shall include in the management of the case a serological test for syphilis and
a laboratory test for gonorrhea, notwithstanding the fact that either or both
tests have already been performed during the pregnancy.
205.4 Any person required by the provisions of this section to make a written
report of a case of venereal disease shall submit the report to the Director in
a sealed envelope, marked “Confidential.”
205.5 The name of the person reported as having a case of venereal disease may
be referred to by number.
205.6 Whenever the person reporting a case of venereal disease elects to report
by number instead of by name, a record shall be kept of the case in the files of
the person reporting under the same number for a period of not less than three
(3) years from the date of diagnosis.
205.7 The record required in § 205.6 shall be made available to the Director
upon request.
205.8 The reports and records incident to a case of venereal disease shall be
used for statistical and public health purposes only, and the Director shall not
disclose the identity of the person so reported except under order of a court or
with the written permission of the person.
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FLORIDA
RULE 64B24-7.007, F.A.C.
FLA. ADMIN. CODE R. 64B24-7.007
64B24-7.007. RESPONSIBILITIES OF MIDWIVES DURING THE ANTEPARTUM PERIOD.
1. The licensed midwife shall:
a. Require each patient to have a complete history and physical examination
which includes:
1. Pap smear.
2. Serological screen for syphilis.
3. Gonorrhea and Chlamydia screening.
4. Blood group including Rh factor and antibody screen.
5. Complete blood count (CBC).
6. Rubella titer.
7. Urinalysis with culture.
8. Sickle cell screening for at risk population.
9. Screen for hepatitis B surface antigen (HBsAG).
10. Screen for HIV/AIDS.
b. Conduct the Healthy Start Prenatal Screen interview or assure that each
patient has been previously screened.
c. Provide counseling and offer screening related to the following:
1. Neural tube defects.
2. Group B Streptococcus.
3. CVS or genetic amniocentesis for women 35 years of age or older at the
time of delivery.
4. Nutritional counseling.
5. Childbirth preparation.
6. Risk Factors.
7. Common discomforts of pregnancy.
8. Danger signs of pregnancy.
d. Follow-up screening:
1. Hematocrit or hemoglobin levels at 28 and 36 weeks gestation.
2. Diabetic screening between 24 and 28 weeks gestation.
3. Antibody screen for Rh negative mothers, at 28 weeks gestation.
Counsel and encourage RhoGAM prophylaxis. In those clients declining
RhoGAM prophylaxis repeat antibody screen at 36 weeks.
e. Require prenatal visits every four weeks until 28 weeks gestation, every
two weeks from 28 to 36 weeks gestation and weekly from 36 weeks until
delivery.
2. The following procedures and examinations shall be completed and recorded at
each prenatal visit:
a. Weight.
b. Blood pressure.
c. Urine dip stick for protein and glucose each visit with leukocytes,
ketones, and nitrites as indicated.
d. Fundal height measurements.
e. Fetal heart tones and rate.
f. Assessment of edema and patellar reflexes, when indicated.
g. Indication of weeks’ gestation and size correlation.
h. Determination of fetal presentation after 28 weeks of gestation.
i. Nutritional assessment.
j. Assessment of subjective symptoms of PIH, UTI and preterm labor.
3. An assessment of the Expected Date of Delivery (EDD) and gestational age
shall be done by 20 weeks, if practical, according to:
a. Last normal menstrual period.
b. Reference to the statement of uterine size recorded during the initial
exam.
c. Hearing fetal heart tones at eleven weeks with a Doppler unit, if one is
available, and patient gives consent.
d. Recording of quickening date.
e. Recording weeks of gestation by dates and measuring in centimeters the
height of the uterine fundus.
f. Hearing the fetal heart tones at twenty weeks with a fetoscope.
4. If a reliable EDD cannot be established by the above criteria, then the
licensed midwife shall encourage the patient to have an ultrasound for EDD.
5. The midwife shall refer a patient for consultation to a physician with
hospital obstetrical privileges if any of the following conditions occur
during the pregnancy:
a. Hematocrit of less than 33% at 37th week gestation or hemoglobin less
than 11 gms/100 ml.
b. Unexplained vaginal bleeding.
c. Abnormal weight change defined as less than 12 or more than 50 pounds at
term.
d. Non-vertex presentation persisting past 37th week of gestation.
e. Gestational age between 41 and 42 weeks.
f. Genital herpes confirmed clinically or by culture at term.
g. Documented asthma attack.
h. Hyperemesis not responsive to supportive care.
i. Any other severe obstetrical, medical or surgical problem.
6. The midwife shall transfer a patient if any of the following conditions
occur during the pregnancy:
a. Genetic or congenital abnormalities or fetal chromosomal disorder.
b. Multiple gestation.
c. Pre-eclampsia.
d. Intrauterine growth retardation.
e. Thrombophlebitis.
f. Pyelonephritis
g. Gestational diabetes confirmed by abnormal glucose tolerance test.
h. Laboratory evidence of Rh sensitization.
7. If the conditions listed pursuant to this section are resolved
satisfactorily and the physician and midwife deem that the patient is
expected to have a normal pregnancy, labor and delivery, then the care of
the patient shall continue with the licensed midwife.
RULE 59A-11.012, F.A.C.
FLA. ADMIN. CODE R. 59A-11.012
59A-11.012. PRENATAL CARE.
1. Initial Visit shall include:
a. A comprehensive health history shall be completed which includes
medical, emotional, dietary, and obstetrical data including a pre-term
delivery risk assessment.
b. A physical examination shall be completed by a physician, or certified
nurse midwife or advanced practice registered nurse, or licensed midwife,
which includes measurement of height and weight, vital signs including
blood pressure and examination of the skin, head and neck, heart and
lungs, breasts, abdomen, pelvis and neurologic reactions.
c. The following tests are required:
Hemoglobin or hematocrit, urinalysis by dipstick for protein, sugar, and
ketones; serological test for syphilis; cervical cytology, and Rh
determination and blood type. Results of a cervical cytology done within
one year is acceptable. The hemoglobin test and urinalysis may be
performed by a clinical staff member or qualified personnel.
2. Return visits shall include:
a. Measurements of the weight, blood pressure, fundal height, and fetal
heart rate when applicable;
b. Urinalysis by dipstick for protein and sugar;
c. Hemoglobin or hematocrit should be repeated at least twice and more often
if indicated during the course of the pregnancy;
d. Review of signs and symptoms of complications of pregnancy and risk
status; and,
e. Examination to determine the estimated weeks of gestation, fetal position
and presentation.
3. Return prenatal visits shall be scheduled at least every four weeks until
the 32nd week, every two weeks until the 36th week and then every week until
delivery unless the client’s condition requires more frequent visits.
4. A prenatal delivery risk assessment shall be performed during the initial
visit and repeated at 28 weeks gestation.
5. All patients shall receive specific instruction regarding pre-term labor
including the potential hazards, preventive measures, symptoms, detection
and timing of contractions, and the need for prompt notification of the
health provider.
6. All clients found to be at high obstetrical risk pursuant to criteria
described in rule 59A-11.009, F.A.C., shall be referred to a qualified
physician for continued care.
WEST’S F.S.A. § 383.312
383.312. PRENATAL CARE OF BIRTH CENTER CLIENTS
1. A birth center shall ensure that its clients have adequate prenatal care, as
defined by the agency, and shall ensure that serological tests are
administered as required by this chapter.
2. Records of prenatal care shall be maintained for each client and shall be
available during labor and delivery.
RULE 64D-3.042, F.A.C.
FLA. ADMIN. CODE R. 64D-3.042
64D-3.042. STD TESTING RELATED TO PREGNANCY.
1. Practitioners attending a woman for prenatal care shall cause the woman to
be tested for chlamydia, gonorrhea, hepatitis B, HIV and syphilis as
follows:
a. At initial examination related to her current pregnancy; and again
b. At 28 to 32 weeks gestation.
2. Exceptions to the testing outlined in subsection (1) above are as follows:
a. A woman, who tested positive for hepatitis B surface antigen (HbsAg)
during the initial examination related to her current pregnancy, need not
be re-tested at 28-32 weeks gestation.
b. A woman, with documentation of HIV infection or AIDS need not be
re-tested during the current pregnancy.
3. Women who appear at delivery or within 30 days postpartum with:
a. No record of prenatal care; or
b. Prenatal care with no record of testing;
c. Prenatal care with no record of testing after the 27th week of gestation
shall be considered at a high risk for sexually transmissible diseases
and shall be tested for hepatitis B surface antigen (HBsAg), HIV and
syphilis prior to discharge.
4. Emergency Departments of hospitals licensed under Chapter 395, F.S., may
satisfy the testing requirements under this rule by referring any woman
identified as not receiving prenatal care after the 12th week of gestation,
to the county health department.
a. The referral shall be in writing; and
b. A copy shall be submitted to the county health department having
jurisdiction over the area in which the emergency department is located.
5. Prior to any testing required by this rule, practitioners shall:
a. Notify the woman which tests will be conducted;
b. Inform the woman of her right to refuse any or all tests;
c. Place a written statement of objection signed by the woman each time she
refuses required testing in her medical record specifying which tests
were refused. If the woman refuses to sign the statement, the provider
shall document the refusal in the medical record. No testing shall occur
for the infections specified in the refusal statement of objection.
6. Women who had a serologic test for syphilis during pregnancy that was
reactive, regardless of subsequent tests that were non-reactive shall be
tested as soon as possible at or following delivery.
7. a. Specimens shall be submitted to a laboratory licensed under Part I,
Chapter 483, F.S., to perform tests for chlamydia, gonorrhea, hepatitis B
surface antigen (HBsAg), HIV and syphilis.
b. The practitioner submitting the specimens for testing to a licensed
laboratory shall state that these specimens are from a pregnant or
postpartum woman.
8. Practitioners required by law to prepare birth and stillbirth certificates
shall document on the certificate if chlamydia, gonorrhea, hepatitis B, HIV,
syphilis infections or genital herpes or genital human papilloma virus were
present and/or treated during this pregnancy.
9. Nothing in this rule shall prohibit a practitioner from testing these women
for other sexually transmissible diseases in accordance to prevailing
national standards, community disease distribution or the professional
judgment of the practitioner.
WEST’S F.S.A. § 384.31
384.31. TESTING OF PREGNANT WOMEN; DUTY OF THE ATTENDANT
Every person, including every physician licensed under chapter 458 or chapter
459 or midwife licensed under part I of chapter 464 or chapter 467, attending a
pregnant woman for conditions relating to pregnancy during the period of
gestation and delivery shall cause the woman to be tested for sexually
transmissible diseases, including HIV, as specified by department rule. Testing
shall be performed by a laboratory appropriately certified by the Centers for
Medicare and Medicaid Services under the federal Clinical Laboratory Improvement
Amendments and the federal rules adopted thereunder for such purposes. The woman
shall be informed of the tests that will be conducted and of her right to refuse
testing. If a woman objects to testing, a written statement of objection, signed
by the woman, shall be placed in the woman’s medical record and no testing shall
occur.
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GEORGIA
GA. CODE ANN., § 31-17-4
§ 31-17-4. SEROLOGIC TESTS FOR PREGNANT WOMEN
The department may require every pregnant woman to submit to a standard
serologic test, as defined by the department, and may require any person
attending or giving prenatal care to such woman to take or cause to be taken a
blood specimen for use in such test. Such specimens shall be submitted for
laboratory testing in the manner prescribed by the department; and all
laboratories conducting such tests shall comply with the rules, regulations, and
reporting requirements prescribed therefor[sic] by the department.
GA. CODE ANN., § 31-17-4.2
§ 31-17-4.2. GEORGIA HIV/SYPHILIS PREGNANCY SCREENING
1. This Code section shall be known and may be cited as the “Georgia
HIV/Syphilis Pregnancy Screening Act of 2015.”
2. Except in cases where the pregnant woman refuses the testing, a pregnant
woman shall be tested for HIV and syphilis:
1. At the pregnant woman’s first prenatal visit;
2. When she is at 28-32 weeks’ gestation; and
3. At delivery.
Each such test shall be conducted by the physician or other healthcare
provider who is providing prenatal care for such pregnant woman at each
such point in the woman’s pregnancy.
3. If the woman tests positive for HIV or syphilis, counseling services
provided by the Department of Public Health shall be made available to her
and she shall be referred to appropriate medical care providers for herself
and her child.
4. If for any reason the pregnant woman is not tested for HIV and syphilis,
that fact shall be recorded in the patient’s records, which, if based upon
the refusal of the patient, shall relieve the physician or other healthcare
provider of any other responsibility under this Code section.
5. The Department of Public Health shall be authorized to promulgate rules and
regulations for the purpose of administering the requirements under this
Code section.
GA COMP. R. & REGS. 511-5-4-.03
511-5-4-.03. PROVISIONS
1. Unless the patient declines screening, every pregnant woman shall have a
blood specimen taken as prescribed herein for a standard serologic test for
syphilis, a standard serologic test for HIV, a standard serologic test for
hepatitis B and a standard serologic test for hepatitis C.
2. Every health care provider in this state providing prenatal care to a
pregnant woman, or delivering or attending a woman just delivered, shall
take or cause to be taken a venous blood specimen for submission to a
clinical laboratory for a standard serologic test for syphilis, a standard
serologic test for HIV, a standard serologic test for hepatitis B and a
standard serologic test for hepatitis C, as follows:
1. At the initial visit to the health care provider for prenatal care, a
standard serologic test for:
1. Syphilis;
2. HIV;
3. Hepatitis B; and
4. Hepatitis C.
2. In the third trimester in the following circumstances:
1. A standard serologic test for syphilis, as required in O.C.G.A.
Section 31-17-4.2. The specimen shall be taken early during the third
trimester, ideally at 28-32 weeks of gestation;
2. A standard serologic test for HIV, as required in O.C.G.A. Section
31-17-4.2; and
3. A standard serologic test for hepatitis C if the woman has known or
potential exposures to hepatitis C.
3. As soon as possible upon admission to the hospital or birth facility for
delivery:
1. A standard serologic test for syphilis, for women not tested
prenatally, who deliver a stillborn infant, are at high risk for
syphilis, or as long as Georgia is classified by the Centers for
Disease Control and Prevention as a state with high syphilis
morbidity. In accordance with O.C.G.A. Section 31-17-4.2, if a
syphilis test was conducted in the third trimester, and the woman does
not disclose activities posing a risk for syphilis infection more
recently, this test is not required;
2. A standard serologic test for HIV, for women not tested prenatally and
for women at increased risk for HIV infection who were not tested in
the third trimester. In accordance with O.C.G.A. Section 31-17-4.2, if
an HIV test was conducted in the third trimester, and the woman does
not disclose activities posing a risk for HIV infection more recently,
this test is not required;
3. A standard serologic test for Hepatitis B, for women not tested
prenatally, with signs or symptoms of hepatitis, or at high risk for
hepatitis B; and
4. A standard serologic test for Hepatitis C, for women not tested
prenatally.
3. Patients shall be notified of all tests to be conducted and shall have the
opportunity to refuse the test.
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HAWAII
HRS § 325-51
§ 325-51. BLOOD SAMPLES OF PREGNANT WOMEN REQUIRED
Every physician attending a pregnant woman in the State for conditions relating
to the woman’s pregnancy during the period of gestation or at delivery, shall,
in the case of every woman so attended, take or cause to be taken one or more
samples of the blood of the woman, except when the attending physician shall
have evidence that a pregnant woman has met this requirement through a previous
test for syphilis, and shall submit such samples to an approved laboratory for a
standard serologic test for syphilis. Every other person permitted by law to
attend pregnant women in the State, but not permitted by law to take blood
samples, shall cause one or more samples of the blood of every pregnant woman
attended by the person to be taken by a duly licensed physician or state
certified laboratory, or any other person permitted by law to withdraw blood and
shall have the samples submitted to an approved laboratory for a standard
serologic test for syphilis. The samples of blood shall be taken at such times
during the period of gestation as are designated by rules adopted by the
department of health. Every pregnant woman shall permit the sample of the
woman’s blood to be taken as hereinabove provided.
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IDAHO
I.C. § 39-1001
§ 39-1001. SEROLOGICAL TEST OF PREGNANT OR RECENTLY-DELIVERED WOMEN
Every licensed physician attending a pregnant woman for a condition relating to
her pregnancy, or at delivery, or after delivery for a condition relating to her
pregnancy, shall in the case of every woman so attended, take or cause to be
taken a sample of blood of such woman at the time of first examination or within
fifteen (15) days thereafter, and shall submit such sample to the laboratory of
the department of health and welfare or to a laboratory approved by the director
of the department, for a standard serological test for syphilis. In submitting
such sample to the laboratory, the physician shall specify whether it is for a
prenatal test or a test following recent delivery. The laboratory of the
department of health and welfare shall analyze such sample upon the request of
any licensed physician and may collect a fee for the performance of such
analyses.
I.C. § 39-1002
§ 39-1002. PROCEDURE WHEN WOMAN NOT ATTENDED BY LICENSED PHYSICIAN
Every other person attending a pregnant or recently delivered woman in the
state, but not permitted by law to take blood samples, shall within fifteen (15)
days of the first examination cause a sample of blood of such woman to be taken
by a licensed physician and have the sample submitted to the laboratory of the
state department of health and welfare for a standard serological test for
syphilis, or to a laboratory approved by said board.
I.C. § 39-1006
§ 39-1006. PENALTY FOR VIOLATIONS
Any person who violates the provisions of sections 39-1001–39-1006 shall be
guilty of a misdemeanor; provided, however, that every licensed physician or
other person attending a pregnant or recently delivered woman, who requests such
sample in accordance with the provisions of sections 39-1001–39-1006, and whose
request is refused, shall not be guilty of a misdemeanor.
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ILLINOIS
77 ILL. ADM. CODE 250.1830
250.1830 GENERAL REQUIREMENTS FOR ALL OBSTETRIC DEPARTMENTS
a. The temperature and humidity in the nurseries and in the delivery suite
shall be maintained at a level best suited for the protection of mothers and
infants as recommended by the Guidelines for Perinatal Care. Chilling of the
neonate shall be avoided; a non-stable neonate shall, immediately after
birth, be placed in a radiant heat source that is ready to receive the
infant and that allows access for resuscitation efforts. The radiant heat
source shall comply with the recommendations of the Guidelines for Perinatal
Care. When the neonate has been stabilized, if the mother wishes to hold her
newborn, a radiant heater or pre-warmed blankets shall be available to keep
the neonate warm. Stable infants shall be placed, and remain, in direct
skin-to-skin contact with their mother immediately after delivery to
optimally support infant breastfeeding and to promote mother/infant bonding.
Personnel shall be available who are trained to use the equipment to
maintain a neutral thermal environment for the neonate. For general
temperature and humidity requirements, see Section 250.2480(d)(1). In
general, a temperature between 72 degrees and 76 degrees and relative
humidity between 35% and 60% are acceptable.
b. Linens and Laundry: Linens shall be cleaned and disinfected in compliance
with the Guidelines for Perinatal Care.
1. Nursery linens shall be washed separately from other hospital linens.
2. No new unlaundered garments shall be used in the nursery.
c. Sterilizing equipment, as required in Section 250.1090, shall be available.
Sterilizing equipment may be provided in the obstetric department or in a
central sterilizing unit, provided that flash sterilizing equipment or
adequate sterile supplies and instruments are provided in the obstetric
department.
d. Accommodations and Facilities for Obstetric Patients
1. The hospital shall identify specific rooms and beds, adjacent when
possible to other obstetric facilities, as obstetric rooms and beds.
These rooms and beds shall be used exclusively for obstetric patients or
for combined obstetric and clean gynecological service beds in accordance
with Section 250.1820(g).
2. Patient rooms and beds that are adjacent to another nursing unit may be
used for clean cases as part of the adjacent nursing unit. A corridor
partition with doors is recommended to provide a separation between the
obstetric beds and facilities and the non-obstetric rooms. The doors
shall be kept closed except when in active use as a passageway.
3. Facilities shall be available for the immediate isolation of all patients
in whom an infectious condition inimical to the safety of other obstetric
and neonatal patients exist.
4. Labor rooms shall be convenient to the delivery rooms and shall have
facilities for examination and preparation of patients. Each room used
for labor, delivery and postpartum (see Section 250.1870) shall include a
bathroom equipped with a toilet and a shower. The bathroom also shall
include a sink, unless a sink is located in the patient room. The
bathroom shall be directly accessible from the patient room without going
through the corridor.
5. Delivery rooms shall be equipped and staffed to provide emergency
resuscitation for infants pursuant to the recommendation of the American
Academy of Pediatrics and ACOG and shall comply with the American Academy
of Pediatrics/American Health Association’s American Heart Association
(AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency
Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal
Resuscitation Guidelines.
6. If only one delivery room is available and in use, one labor room shall
be arranged as an emergency delivery room and shall have a minimum clear
floor area of 180 square feet.
7. The patient shall be kept under close observation until her condition is
stabilized following delivery. Observations at established time intervals
shall be recorded in the patient’s medical record. A recovery area shall
be provided. Emergency equipment and supplies shall be available for use
in the recovery area.
e. Accommodations and Facilities for Infants
1. Level I nurseries:
A. A clean nursery or nurseries shall be provided, near the mothers’
rooms, with adequate lighting and ventilation. A minimum of 30 square
feet of floor area for each bassinet and 3 feet between bassinets
shall be provided. Equipment shall be provided to prevent direct draft
on the infants. Individual nursery rooms shall have a capacity of six
to eight neonates or 12 to 16 neonates. The normal newborn infant care
area in a smaller hospital shall limit room size to eight neonates,
with a minimum of two rooms available to permit cohorting in the
presence of infection.
B. Bassinets equipped to provide for the medical examination of the
newborn infant and for the storage of necessary supplies and equipment
shall be provided in a number to exceed obstetric beds by at least 20%
to accommodate multiple births, extended stay, and fluctuating patient
loads. Bassinets shall be separated by a minimum of 3 feet, measuring
from the edge of one bassinet to the edge of the adjacent one.
C. A glass observation window shall be provided through which infants may
be viewed.
D. Resuscitation equipment as described in subsection (e)(1)(E)(iii), and
personnel trained to use it, shall be available in the nursery at all
times.
E. Each nursery shall have necessary equipment immediately available to
stabilize the sick infant prior to transfer. Equipment shall consist
of:
i. A heat source capable of maintaining the core temperature of even
the smallest infant at 98 degrees (an incubator, or preferably a
radiant heat source);
ii. Equipment with the ability to monitor bedside blood sugar;
iii. A resuscitation tray containing equipment pursuant to the
American Heart Association (AHA) Guidelines for Cardiopulmonary
Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of
Pediatric and Neonatal Patients: Neonatal Resuscitation
Guidelines; and
iv. Equipment for delivery of 100% oxygen concentration, and the
ability to measure delivered oxygen in fractional inspired
concentrations (FI O2) pursuant to AAP recommendations. The
oxygen analyzer shall be calibrated and serviced according to the
manufacturer’s instructions at least monthly by the hospital’s
respiratory therapy department or other responsible personnel
trained to perform the task.
F. Consultation and Referral Protocols shall comply with the Regionalized
Perinatal Health Care Code.
2. Level II and Level III nurseries shall comply with the Regionalized
Perinatal Health Care Code. Cribs shall be separated by 4 to 6 feet to
allow for ease of movement of additional personnel, and to allow space
for additional equipment used in care of infants in these areas. New
buildings or additions or material alterations to existing buildings that
affect the Level II with Extended Neonatal Capabilities nursery shall
provide at least 70 square feet of space for each infant.
3. A Level III nursery shall provide 80 to 100 square feet of space for each
infant.
4. Facilities shall be available for the immediate isolation of all newborn
infants who have or are suspected of having an infectious disease.
5. When an infectious condition exists or is suspected of existing, the
infant shall be isolated in accordance with policies and procedures
established and approved by the hospital and consistent with recommended
procedures of the Guidelines for Perinatal Care and the Control of
Communicable Diseases Code.
f. The personnel requirements and recommendations set forth in Subpart D apply
to the operation of the obstetric department, in addition to the following:
1. Each hospital shall have a staffing plan for nursing personnel providing
care for obstetric and neonatal patients. The registered nursing
components of the plan shall comply with Section 250.1130 of this Part,
with requirements for the level of perinatal care, as designated in
accordance with the Regionalized Perinatal Health Care Code, the
Guidelines for Perinatal Care, the National Association of Neonatal
Nurses’ (NANN) Position Statement #3009 Minimum RN Staffing in NICUs, and
the following parameters:
A. Nursing supervision by a registered nurse shall be provided for the
entire 24-hour period for each occupied unit of the obstetric and
neonatal services. This nurse shall have education and experience in
obstetric and neonatal nursing.
B. At least one registered nurse trained in obstetric and nursery care
shall be assigned to the care of mothers and infants at all times. To
prepare for an unexpected delivery, at least one registered nurse or
LPN trained to give care to newborn infants shall be assigned at all
times to the nursery with duties restricted to the care of the
infants. Infants shall never be left unattended.
C. A registered nurse shall be in attendance at all deliveries and shall
be available to monitor the mother’s general condition and that of the
fetus during labor, for at least two hours after delivery, and longer
if complications occur.
D. Nursing personnel providing care for obstetric and other patients
shall be instructed on a continuing basis in the proper technique to
prevent cross-infection. When it is necessary for the same nurse to
care for both obstetric and non-obstetric patients in the gynecologic
unit, proper technique shall be followed.
E. Obstetric and neonatal department nurses providing input to the
hospital’s nursing care committee pursuant to Section 250.1130 shall,
prior to proposing their recommendations for the hospital’s written
staffing plan, consider the staffing standards listed in subsection
(f)(1).
F. Temporary relief from outside the obstetric and neonatal division by
qualified personnel shall be permitted as necessary according to
appropriate infection control policy.
G. For each shift in the obstetric department, at least one of the
registered nurses or LPNs shall also have certification or experience
in lactation training, pursuant to the requirements of subsection (k).
2. Nursing staff – Level I requirements for occupied units. These units
shall meet the following requirements in addition to General Care
Requirements in Section 250.1830(f)(1).
A. At least two nursing personnel shall be assigned per shift. One shall
be a registered nurse and one shall be a registered nurse or an LPN.
B. The capability to provide neonatal resuscitation in the delivery room
shall be demonstrated by the current completion of a nationally
recognized neonatal resuscitation program by medical, nursing and
respiratory care staff or a hospital rapid response team, in
accordance with the requirements of the Regionalized Perinatal Health
Care Code.
C. Hospitals shall have the capability for continuous electronic
maternal-fetal monitoring for patients, with staff available 24 hours
a day, including physician and nursing, who are knowledgeable of
electronic maternal-fetal monitoring use and
interpretation. Physicians and nurses shall complete a competence
assessment in electronic maternal-fetal monitoring every two years, in
accordance with the Regionalized Perinatal Health Care Code.
3. Nursing staff – Level II requirements for occupied units. These units
shall meet the requirements for Level I in subsection (f)(2). Nursery
personnel may be shared with the Level I nursery as needed.
4. Nursing staff – Level II with Extended Neonatal Capabilities requirements
for occupied units. In addition to the requirements in subsection (f)(3),
the obstetric-newborn nursing services shall be directed by a full-time
registered nurse experienced in perinatal nursing. Preference shall be
given to registered nurses with a master’s degree.
5. Nursing staff – Level III requirements for occupied units. These units
shall meet the following requirements in addition to requirements in
subsection (f)(3). Half of all neonatal intensive care direct nursing
care hours shall be provided by registered nurses who have two years or
more of nursing experience in a Level III NICU. All neonatal intensive
care direct nursing care hours shall be provided or supervised by
registered nurses who have advanced neonatal intensive care training and
documented competence in neonatal pathophysiology and care technologies
used in the NICU.
6. Medical personnel
A. Each hospital providing obstetric services shall have an organized
obstetric staff with a chief of obstetric service. The chief’s level
of qualification and expertise shall be appropriate to the hospital’s
designated level of care. The responsibilities of the chief of
obstetric services shall include the following requirements, as they
relate to the care of obstetric patients:
i. General supervision of the care of the perinatal patients
assigned to the unit;
ii. Establishment of criteria for admissions;
iii. Adherence to licensing requirements;
iv. Adoption, by the medical staff, of standards of practice and
privileges;
v. Identification of clinical conditions and procedures requiring
consultation;
vi. Arrangement of conferences, held at least quarterly, to review
operations, complications and mortality;
vii. Assurance that the clinical records, consultations and reports
are properly completed and analyzed; and
viii. Provision for exchange of information between medical,
administrative and nursing staffs.
B. Each hospital providing pediatric services shall have an organized
pediatric staff with a chief of pediatric service. The chief’s level
of qualification and expertise shall be appropriate to the hospital’s
designated level of care. The responsibilities of the chief of
pediatric services shall include those listed in subsection (f)(6)(A),
as they relate to the care of newborn infants.
C. Level I shall comply with the Regionalized Perinatal Health Care Code:
i. One physician shall be Chief of Obstetrical Care. He or she shall
be a board certified or board qualified obstetrician. If this is
not possible, a physician with experience and regular practice may
be the Chief and be responsible for obstetrical care and available
on a 24-hour basis, and a source of obstetric or maternal fetal
medicine consultation shall be documented when indicated.
ii. One physician shall be Chief of Pediatric Service. He or she shall
be a board certified or board qualified pediatrician. If this is
not possible, a physician with experience and regular practice may
be the Chief and be responsible for pediatric care and available
on a 24-hour basis, and a source of neonatology consultation shall
be documented when indicated.
D. Level II shall comply with the Regionalized Perinatal Health Care
Code:
A board certified obstetrician shall be Chief of Obstetrical Care. A
board certified pediatrician shall be Chief of Neonatal Care.
Obstetrical anesthesia shall be directed by a board certified
anesthesiologist with experience and competence in obstetrical
anesthesia. Hospital staff shall also include a pathologist and an on
call radiologist 24 hours a day. Specialized medical and surgical
consultation shall be readily available.
E. Level II With Extended Neonatal Capabilities: Staffing shall comply
with the Regionalized Perinatal Health Care Code.
F. Level III: Staffing shall comply with the Regionalized Perinatal
Health Care Code.
g. Practices and procedures for care of mothers and infants:
1. The hospital shall follow procedures approved by the infection control
committee for the isolation of known or suspected cases of infectious
disease in the obstetric department.
2. Patients with clean obstetric complications (regardless of month of
gestation), such as pregnancy-induced hypertension for observation and
treatment, placenta previa for observation or delivery, ectopic
pregnancy, and hypertensive heart disease in a pregnant patient, may be
admitted to the obstetric department and be subject to the same
requirements as any other obstetric case. (See Section 250.1820(g)(6).)
3. The physician shall determine whether a prenatal serological test for
syphilis and a test for HIV have been done on each mother and the
results recorded. If no tests have been done before the admission of the
patients, the tests shall be performed as soon as possible pursuant to
the Perinatal HIV Prevention Act. Specimens for a syphilis test may be
submitted in appropriate containers to an Illinois Department of Public
Health laboratory for testing without charge. Mothers shall be tested
for Group B streptococcus prior to delivery and for Hepatitis B prior to
discharge of either mother or infant, pursuant to AAP recommendations.
4. No obstetric patient under the effect of an analgesic or an anesthetic,
in the second stage of labor or delivery, shall be left unattended at
any time.
5. Fetal lung maturity shall be established and documented prior to
elective inductions and caesarean sections if the infant is at less than
39 weeks of gestation, or 38 weeks of gestation for twins. The hospital
shall establish a written policy and procedure concerning the
administration of oxytocic drugs.
A. Oxytocin shall be used for the contraction stress test only when
qualified personnel, determined by the hospital staff and
administration, can attend the patient closely. Written policies and
procedures shall be available to the team members assuming this
responsibility.
B. The oxytocin solution shall be administered intravenously via a
controlled infusion device, using both a primary intravenous solution
and a secondary oxytocin solution.
C. Oxytocin shall be used for medical induction or stimulation of labor
only when qualified personnel, determined by the hospital staff and
administration, can attend the patient closely. Written policies and
procedures shall be available to the team members assuming this
responsibility. The following shall be included in these policies:
i. An attending physician shall evaluate the patient for induction
or stimulation, especially with regard to indications.
ii. The physician or other individuals starting the oxytocin shall
be familiar with its effect and complications and be qualified
to identify both maternal and fetal complications.
iii. A qualified physician shall be immediately available as is
necessary to manage any complication effectively.
iv. During oxytocin administration, the fetal heart rate; the
resting uterine tone; and the frequency, duration and intensity
of contractions shall be monitored electronically and recorded.
Maternal blood pressure and pulse shall be monitored and
recorded at intervals comparable to the dosage regimen; that is,
at 30 to 60 minute intervals, when the dosage is evaluated for
maintenance, increase or decrease. Evidence of maternal and
fetal surveillance shall be documented.
6. Identification of infants:
A. While the neonate is still in the delivery room, the nurse in the
delivery room shall prepare identical identification bands for both
the mother and the neonate, as outlined in the hospital’s policy.
Wrist bands alone may be used; however, it is recommended that both
wrist and ankle bands be used on the neonate. The hospital shall not
use foot-printing and fingerprinting alone as methods of patient
identification. The bands shall indicate the mother’s admission
number, the neonate’s gender, the date and time of birth, and any
other information required by hospital policy. Delivery room
personnel shall review the bands prior to securing them on the mother
and the neonate to ensure that the information on the bands is
identical. The nurse in the delivery room shall securely fasten the
bands on the neonate and the mother without delay as soon as he/she
has verified the information on the identification bands. The birth
records and identification bands shall be checked again before the
neonate leaves the delivery room.
B. If the condition of the neonate does not allow the placement of
identification bands, the identification bands shall accompany the
neonate and shall be attached as soon as possible, as outlined in the
hospital’s policy. Identification bands shall not be left unattached
and unattended in the nursery.
C. When the neonate is taken to the nursery, both the delivery room
nurse and the admitting nursery nurse shall check the neonate’s
identification bands and birth records, verify the gender of the
neonate, and sign the neonate’s medical record. The admitting nurse
shall complete the bassinet card and attach it to the bassinet.
D. When the neonate is taken to the mother, the nurse shall check the
mother’s and the neonate’s identification bands, verify the gender of
the neonate and verify that the information on the bands is
identical.
E. The umbilical cord (cords, with multiple births) shall be identified
according to hospital policy (e.g., by the use of a different number
of clamps) so that umbilical cord blood specimens are correctly
labeled. All umbilical cord blood samples shall be labeled correctly
with an indication that these are a sample of the neonate’s umbilical
cord blood and not the blood of the mother.
F. The hospital shall develop a newborn infant security system. This
system shall include instructions to the mother regarding safety
precautions designed to avoid abduction. Electronic sensor devices
may be included as well.
7. Within one hour after delivery, ophthalmic ointment or drops containing
tetracycline or erythromycin shall be instilled into the eyes of the
newborn infant as a preventive against ophthalmia neonatorum. The eyes
shall not be irrigated.
8. A single parenteral dose of vitamin K-1, water soluble to 0.5-1.0
milligrams, shall be given to the infant, shortly after birth, but
usually within the first hour after delivery, as a prophylaxis against
hemorrhagic disorder in the first days of life.
9. Each infant shall be given complete individual crib-side care. The use
of a common bath table is prohibited. Scales shall be adequately
protected to prevent cross-infection.
10. Artificial feedings and formula changes shall not be instituted except
by written order of the attending physician, pursuant to the
requirements of the Hospital Infant Feeding Act.
11. Facilities for drug services. See Section 250.2130(a).
12. Newborn infants shall be transported from the delivery room to the
nursery in a safe manner. Adequate support systems (heating, oxygen,
suction) shall be incorporated into the transport units for infants
(e.g., to x-ray). Chilling of the newborn and cross-infection shall be
avoided. If travel is excessive and through other areas, special
transport incubators may be required. The method of transporting infants
from the nursery to the mothers shall be individual, safe and free from
cross-infection hazards.
13. The stay of the mother and the infant in the hospital after delivery
shall be planned to allow the identification of problems and to
reinforce instructions in preparation for the infant’s care at home. The
mother and infant shall be carefully observed for a sufficient period of
time and assessed prior to discharge to ensure that their conditions are
stable. Healthy infants shall be discharged from the hospital
simultaneously with the mother, or to other persons authorized by the
mother, if the mother remains in the hospital for an extended stay.
Follow-up shall be provided for mothers and infants discharged within 48
hours after delivery, including a face-to-face encounter with a health
care provider who will assess the condition of mother and infant and
arrange for intervention if problems are identified.
14. When a patient’s condition permits, an infant may be transferred from an
intensive care nursery to the referring nursery or to another nursery
that is nearest the home and at which an appropriate level of care may
be provided. Transfers shall be conducted pursuant to the Regionalized
Perinatal Health Care Code.
15. The hospital shall have a policy regarding circumcisions performed by a
Mohel.
16. Circumcisions shall not be performed in the delivery room or within the
first six hours after birth. A physician may order and perform a
circumcision when the infant is over the age of six hours and, in the
physician’s professional judgment, is healthy and stable.
17. The hospital shall comply with the Guidelines for Perinatal Care and
Guidelines for Women’s Health Care (see Section 250.160).
h. Medical Records
1. Obstetric records:
A. Adequate, accurate, and complete medical records shall be maintained
for each patient. The medical records shall include findings during
the prenatal period, which shall be available in the obstetric
department prior to the patient’s admission and shall include medical
and obstetric history, observations and proceedings during labor,
delivery and the postpartum period, and laboratory and x-ray findings.
B. Records shall be maintained in accordance with hospital medical
records policies and procedures, including the applicable requirements
of the Health Insurance Portability and Accountability Act and the
minimum observations and laboratory tests outlined in Guidelines for
Perinatal Care and Guidelines for Women’s Health Care. The physician
director of the obstetric department shall require all physicians
delivering obstetric care to send copies of the prenatal records,
including laboratory reports, to the obstetric unit at or before 37
weeks of gestation, including updates from that time until admission.
2. Infant records. Accurate and complete medical records shall be maintained
for each infant. The medical records shall include:
A. History of maternal health and prenatal course, including mother’s HIV
status, if known.
B. Description of labor, including drugs administered, method of
delivery, complications of labor and delivery, and description of
placenta and amniotic fluid.
C. Time of birth and condition of infant at birth, including the Apgar
score at one and five minutes, the age at which respiration became
spontaneous and sustained, a description of resuscitation if required,
and a description of abnormalities and problems occurring from birth
until transfer from the delivery room.
D. Report of a complete and detailed physical examination within 24 hours
following birth; report of a physical examination within 24 hours
before discharge and daily during any remaining hospital stay.
E. Physical measurements, including length, weight and head circumference
at birth, and weight every day; temperature twice daily.
F. Documentation of infant feeding: intake, content, and amount if by
formula.
G. Clinical course during hospital stay, including treatment rendered and
patient response; clinical note of status at discharge.
3. The hospital shall keep a record of births that contains data sufficient
to duplicate the birth certificate. The requirement may be met by:
A. retaining the yellow “hospital copy” of the birth certificate properly
bound in chronological order, or
B. retaining this copy with the individual medical record.
i. Reports
1. Each hospital that provides obstetric and neonatal services shall submit
a monthly perinatal activities report to its affiliated Administrative
Perinatal Center.
2. Maternal death report
A. The hospital shall submit an immediate report of the occurrence of a
maternal death to the Department, in accordance with the Department’s
rules titled Maternal Death Review. Maternal death is the death of any
woman dying of any cause whatsoever while pregnant or within one year
after termination of the pregnancy, irrespective of the duration of
the pregnancy at the time of the termination or the method by which it
was terminated. A death shall be reported regardless of whether the
death occurred in the obstetric department or any other section of the
hospital, or whether the patient was delivered in the hospital where
death occurred, or elsewhere.
B. The filing of this report shall in no way preclude the necessity of
filing a death certificate or of including the death on the Perinatal
Activities Report.
3. The hospital shall comply with the laws of the State and the rules of the
Department in the preparation and filing of birth, death and fetal death
certificates.
4. Epidemic and communicable disease reporting
A. The hospital shall develop a protocol for the management and reporting
of infections consistent with the Control of Communicable Diseases
Code, the Perinatal HIV Prevention Act, Guidelines for Perinatal Care
and Guidelines for Women’s Health Care, and as approved by the
infection control committee. These policies shall be known to
obstetric and nursery personnel.
B. The facility shall particularly address those infections specifically
related to mothers and infants, including but not limited to,
methicillin-resistant Staphylococcus Aureus occurring in infants under
61 days of age, ophthalmia neonatorum, and perinatal hepatitis B
infection.
j. Infant Feeding Policy
1. For the purposes of this subsection (j):
A. Baby-Friendly Hospital Initiative means the voluntary program
sponsored by the World Health Organization (WHO) and the United
Nations Children’s Fund (UNICEF) that recognizes hospitals that meet
certain evaluation criteria regarding the promotion of breastfeeding.
B. Infant Nutrition Resource means breastfeeding education and infant
formula safety and preparation.
2. Infant Feeding Policy Required
A. Every hospital that provides birthing services must adopt an infant
feeding policy that promotes breastfeeding. In developing the policy,
a hospital shall consider guidance provided by the Baby-Friendly
Hospital Initiative.
B. An infant feeding policy adopted under this Section shall include
guidance on the use of formula for medically necessary
supplementation, if preferred by the mother, or when exclusive
breastfeeding is contraindicated for the mother or for the infant.
3. Communication of Policy. A hospital shall routinely communicate the
infant feeding policy to staff in the hospital’s obstetric and neonatal
areas, beginning with hospital staff orientation. The hospital shall also
ensure that the policy and infant nutrition resources are posted in a
conspicuous place in the hospital’s obstetric or neonatal area or on the
hospital’s Internet or Intranet web site or on the Internet or Intranet
web site of the health system of which the hospital is a part. The
hospital shall make copies of the policy available to the Department upon
request.
4. Application of Policy. A hospital’s infant feeding policy adopted
under the Hospital Infant Feeding Act must apply to all mother-infant
couplets in the hospital’s obstetric and neonatal areas. (Sections 5
through 20 of the Hospital Infant Feeding Act)
k. Breast Milk and Formula
1. Pursuant to the requirements of subsection (j), the hospital shall
provide the mother with information regarding lactation, the nutritional
benefits of breast milk, and lactation support organizations within the
area. The hospital staff shall include, at a minimum, lactation support
staff with certification or experience in lactation training. The
lactation support staff shall attend continuing education in relation to
lactation counseling and training, consistent with hospital policy. At
least one lactation support staff shall be on duty at all times in the
obstetric department.
2. Pursuant to the requirements of subsection (j), the hospital shall have a
policy for the preparation of formula by hospital staff when
hospital-prepared formula is needed in place of commerciallyprepared
formula. Adequate space, equipment and procedures for processing,
handling and storing commercially-prepared formula shall be provided.
A. All hospitals providing obstetric or pediatric services that prepare
their own formula shall provide a well-ventilated and well-lighted
formula room, which shall be adequately supervised and used
exclusively for the preparation of formulas.
B. Equipment shall include hand-washing facilities with hot and cold
running water with knee, foot or elbow controlled valves; a
double-section sink for washing and rinsing bottles; facilities for
storing cleaning equipment, refrigeration facilities; utensils in good
condition for preparation of formulas; cupboard and work space and a
work table; an autoclave and a supply of individual formula bottles,
nipples and protecting caps, adequate to prepare a 24-hour supply of
formula and water for each infant. Procedures shall be established by
the hospital and enforced.
l. Visiting Policy
1. The visiting requirements set forth in Subpart B shall apply to obstetric
departments, except as modified in this subsection (l).
2. Each obstetric department shall have a visiting policy that complies with
the Guidelines for Perinatal Care and is approved by the hospital’s
infection control committee.
3. The visiting policy shall cover all programs in the obstetric department.
4. The visiting policy shall comply with the hospital’s infection control
policy and shall include signage instructing visitors to wash their
hands.
m. Every hospital shall demonstrate to the Department that the followinghave
been adopted:
1. Procedures designed to reduce the likelihood that an infant patient will
be abducted from the hospital. The procedures may include, but need not
be limited to, architectural plans to control access to infant care
areas, video camera observation of infant care areas, and procedures for
identifying hospital staff and visitors.
2. Procedures designed to aid in identifying allegedly abducted infants who
are recovered. The procedures may include, but need not be limited to,
foot-printing infants by staff who have been trained in that procedure,
photographing infants, and obtaining and retaining blood samples for
genetic testing. (Section 6.15 of the Act)
410 ILCS 320/1
320/1. BLOOD TESTS FOR PREGNANT WOMEN AS TO SYPHILIS
1. § Every physician, or other person, attending in a professional capacity a
pregnant woman in Illinois, shall take or cause to be taken a sample of
blood of such woman at the time of the first examination, and a second
sample of blood shall be taken or caused to be taken during the third
trimester of pregnancy. These blood specimens shall be submitted to a
laboratory approved by the Department of Public Health for a serological
test for syphilis approved by the State Department of Public Health. In the
event that any such blood test shall show a positive or doubtful result an
additional test or tests shall be made. Such serological test or tests
shall, upon request of any physician, be made free of charge by the State
Department of Public Health or the Health Departments of cities, villages
and incorporated towns maintaining laboratories for the testing of blood
specimens of any woman who resides in that city, village or incorporated
town.The provisions of this Section shall not apply to any woman who objects
to such serological tests on the grounds that such tests are contrary to her
religious beliefs and practices.
77 ILL. ADM. CODE 630.30
630.30. HEALTH SERVICES FOR WOMEN OF REPRODUCTIVE AGE
The Division of Family Health, Department of Public Health, State of Illinois,
through its Maternal and Child Health Program may allocate funds for programs
providing health services for women of reproductive age. All such services must
be delivered based upon the standards of the American College of Obstetrics and
Gynecology set forth in Section 630.80(a)(5), Family Planning Services Code (77
Ill. Adm. Code 635.90), Regionalized Perinatal Health Care Code (77 Ill. Adm.
Code 640), and Hospital Licensing Requirements (77 Ill. Adm. Code 250.1810-1860)
(See Section 630.80(a)(5)). One or more of the following MCH services may be
included in application proposals for Title V and State MCH Project grant funds:
a. Services for nonpregnant women that relate to the occurrence and course of
future pregnancy.
1. Comprehensive family planning services as described in the Department’s
Family Planning Services Code – 77 Ill. Adm. Code 635.90.
2. Genetic evaluation counseling as indicated.
3. Counseling and referral to licensed adoption services if indicated or
desired.
b. Services for pregnant woman.
1. Early diagnosis of pregnancy.
2. Counseling regarding plans for pregnancy continuation.
A. For those electing to carry to term, referral for and provision of
prenatal care. Referral to childbirth preparation classes as desired
or to adoption services at licensed agencies if indicated.
B. For those electing abortion, referral to appropriate counseling and
family planning facilities.
3. Prenatal care services including:
A. History (general medical-surgical, social and occupational, family and
genetic background, health habits, previous pregnancies, and current
pregnancy).
B. Complete physical examination including blood pressure, height and
weight, and fetal development as well as a complete systems review.
C. Laboratory tests as appropriate, such as syphilis serology,
Papanicolau smear, gonococcal culture, chlamydia smear, hepatitis B,
diabetic screening, hemoglobin/hematocrit, urinalysis for glucose and
protein, Rh determination and irregular antibody screening, blood
group determination, and rubella test.
D. Diagnosis and treatment or referral and follow-up of general health
problems, both acute and chronic, preexisting or arising during the
prenatal period, that can adversely affect pregnancy, fetal
development, or maternal health.
E. Referral and follow-up of mental health problems, both acute and
chronic, preexisting or arising during the prenatal period, that can
adversely affect pregnancy, fetal development, or maternal health.
F. Nutritional assessment and services as needed. Provision of vitamin,
iron and other supplements as appropriate. The water supply for
clients on nonpublic sources should be tested for nitrates by the
Illinois Department of Public Health Laboratories.
G. Dental services limited to oral pathology that can directly affect the
outcome of pregnancy.
H. Subsequent prenatal visits should include at the minimum: blood
pressure, weight, urinalysis for protein and glucose, ascertaining
fetal development, update on pertinent medical history, height of
fundus, rate and location of fetal heart tones, periodic hemoglobin
and/or hematocrit as well as a vaginal examination and other special
tests as indicated (e.g., Rh titer). Visits should occur at ACOG
recommended frequency.
I. Screening, diagnosis (including amniocentesis), and counseling with
follow-up for selected fetal genetic defects.
J. An assessment to identify high risk pregnancies and appropriately
consult and/or refer within the Perinatal System.
K. Home health and homemaker services.
L. Counseling and anticipatory guidance with referral and followup as
needed regarding:
i. Physical activity and exercise.
ii. Nutrition during pregnancy, including the importance of adequate
but not excessive weight gain.
iii. Avoidance during pregnancy of smoking, alcohol and other drugs;
and of environmental hazards including radiation, hazardous
chemicals, and various workplace hazards.
iv. Signs of problems arising during pregnancy and at the onset of
labor, including signs of preterm labor.
v. Preparation of the woman (and her partner where appropriate) for
labor and delivery, including plans for place of delivery and
use of anesthesia.
vi. Use of medication during pregnancy.
vii. Infant nutritional needs and feeding practices, including breast
feeding.
viii. Child care arrangements.
ix. Parenting skills, including meeting the physical, emotional and
intellectual needs of the infant, with specific appraisal to
detect parents at risk of child abuse or neglect.
x. Planning for continuous and comprehensive pediatric care
following delivery, including arrangements for a pediatric
antenatal visit to link the family to pediatric care.
xi. Emotional and social changes occasioned by the birth of a child,
including changes in marital and family relationships, the
special needs of the mother in the postpartum period, and
preparing the home for the arrival of the newborn.
xii. Referral to appropriate community health resources such as WIC,
food stamps, welfare and social services that can benefit health
status significantly.
xiii. Discussions regarding postpartum family planning options.
xiv. Housing (including alternative placement).
xv. Other relevant topics in response to patient concern.
4. Services in the intrapartum period.
A. Assessing the progress of labor and the condition of the mother and
fetus throughout labor.
B. Medical services during labor and delivery for diagnosis and
management of conditions threatening the mother and/or infant,
including the availability of a Cesarean birth operation when
indicated and consultation and/or referral for high risk perinatal
problems within the Perinatal System.
C. Delivery and/or referral of the baby to the appropriate level facility
within the Perinatal System.
D. RH workup and Rhogam administration as indicated.
5. Services during the postpartum period.
A. Diagnosis and treatment or referral and follow-up of general health
problems, both acute and chronic, preexisting or arising during the
postpartum period that can adversely affect the mother’s health and/or
child caring abilities.
B. Diagnosis and treatment or referral and follow-up of mental health or
behavioral problems, both acute and chronic, preexisting or arising
during the perinatal and postpartum periods (including maternal
depression) that can adversely affect the mother’s health and/or child
care abilities.
C. Counseling and anticipatory guidance with referrals and follow-up as
needed regarding:
i. Postpartum changes, both normal and abnormal.
ii. Family planning methods.
iii. Infant development and behavior.
iv. Infant nutritional needs and feeding practices, including
breast feeding.
v. Automobile restraints for infants and children, and general
accident prevention concepts (especially home accidents and
accidental poisoning).
vi. Infant stimulation and parenting skills, with specific
appraisal to identify parent as risk for child abuse or
neglect.
vii. Need for and importance of immunizations.
viii. Effect on children of parental smoking, use of alcohol and
other drugs, and other health-damaging behaviors.
ix. The importance of a source of continuous and comprehensive care
for both mother and child, including identification of
available resources to help with such problems as illness in
the newborn, breast feeding difficulties or problems with
contraception.
x. Recognition and management of illness in the newborn.
xi. Infant care.
xii. Child care arrangements.
xiii. Using community health resources such as WIC, food stamps,
welfare and social services that bear significantly on health
status.
xiv. Physical activity and exercise.
xv. Nutrition assessment and services.
xvi. General health practices.
xvii. Genetic diagnostic services and counseling if indicated.
xviii. Other relevant topics in response to parental concern.
xix. Organic medical problems such as renal and heart disease,
hypertension, diabetes, and endocrine problems.
D. Diagnosis and treatment or referral and follow-up for general health
problems (of project registrants) that can adversely affect future
pregnancy, fetal development, and maternal health such as:
i. Sexually transmitted diseases.
ii. Immune status (such as rubella).
iii. Gynecological anatomic and functional disorders.
iv. Inadequate nutritional status, including both under and
overweight.
v. Occupational exposures.
vi. Acute dental problems such as infection.
vii. Family history of genetic disorder.
E. Comprehensive family planning services, during intrapartum and
postpartum period, including:
i. Information, education, and counseling regarding family planning
concepts and techniques, and other issues such as the importance
of prenatal care, and risks to mother and child of childbearing
at extremes of the reproductive age span.
ii. History and physical examination, including heart, lungs,
thyroid, breast and pelvic examination, as indicated, and tests
such as a Papanicolau smear, gonococcal culture, chlamydia
testing, hematocrit urinalysis, and serological examination for
syphilis, as appropriate.
iii. Provision of family planning methods and instruction regarding
their use.
iv. Sterilization counseling, information, and education.
v. Sterilization treatment services for persons 21 years of age and
over, and legally capable of consent.
vi. Rubella immunization as indicated.
vii. Genetic counseling services.
F. Home health and homemaker services.
G. Routine postpartum examination, four to six weeks following delivery
with referrals and follow-up as needed, including:
i. Physical examination and intrapartum history.
ii. Laboratory services as appropriate.
iii. Family planning services.
iv. Rubella immunization as indicated.
c. Access-related services:
1. Outreach services.
2. Translator and 24-hour emergency telephone services.
3. Child care services to facilitate obtaining needed health services and
other social services as needed.
4. Availability of services directly or through referral regardless of
handicapping conditions.
5. Transportation.
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INDIANA
IC 16-41-15-10
16-41-15-10 SYPHILIS TESTING DURING PREGNANCY; DUTY OF PHYSICIAN
Sec. 10. A physician who diagnoses a pregnancy of a woman shall take or cause to
be taken a sample of blood:
1. at the time of diagnosis of pregnancy; and
2. during the third trimester of pregnancy, if the woman belongs to a high risk
population for which the Centers for Disease Control “Sexually Transmitted
Diseases Treatment Guidelines” recommend a third trimester syphilis testing;
and shall submit each sample to an approved laboratory for a standard
serological test for syphilis.
IC 16-41-15-11
16-41-15-11 SYPHILIS TESTING DURING PREGNANCY; DUTY OF ATTENDANT
Sec. 11. A person other than a physician who is permitted by law to attend a
pregnant woman, but who is not permitted by law to take blood specimens, shall
cause a sample of the blood of the pregnant woman to be taken by a licensed
physician, who shall submit the sample to an approved laboratory for a standard
serological test for syphilis.
IC 16-41-15-12
16-41-15-12 SYPHILIS TESTING AT TIME OF DELIVERY
Sec. 12. If at the time of delivery positive evidence is not available to show
that standard serological tests for syphilis have been made in accordance with
section 10 of this chapter, the person in attendance at the delivery shall take
or cause to be taken a sample of the blood of the woman at the time of the
delivery and shall submit the sample to an approved laboratory for a standard
serological test for syphilis.
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IOWA
I.C.A. § 139A.37
139A.37. PREGNANT WOMEN
The department shall adopt rules which incorporate the prenatal guidelines
established by the centers for disease control and prevention of the United
States department of health and human services as the state guidelines for
prenatal testing and care relative to infectious disease.
I.C.A. § 139A.39
139A.39. RELIGIOUS EXCEPTIONS
A provision of this chapter shall not be construed to require or compel any
person to take or follow a course of medical treatment prescribed by law or a
health care provider if the person is an adherent or member of a church or
religious denomination and in accordance with the tenets or principles of the
person’s church or religious denomination the person opposes the specific course
of medical treatment. However, such person while in an infectious stage of
disease shall be subject to isolation and such other measures appropriate for
the prevention of the spread of the disease to other persons.
IOWA ADMIN. CODE 641-1.18(135,139A)
641-1.18(135,139A) SPECIMENS FOR WHICH THE FEE CHARGED BY THE STATE HYGIENIC
LABORATORY SHALL BE WAIVED.
1.18(1) Purpose. Iowa Code section 263.8 and 681—subrule 5.3(1) provide that
the state hygienic laboratory shall perform without charge all bacteriological,
serological, and epidemiological examinations and investigations which are
required by the department and established in rule, including specimens relating
to diseases communicable from human to human and from animals to human and any
specimen when there is probable cause that a direct threat to public health
exists. The purpose of this rule is to designate those examinations which shall
be performed by the state hygienic laboratory without charge pursuant to these
legal authorities.
1.18(2) Acute infectious diseases. Regardless of the entity that submits the
specimen, the following examinations shall be performed by the state hygienic
laboratory without charge:
a. Anthrax;
b. Botulism;
c. Cholera;
d. Diphtheria;
e. Haemophilus influenzae type B invasive disease;
f. Measles;
g. Meningococcal invasive disease;
h. Pulsed-field gel electrophoresis (PFGE) (Listeria, Salmonella, E. coli);
i. Plague;
j. Poliomyelitis;
k. Rabies, animal (human exposure only);
l. Rabies, human;
m. Smallpox;
n. Vancomycin intermediate Staphylococcus aureus (VISA) and
vancomycin-resistant Staphylococcus aureus (VRSA) confirmation;
o. Tuberculosis (exception: QuantiFERON-TB Gold testing that is not associated
with contact investigation);
p. Viral hemorrhagic fever;
q. Yellow fever; and
r. Under any of the following circumstances:
1. All outbreaks (respiratory and enteric pathogens, and environmental
contaminants where justified) shall be reported to the department, and
the department will instruct the state hygienic laboratory to waive the
fee.
2. Periodic confirmations at the request of the department.
3. All situations where negative stool cultures are being requested for
public health purposes.
4. When the state hygienic laboratory is specifically funded to do testing.
1.18(3) Sexually transmitted disease and infections and HIV/AIDS. The following
examinations shall be performed by the state hygienic laboratory without charge
if the following defined criteria have been met and if the specimen was sent to
the state hygienic laboratory from sites approved by and submitted to the
laboratory by the department:
a. Chlamydia and gonorrhea.
1. All individuals 24 years of age or younger.
2. Individuals above the age of 24 with any of the following:
i. New or multiple sex partners in the last 90 days;
ii. Persons with reported symptoms consistent with chlamydia or
gonorrhea;
iii. Persons with observed clinical signs consistent with chlamydia or
gonorrhea or pelvic inflammatory disease (PID);
iv. Persons recently diagnosed with another sexually transmitted
infection (STI);
v. Persons who have a sex partner in one of the other risk groups (new
or multiple partners, STI diagnosis); or
vi. Women presenting for an intrauterine device (IUD) insertion.
3. Persons who have tested positive within the last four months (i.e.,
retesting).
4. Persons diagnosed with gonorrhea and treated with alternative regimens as
defined by the Centers for Disease Control and Prevention (CDC) (i.e.,
tests of cure).
b. Hepatitis B. All unvaccinated individuals at increased risk, including:
1. Men who have sex with men;
2. HIV-positive persons; or
3. Persons who have ever injected drugs.
c. Maternal hepatitis B.
1. Testing related to case management of HBsAG-positive pregnant women;
2. Household contacts of HBsAG-positive pregnant women tested for infection
or immunity (HBsAG, anti-HBs);
3. Children born to HBsAG-positive women (postvaccination serology testing).
d. Hepatitis C. All individuals at increased risk, including persons who have
ever injected drugs.
e. Herpes simplex virus. Individuals who present with clinical signs of genital
herpes.
f. Human immunodeficiency virus (HIV). All individuals at increased risk,
including:
1. Men who have sex with men;
2. Disproportionately impacted populations (as determined by the department
based on epidemiological data);
3. Persons who have ever injected drugs;
4. Persons who exchange sex for drugs or money; or
5. Persons with an STI diagnosis within the last 12 months or someone who
has a partner in another risk group (IDU, MSM, recent STI, exchange sex
for drugs or money).
g. Syphilis.
1. All individuals at increased risk, including:
i. Persons who have had signs or symptoms consistent with primary or
secondary syphilis within the last 12 months;
ii. Men who have sex with men;
iii. Persons diagnosed with other STIs;
iv. Persons who exchange sex for drugs or money; or
v. Persons who have recently been treated for syphilis to monitor
serologic response (titers) at intervals recommended by the CDC.
2. (2) All pregnant women at first prenatal visit. Tests that are initially
reactive will be followed up with a secondary test of different
methodology to assist with diagnosis and staging of the infection (i.e.,
specimens reactive using a nontreponemal test will be analyzed using a
treponemal test). Testing should be repeated in the third trimester for
women at high risk of having been exposed to the infection.
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KANSAS
K.S.A. 65-153F
65-153F. PRENATAL SEROLOGICAL TESTS FOR SYPHILIS AND HEPATITIS B; APPROVED
LABORATORIES; LABORATORY REPORTS, CONFIDENTIALITY
Each physician or other person attending a pregnant woman in this state during
gestation, with the consent of such woman, shall take or cause to be taken a
sample of blood of such woman within 14 days after diagnosis of pregnancy is
made. Such sample shall be submitted for serological tests which meet the
standards recognized by the United States public health service for the
detection of syphilis and hepatitis b to a laboratory approved by the secretary
of health and environment for such serological tests. Any state, United States
public health service, or United States army, navy or air force laboratory or
any laboratory approved by the state health agency of the state in which the
laboratory is operated shall be considered approved for the purposes of this
act. Any laboratory in this state, performing the tests required by this section
shall make a report to the secretary of health and environment of all positive
or reactive tests on forms provided by the secretary of health and environment
and also shall make a report of the test results to the submitting physician or
person attending the woman. Laboratory statements, reports, files and records
prepared pursuant to this section shall be confidential and shall not be
divulged to or open to inspection by any person other than state or local health
officers or their duly authorized representatives, except by written consent of
the woman.
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KENTUCKY
KRS § 214.160
214.160 BLOOD SPECIMEN OF PREGNANT WOMEN TO BE TAKEN; LABORATORY TEST; SUBSTANCE
ABUSE TESTS OF PREGNANT WOMEN AND NEWBORN INFANTS; USE OF TESTS; TESTS FOR
PRESENCE OF HEPATITIS B AND HEPATITIS C
1. Every physician and every other person legally permitted to engage in
attendance upon a pregnant woman in this state shall take or cause to be
taken from the woman a specimen of blood for serological test for syphilis
as soon as he is engaged to attend the woman and has reasonable grounds for
suspecting that pregnancy exists. If the woman is in labor at the time the
diagnosis of pregnancy is made, which may make it inadvisable to obtain a
blood specimen at that time, the specimen shall be obtained within ten (10)
days after delivery. The specimen of blood shall be submitted to the
laboratory of the Cabinet for Health and Family Services or a laboratory
approved by the cabinet for the purpose of having made a serological test
for syphilis. The test shall be of a type approved by the Cabinet for Health
and Family Services.
2. The Cabinet for Health and Family Services shall, as often as necessary,
publish a list of the five (5) most frequently abused substances, including
alcohol, by pregnant women in the Commonwealth. Any physician and any other
person legally permitted to engage in attendance upon a pregnant woman in
this state may perform a screening for alcohol or substance dependency or
abuse, including a comprehensive history of such behavior. Any physician may
administer a toxicology test to a pregnant woman under the physician’s care
within eight (8) hours after delivery to determine whether there is evidence
that she has ingested alcohol, a controlled substance, or a substance
identified on the list provided by the cabinet, or if the woman has
obstetrical complications that are a medical indication of possible use of
any such substance for a nonmedical purpose.
3. Any physician or person legally permitted to engage in attendance upon a
pregnant woman may administer to each newborn infant born under that
person’s care a toxicology test to determine whether there is evidence of
prenatal exposure to alcohol, a controlled substance, or a substance
identified on the list provided by the Cabinet for Health and Family
Services, if the attending person has reason to believe, based on a medical
assessment of the mother or the infant, that the mother used any such
substance for a nonmedical purpose during the pregnancy.
4. The circumstances surrounding any positive toxicology finding shall be
evaluated by the attending person to determine if abuse or neglect of the
infant, as defined under KRS 600.020(1), has occurred and whether
investigation by the Cabinet for Health and Family Services is necessary.
5. No prenatal screening for alcohol or other substance abuse or positive
toxicology finding shall be used as prosecutorial evidence.
6. No person shall conduct or cause to be conducted any toxicological test
pursuant to this section on any pregnant woman without first informing the
pregnant woman of the purpose of the test.
7. Every physician or other person legally permitted to engage in attendance
upon a pregnant woman in the Commonwealth shall take or cause to be taken
from the woman a specimen of blood which shall be submitted for the purpose
of serologic testing for the presence of hepatitis B surface antigen to a
laboratory certified by the United States Department for Health and Human
Services pursuant to Section 333 of the Public Health Service Act (42 U.S.C.
sec. 263a), as revised by the Clinical Laboratory Improvement Amendments
(CLIA), Pub.L. 100-578.
8. a. Every physician or other person legally permitted to engage in attendance
upon a pregnant woman in the Commonwealth shall take or cause to be taken
from the woman a specimen of blood which shall be submitted for the
purpose of serologic testing for the presence of hepatitis C virus
antibodies and RNA in the blood.
b. The results of this testing shall be recorded by the physician or other
person legally permitted to engage in attendance upon a pregnant woman in
the Commonwealth, in:
1. The permanent medical record of the woman; and
2. The permanent medical record of the child or children she was pregnant
with at the time of the testing after the child or children are born.
c. If the woman receives a test result that shows she is positive for
hepatitis C virus antibodies or RNA, the physician or other person
legally permitted to engage in attendance upon a pregnant woman in the
Commonwealth shall orally inform and clearly document the woman or the
legal guardian of the child or children she was pregnant with at the time
of the testing, that it is recommended that serologic testing for the
presence of hepatitis C virus antibodies and confirmation RNA in the
blood be conducted on the child or children she was pregnant with at the
time of the testing at the twenty-four (24) month recommended well baby
pediatric check-up.
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LOUISIANA
LSA-R.S. 40:1121.21
FORMERLY CITED AS LA R.S. 40:1091
§ 1121.21. BLOOD SAMPLES; STANDARD TEST
A. Every physician who attends any pregnant woman for conditions relating to
pregnancy during the period of gestation shall offer to take or to have
taken a sample of her blood at the time of first examination or as soon as
possible thereafter. Additionally, every physician who attends any pregnant
woman for conditions relating to pregnancy during the third trimester of
gestation shall offer to take or to have taken a sample of her blood at the
time of first examination during such trimester or as soon as possible
thereafter, regardless of whether such a sample was taken or offered during
the first two trimesters of her pregnancy. Every physician who attends any
pregnant woman during labor or delivery shall offer to take or to have taken
a sample of her blood at such time or as soon as possible thereafter. If
available documentation indicates that a sample of her blood was already
screened in accordance with this Section during the third trimester of her
pregnancy, and she does not disclose when questioned any activities posing a
risk for infection with HIV or syphilis occurring more recently than would
have been detected by such screening, the attending physician during labor
or delivery is not required to offer to take or to take a blood sample. If
no objection is made by the woman, a blood sample shall be taken and
submitted to any approved laboratory for a standard test for syphilis as
approved by the American Board of Pathology and for a standard diagnostic
HIV test approved by the Food and Drug Administration.
B. All other persons permitted by law to attend pregnant women but not
permitted to take blood samples shall have a sample of the blood of every
pregnant woman attended by them taken by a duly licensed physician, if no
objection to the taking of the sample is made by the woman, and submitted to
an approved laboratory for a standard test for syphilis and a standard
diagnostic HIV test.
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MAINE
22 M.R.S.A. § 1231
§ 1231. BLOOD SAMPLE FOR LABORATORY TEST
Every physician attending a woman in the State by reason of her being pregnant
during gestation shall in the case of every woman so attended take or cause to
be taken, with her consent, a sample of blood of such woman, and submit such
sample for a standard serological test for syphilis and Rh factors to a
laboratory of the department or to a laboratory approved for these tests by the
department. Such laboratory tests as are required by sections 1231 to 1234 must
be made on request without charge by the department.
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MARYLAND
MD CODE, HEALTH – GENERAL, § 18-307
§ 18-307. BLOOD TESTS FOR SYPHILIS
APPLICATION OF SECTION
(a) This section does not apply to a woman who objects to a standard
serological syphilis test because the test is against the religious beliefs and
practices of the woman.
SUBMISSION OF BLOOD TEST
(b)(1) The individual attending a woman for pregnancy shall submit to a medical
laboratory:
i. A blood sample taken from the woman at the time that the individual first
examines the woman; and
ii. A blood sample taken from the woman during the third trimester of the
pregnancy.
(2) The medical laboratory to which a blood sample is submitted shall do a
standard serological syphilis test that is approved by the Department.
COMAR 10.06.01.17
.17 SYPHILIS AND HIV.
A. Control of a Case.
1. For an individual who appears to have or who has syphilis in a stage
which is or may become communicable, or HIV, a physician shall instruct
the individual in the use of any measure and render any treatment which
may be necessary to prevent the spread of the disease.
2. An individual under medical observation for diagnosis of syphilis or HIV
shall remain under medical supervision until the:
a. Observation for diagnosis has been completed;
b. Syphilis or HIV, if present, has been reported to the health officer;
c. Individual with syphilis has had the treatment that is necessary for
the protection of the public health; and
d. Individual with HIV has entered into HIV medical care.
3. A physician shall report to the health officer within 1 working day and
in writing the name and address of an individual who is:
a. Receiving or has received treatment for syphilis; or
b. Under medical observation for diagnosis or treatment of syphilis in an
infectious or potentially infectious stage, who fails to return for
observation or treatment within 1 week of the date of a missed
appointment, and is not known to the attending physician to be under
medical observation or treatment elsewhere for this infection.
4. A health officer shall:
a. Investigate an individual reported to the health officer under the
provisions of § A(3) of this regulation or Health-General Article, §
18-201.1, Annotated Code of Maryland, who is within the health
officer’s territorial jurisdiction;
b. Take such measures as may be deemed necessary for the protection of
the public health; and
c. Forward to the Secretary immediately a report of an individual
reported under the provisions of § A of this regulation or
Health-General Article, § 18-201.1, Annotated Code of Maryland, who is
outside the health officer’s territorial jurisdiction for referral to
the health officer of the proper jurisdiction.
B. Control of Contacts.
1. A physician in attendance upon a patient having syphilis or HIV:
a. Shall endeavor to bring an individual with whom the patient has had
potentially infectious contact to examination and, as appropriate,
prophylaxis by:
i. Requesting the health officer to conduct a contact investigation
of any case of syphilis or HIV; or
ii. Interviewing the patient in order to ascertain the names,
descriptions, addresses, telephone numbers, and email addresses of
those with whom the patient has had potentially infectious
contact;
b. Shall report immediately to the health officer an individual
identified as having had potentially infectious contact with a patient
having syphilis reported under the provisions of § A(3) of this
regulation; and
c. May report to the health officer an individual identified as having
had potentially infectious contact with a patient having HIV reported
under Health-General Article, § 18-201.1, Annotated Code of Maryland,
if a patient that has been informed of the patient’s HIV positive
status refuses to notify the patient’s sexual and needle-sharing
partners.
2. A health officer shall:
a. Investigate and notify immediately an individual reported under the
provisions of § B(1)(b) of this regulation, who is within the health
officer’s jurisdiction, of the individual’s exposure and advise the
individual to undergo a medical examination to ascertain whether the
individual is infected with syphilis or HIV; and
b. Forward immediately to the Secretary all reports of individuals who
are outside the health officer’s territorial jurisdiction for referral
to the health officer of the proper jurisdiction.
3. A reported individual shall:
a. Within 1 week of notification, be examined to ascertain whether the
individual has been infected with syphilis or HIV; and
b. Be treated with a regimen appropriate for the stage of syphilis to
which the individual has been exposed.
C. Infection Control. A health care provider shall practice standard
precautions.
D. Congenital Syphilis.
1. A physician in attendance upon a pregnant woman shall:
a. Serologically test her for syphilis in accordance with Health-General
Article, § 18-307, Annotated Code of Maryland, by taking a blood
sample and assuring the test is completed:
i. At the time the physician first examines the woman, either at the
first prenatal visit or at the time of delivery if the woman has
had no prenatal care;
ii. In the third trimester at the prenatal visit at 28 weeks of
gestation or the first prenatal visit after 28 weeks of
gestation; and
iii. At delivery, for high prevalence communities or high risk
individuals;
b. Render appropriate treatment within 1 week whenever syphilis, in any
stage, is diagnosed; and
c. Report the case to a health officer immediately.
2. A physician in attendance upon an infant born to an untreated woman who
has a positive serological test for syphilis shall:
a. Evaluate the infant for possible congenital syphilis and render all
indicated treatment; and
b. Report immediately to the health officer the following information:
i. The name, address, and telephone number of the mother,
ii. The results of the serological testing, including titers, and
iii. The results of the medical evaluation for congenital syphilis for
the infant.
3. A health officer shall:
a. Investigate immediately an individual reported to the health officer
under the provisions of § D(1)(c) and (2)(b) of this regulation, who
is within the health officer’s jurisdiction; and
b. Forward immediately to the Secretary a report of an individual
reported under the provisions of § D(1)(c) and (2)(b) of this
regulation, who is outside the health officer’s jurisdiction for
referral to a health officer of the proper jurisdiction.
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MASSACHUSETTS
M.G.L.A. 111 § 121A
§ 121A. SEROLOGICAL TEST FOR SYPHILIS OF PREGNANT WOMEN
A physician attending a pregnant woman in this commonwealth during gestation
shall take or cause to be taken a sample of blood of such woman at the time of
first examination, and shall submit such sample for a standard serological test
for syphilis to a laboratory of the department or to a laboratory approved for
such test by the department; provided, that not more than one physician
attending a pregnant woman during gestation shall be required to comply with the
provisions of this section.
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MICHIGAN
M.C.L.A. 333.5123
333.5123. PREGNANT WOMEN; TESTING FOR HIV, SYPHILIS, AND HEPATITIS B; RECORDS
Sec. 5123. (1) Except as otherwise provided in subsection (3), a physician or an
individual otherwise authorized by law to provide medical treatment to a
pregnant woman shall take or cause to be taken at the time of the woman’s
initial examination test specimens of the woman for the purpose of performing
tests for HIV, syphilis, and hepatitis B, and take or cause to be taken during
the third trimester of the woman’s pregnancy test specimens of the woman for the
purpose of performing tests for HIV, hepatitis B, and syphilis in accordance
with guidelines established by the federal Centers for Disease Control and
Prevention, and shall submit the specimens to a clinical laboratory approved by
the department for the purpose of performing tests approved by the department
for the infections described in this subsection.
(2) Except as otherwise provided in subsection (3), if, when a woman appears at
a health care facility to deliver an infant or for care in the immediate
postpartum period having recently delivered an infant outside a health care
facility, no record of results from the tests required under subsection (1) is
readily available to the physician or individual otherwise authorized to provide
care in such a setting, then the physician or individual otherwise authorized to
provide care shall take or cause to be taken test specimens of the woman and
shall submit the specimens to a clinical laboratory approved by the department
for the purpose of performing tests approved by the department for syphilis,
HIV, and hepatitis B.
(3) Subsections (1) and (2) do not apply if, in the professional opinion of a
physician, the tests are medically inadvisable or the woman does not consent to
be tested. The woman may orally communicate her decision to decline the testing.
(4) The physician or other individual described in subsections (1) and (2) shall
make and retain a record showing the date the tests required under subsections
(1) and (2) were ordered and the results of the tests. If the tests were not
ordered by the physician or other person, the record must contain an explanation
of why the tests were not ordered.
(5) The test results and the records required under subsection (4) are not
public records, but are available to a local health department and to a
physician who provides medical treatment to the woman or her offspring.
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MINNESOTA
M.S.A. § 147D.05
147D.05. PROFESSIONAL CONDUCT
Subdivision 1. Practice standards.
a. A licensed traditional midwife shall provide an initial and ongoing
screening to ensure that each client receives safe and appropriate care. A
licensed traditional midwife shall only accept and provide care to those
women who are expected to have a normal pregnancy, labor, and delivery. As
part of the initial screening to determine whether any contraindications are
present, the licensed traditional midwife must take a detailed health
history that includes the woman’s social, medical, surgical, menstrual,
gynecological, contraceptive, obstetrical, family, nutritional, and
drug/chemical use histories. If a licensed traditional midwife determines at
any time during the course of the pregnancy that a woman’s condition may
preclude attendance by a traditional midwife, the licensed traditional
midwife must refer the client to a licensed health care provider. As part of
the initial and ongoing screening, a licensed traditional midwife must
provide or recommend that the client receive the following services, if
indicated, from an appropriate health care provider:
1. initial laboratory pregnancy screening, including blood group and type,
antibody screen, Indirect Coombs, rubella titer, CBC with differential
and syphilis serology;
2. gonorrhea and chlamydia cultures;
3. screening for sickle cell;
4. screening for hepatitis B and human immunodeficiency virus (HIV);
5. maternal serum alpha-fetoprotein test and ultrasound;
6. Rh antibody and glucose screening at 28 weeks gestation;
7. mandated newborn screening;
8. Rh screening of the infant for maternal RhoGAM treatment; and
9. screening for premature labor.
b. A client must make arrangements to have the results of any of the tests
described in paragraph (a) sent to the licensed traditional midwife
providing services to the client. The licensed traditional midwife must
include these results in the client’s record.
Subd. 2. Written plan. A licensed traditional midwife must prepare a written
plan with each client to ensure continuity of care throughout pregnancy, labor,
and delivery. The written plan must incorporate the conditions under which the
medical consultation plan, including the transfer of care or transport of the
client, may be implemented.
Subd. 3. Health regulations. A licensed traditional midwife must comply with all
applicable state and municipal requirements regarding public health.
Subd. 4. Client records. A licensed traditional midwife must maintain a client
record on each client, including:
1. a copy of the informed consent form described in section 147D.07;
2. evidence of an initial client screening described in this section;
3. a copy of the written plan described in subdivision 2;
4. a record of prenatal and postpartum care provided to the client at each
visit; and
5. a detailed record of the labor and delivery process.
Subd. 5. Data. All records maintained on each client by a licensed traditional
midwife are subject to sections 144.291 to 144.298.
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MISSOURI
V.A.M.S. 210.030
210.030. BLOOD TESTS OF PREGNANT WOMEN
1. Every licensed physician, midwife, registered nurse and all persons who may
undertake, in a professional way, the obstetrical and gynecological care of
a pregnant woman in the state of Missouri shall, if the woman consents, take
or cause to be taken a sample of venous blood of such woman at the time of
the first prenatal examination, or not later than twenty days after the
first prenatal examination, and subject such sample to an approved and
standard serological test for syphilis, an approved serological test for
hepatitis B and such other treatable diseases and metabolic disorders as are
prescribed by the department of health and senior services. In any area of
the state designated as a syphilis outbreak area by the department of health
and senior services, if the mother consents, a sample of her venous blood
shall be taken later in the course of pregnancy and at delivery for
additional testing for syphilis as may be prescribed by the department. If a
mother tests positive for hepatitis B, the physician or person who
professionally undertakes the pediatric care of a newborn shall also
administer the appropriate doses of hepatitis B vaccine and hepatitis B
immune globulin (HBIG) in accordance with the current recommendations of the
Advisory Committee on Immunization Practices (ACIP). If the mother’s
hepatitis B status is unknown, the appropriate dose of hepatitis B vaccine
shall be administered to the newborn in accordance with the current ACIP
recommendations. If the mother consents, a sample of her venous blood shall
be taken. If she tests positive for hepatitis B, hepatitis B immune globulin
(HBIG) shall be administered to the newborn in accordance with the current
ACIP recommendations.
2. The department of health and senior services shall, in consultation with the
Missouri genetic disease advisory committee, make such rules pertaining to
such tests as shall be dictated by accepted medical practice, and tests
shall be of the types approved by the department of health and senior
services. An approved and standard test for syphilis, hepatitis B, and other
treatable diseases and metabolic disorders shall mean a test made in a
laboratory approved by the department of health and senior services. No
individual shall be denied testing by the department of health and senior
services because of inability to pay.
V.A.M.S. 210.060
210.060. NONCOMPLIANCE A MISDEMEANOR–PENALTY
Any licensed physician, midwife, registered nurse and all persons who may
undertake, in a professional way, the obstetrical and gynecological care of
pregnant women in the state of Missouri, who shall publish in any manner not
required by law the result of said blood tests, or who, if a blood test is made,
fails to follow the provisions of sections 210.030 to 210.060 or who
misrepresents the facts required to be reported in said sections, shall, on
conviction, be adjudged guilty of a misdemeanor, and be punished by imprisonment
in the county jail not exceeding one year, or by a fine of not more than one
thousand dollars, or by both such fine and imprisonment.
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MONTANA
MCA 50-19-103
50-19-103. PRENATAL BLOOD SAMPLE REQUIRED FOR SEROLOGICAL TEST
1. Every female, regardless of age or marital status, seeking prenatal care
from a health care provider is required to submit a blood specimen for the
purpose of a standard serological test. In submitting the specimen to the
laboratory, the health care provider shall designate it as a prenatal test.
2. A health care provider who attends a pregnant woman shall at the first
professional visit take the blood sample and submit it to a laboratory.
3. A person permitted to attend a pregnant woman, but not permitted to take
blood samples, must have the sample taken by a person permitted to take
blood samples and submit it to a laboratory.
4. A health care provider who violates this part is guilty of a misdemeanor.
However, a health care provider who requests a sample of blood in accordance
with this provision and whose request is refused is not guilty of a
violation of this section.
MCA 37-27-312
37-27-312. SCREENING PROCEDURES
In addition to meeting the eligibility criteria for client screening established
by the board pursuant to 37-27-105, a direct-entry midwife shall recommend that
patients secure the following services by an appropriate health care provider:
1. the standard serological test, as defined in 50-19-101, for women seeking
prenatal care;
2. screening for human immunodeficiency virus, when appropriate;
3. maternal serum alpha-fetoprotein test and ultrasound, upon request;
4. Rh antibody and glucose screening at 28 weeks’ gestation, upon request;
5. nonstress testing by a fetal monitor of a fetus at greater than 42 1/2
weeks’ gestation or if other reasons indicate the testing;
6. screening for phenylketonuria;
7. Rh screening of the infant for RhoGAM treatment if the mother is Rh
negative; and
8. screening for premature labor and other risk factors.
MCA 50-19-109
50-19-109. WAIVER OF TEST BY COURT WHEN CONTRARY TO PATIENT’S RELIGIOUS CREED
The district court within the county wherein any person affected by this part
resides may waive the requirements of this part as to the person if the judge is
satisfied, by affidavit or other proof, that the tests required by the part are
contrary to the tenets or practices of the religious creed of which the
applicant is an adherent and that the public health and welfare will not be
injuriously affected thereby.
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NEBRASKA
NEB.REV.ST. § 71-502.03
71-502.03. PREGNANT WOMEN; SUBJECT TO SYPHILIS TEST; FEE; HUMAN IMMUNODEFICIENCY
VIRUS INFECTION TEST
1. Every physician, or other person authorized by law to practice obstetrics,
who is attending a pregnant woman in the state for conditions relating to
her pregnancy during the period of gestation or at delivery shall take or
cause to be taken a sample of the blood of such woman at the time of the
first examination and shall submit such sample to an approved laboratory for
a standard serological test for syphilis. Every other person permitted by
law to attend pregnant women in the state, but not permitted by law to take
blood samples, shall cause such a sample of the blood of such pregnant women
to be taken by a physician, duly licensed to practice either medicine and
surgery or obstetrics, or other person authorized by law to take such sample
of blood and have such sample submitted to an approved laboratory for a
standard serological test for syphilis. The results of all such laboratory
tests shall be reported to the Department of Health and Human Services on
standard forms prescribed and furnished by the department. For the purpose
of this section, a standard serological test shall be a test for syphilis
approved by the department and shall be made at a laboratory approved to
make such tests by the department. Such laboratory tests, as are required by
this section, shall be made on request at the Department of Health and Human
Services Laboratory. A fee may be established by rule and regulation by the
department to defray no more than the actual cost of such tests. Such fee
shall be deposited in the state treasury and credited to the Health and
Human Services Cash Fund. In reporting every birth and stillbirth,
physicians and others required to make such reports shall state on the
portion of the certificate entitled For Medical and Health Use Only whether
a blood test for syphilis has been made upon a specimen of blood taken from
the woman who bore the child for which a birth or stillbirth certificate is
filed and the approximate date when the specimen was taken. No birth
certificate shall show the result of such test. If no test was made, the
reason shall be stated. The department shall provide the necessary clerical,
printing, and other expenses in carrying out this section.
2. Every physician or other person authorized by law to practice obstetrics who
is attending a pregnant woman in the state for conditions relating to her
pregnancy during the period of gestation shall administer or cause to be
administered a test of the pregnant woman’s blood for the presence of the
human immunodeficiency virus infection unless the pregnant woman has given
written informed consent that she does not want to be tested.
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NEVADA
N.R.S. 442.010
442.010. EXAMINATION OF PREGNANT WOMAN FOR DISCOVERY OF SYPHILIS: BLOOD SAMPLE;
TREATMENT FOR INFECTION; EXCEPTION
1. Except as otherwise provided in subsection 6, every:
1. Physician attending a pregnant woman during gestation for conditions
relating to her pregnancy shall make an examination, including a standard
serological test, for the discovery of syphilis. The physician shall take
or cause to be taken a sample of blood of the woman at the times
prescribed by subsection 2, if applicable, and shall submit the sample to
a laboratory licensed pursuant to chapter 652 of NRS for a standard
serological test for syphilis.
2. Person permitted by law to attend upon pregnant women, but not permitted
by law to make blood tests in Nevada, shall cause a sample of the blood
of the pregnant woman to be taken at the times prescribed by subsection
2, if applicable, by a duly licensed physician and submitted to a
laboratory licensed pursuant to chapter 652 of NRS for a standard
serological test for syphilis.
3. Non-hospital medical facility or emergency department or labor and
delivery unit in a hospital that evaluates or treats a woman of
childbearing age shall ensure that:
1. The woman is asked if she is pregnant and, if she responds in the
affirmative, whether she has had the prenatal screenings and tests
recommended by the American College of Obstetricians and Gynecologists
or its successor organization; and
2. An examination is made, including a standard serological test, for the
discovery of syphilis, if the woman indicates that she is pregnant and
has not had the prenatal screenings and tests recommended by the
American College of Obstetricians and Gynecologists or its successor
organization. The non-hospital medical facility, emergency department
or labor and delivery unit shall ensure that a sample of blood of the
woman is taken at the times prescribed by subsection 2, if applicable,
and shall ensure the submission of the sample to a laboratory licensed
pursuant to chapter 652 of NRS for a standard serological test for
syphilis.
2. An examination for the discovery of syphilis pursuant to subsection 1 must
be performed:
1. During the first trimester of pregnancyat the first visit to a physician
or other person permitted by law to attend upon pregnant women, a
non-hospital medical facility or an emergency department or labor and
delivery unit of a hospital or as soon thereafter as practicable;
2. During thethird trimester of pregnancy between the 27th and 36th week of
gestation or as soon thereafter as practicable; and
3. At delivery for a pregnant woman who:
1. Should be routinely tested for infection with syphilis, as recommended
by the Centers for Disease Control and Prevention of the United States
Department of Health and Human Services;
2. Lives in an area designated by the Division as having high syphilis
morbidity;
3. Did not receive prenatal care; or
4. Delivers a stillborn infant after 20 weeks of gestation.
3. A qualified serological test for syphilis is one recognized as such by the
State Board of Health.
4. If the test is made in a state laboratory, it must be made without charge.
5. If a serological or physical examination test performed pursuant to
subsection 1 shows that a pregnant woman is infected with syphilis, the
physician, other person, non-hospital medical facility, emergency department
or labor and delivery unit shall:
1. If the physician, other person, non-hospital medical facility, emergency
department or labor and delivery unit is capable of providing treatment
for syphilis, seek the consent of the pregnant woman to begin such
treatment and, if such consent is obtained, commence treatment; or
2. If the physician, other person, non-hospital medical facility, emergency
department or labor and delivery unit is not capable of providing
treatment for syphilis, seek the consent of the pregnant woman to refer
her for such treatment and, if such consent is obtained, issue the
referral.
6. If the pregnant woman objects to the taking of the sample of blood or the
serological test, the sample must not be taken and the test must not be
performed.
7. As used in this section, “non-hospital medical facility” means:
1. An obstetric center;
2. An independent center for emergency medical care, as defined in NRS
449.013;
3. A psychiatric hospital, as defined in NRS 449.0165;
4. A rural clinic, as defined in NRS 449.0175;
5. A facility for modified medical detoxification, as defined in NRS
449.00385;
6. A mobile unit, as defined in NRS 449.01515; and
7. A community triage center, as defined in NRS 449.0031.
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NEW HAMPSHIRE
N.H. CODE ADMIN. R. MID 502.03
MID 502.03 REQUIREMENTS FOR PRENATAL CARE.
1. A midwife shall provide prenatal care to a client at least:
1. Once a month through the twenty-eighth week of pregnancy;
2. Once every 2 weeks from the twenty-eighth through the thirty-sixth week
of pregnancy; and
3. Once a week from the thirty-sixth week of pregnancy until the onset of
labor.
2. A midwife shall schedule the initial prenatal visit with a client in the
first or second trimester of pregnancy.
3. If a woman requesting midwifery services does not contact the midwife
before the third trimester of her pregnancy, the midwife shall accept her
as a client only if she:
1. Has had adequate prenatal care, or has met the criterion for a low risk
birth as defined by an NHCM’s scope of practice; and
2. Displays adequate fetal growth, fetal heart rate and fetal movement.
4. During the initial prenatal visit the midwife shall:
1. Obtain a maternal health, obstetrical, and gynecological history;
2. Perform a nutritional assessment and provide nutritional counseling;
3. Discuss the availability of options for screening and testing for fetal
abnormalities;
4. Obtain blood pressure;
5. Perform a pelvic exam, if indicated, including
1. Uterine sizing to estimate gestational age;
2. Pelvimetry;
3. A chlamydia and gonorrhea screening test; and
4. A Pap test’
6. Either perform or order blood analysis, including, but not limited to:
1. Blood group and Rh factor;
2. Antibody screen;
3. A complete blood count;
4. Rubella titre;
5. Syphilis serology;
6. Hepatitis B surface antigen;
7. Hepatitis C surface antigen, if indicated; and
8. HIV testing, if accepted by the client;
7. Recommend that the client receive a general physical exam by a qualified
health care provider to screen for general health problems that have the
potential to complicate the pregnancy or delivery; and
8. Obtain informed consent for midwifery care and out-of-hospital birth, to
include the following information:
1. A description of the midwife’s background and credentials;
2. Whether the midwife has professional liability coverage; and
3. The address and telephone number of the council, where complaints
against the midwife may be filed.
5. During subsequent prenatal visits the midwife shall:
1. Assess maternal nutrition and weight gain;
2. Obtain blood pressure;
3. Test urine for protein and glucose;
4. Assess general well-being;
5. Check for signs and symptoms of edema, bleeding, headache, visual
disturbances, or unusual vaginal discharge;
6. Obtain fundal height measurement;
7. Arrange for periodic hematocrit or hemoglobin testing;
8. Assess fetal heart rate and fetal activity;
9. Assess position and presentation of the fetus;
10. Perform or order the following as necessary:
1. Rh antibody screening;
2. Urinalysis;
3. Microscopic analysis of vaginal discharges;
4. Obstetric ultrasound;
5. Prophylactic Rh immune globulin injection;
6. Blood sugar screening;
7. Cultures; and
8. Thyroid screening, if indicated;
11. Observe aseptic technique and standard precautions; and
12. Discuss:
1. Any recent illnesses, symptoms, social or emotional problems;
2. Diet;
3. Medications and supplements;
4. Reading suggestions;
5. Exercise;
6. Rest and sleep requirements;
7. Sexuality;
8. Partner’s role;
9. Birth preparation;
10. Newborn care;
11. Parenting; and
12. Transportation arrangements.
6. A midwife shall advise any client with genital herpes of the ACOG herpes
protocol current at the time of the midwife’s conversation with the client.
7. A midwife shall discuss with clients the standards of care and
recommendations for testing for and treating of group B streptococcus.
8. A midwife shall encourage any client expecting a first child to attend
childbirth education classes.
1. A midwife shall discuss with the client, during the prenatal period, the
selection of a pediatrician, family physician, or other health care
provider who will assume care of the newborn.
2. A midwife shall alert the client to:
1. Signs of complications that necessitate immediate contact with the
midwife; and
2. Signs of labor and when it is time to call the midwife.
9. A midwife shall be on call or make specific arrangements for on call
coverage with another midwife or licensed health care provider whose scope
of practice includes birth.
10. In the third trimester, a midwife shall ensure that a client is adequately
preparing for birth in an out-of-hospital location by discussing:
1. The place of the birth and the facilities available there;
2. The availability of adequate heat and water;
3. The supplies the client must procure;
4. The availability of a telephone;
5. Arrangements for help after the birth;
6. With a client preparing for birth in a private home, the importance of
keeping readily available the following written information, as
appropriate:
1. The name, location, and phone number of the nearest ambulance
service;
2. The name, location, and phone number of the nearest hospital;
3. The name and phone number of the newborn’s health care provider; and
4. The street address of the location of the birth and directions to
that location from the nearest ambulance service; and
11. The transfer of care to a hospital setting in an emergency.
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NEW JERSEY
N.J.A.C. 8:43A–28.8
8:43A–28.8 ADDITIONAL PATIENT CARE SERVICES
a. A certified nurse-midwife and/or physician shall perform an initial physical
assessment of the patient and an evaluation of the patient’s medical and
emotional needs.
b. A certified nurse-midwife and/or physician shall develop and implement a
plan of care, if needed, for each patient with the patient’s participation.
The plan shall include at least care and treatment to be provided for the
duration of the pregnancy, including laboratory studies and provision for
the patient’s health, psychosocial and nutritional needs.
c. Each patient shall have at least the following prenatal laboratory tests and
diagnostic procedures performed:
1. Urinalysis for glucose and protein;
2. Hemoglobin and hematocrit repeated at 28 weeks;
3. Sickle cells preparation (when appropriate);
4. Rh factor and blood typing;
5. Serological test for syphilis at the first prenatal visit, and in the
last trimester of pregnancy or at delivery. If the patient is exposed to
an infected partner, a serological test for syphilis shall be performed
no sooner than three weeks after exposure;
6. Papanicolaou smear at the first prenatal visit if not documented within
the previous six months;
7. Tuberculin test with indicated follow-up if in close contact with a
diagnosed case of tuberculosis or from a high-incidence area so
designated by the Department;
8. Rubella titer. If this is negative, rubella vaccine with appropriate
counseling regarding timing of future pregnancies shall be offered to
the patient after delivery and prior to discharge from the birth center;
9. One hour glucose tolerance test at 28 weeks gestation, if indicated by
risk factors;
10. Maternal serum alpha-fetoprotein testing offered at 15 to 20 weeks; and
11. Hepatitis B virus screen with appropriate follow-up.
d. Each patient shall be individually counseled about her progress in pregnancy
by a certified nurse-midwife, physician, or a registered professional nurse
at every visit, and a progress note shall be recorded in the patient’s
medical record.
e. Each patient shall be examined at least once a month during the first seven
months of gestation. Thereafter, the patient shall be seen every two weeks
until 36 weeks and once a week thereafter. The examination shall be
performed by either a certified nurse midwife or a physician.
f. The results of all tests performed during patient examinations shall be
documented in the patient’s medical record including at a minimum: blood
pressure, weight, dipstick urine analysis for glucose and protein, uterine
growth, fetal heart rate, abdominal inspection and palpation, any unusual
symptoms reported by the patient, and any physical evidence of abnormality.
Evaluation of nutritional status and breast and pelvic examinations shall be
documented on a regular basis. The medical record shall be in conformance
with J.A.C. 8:33C–4.3.
N.J.S.A. 26:4-49.1
26:4-49.1. PREGNANT WOMEN; BLOOD SAMPLE; STANDARD SEROLOGICAL TEST FOR SYPHILIS
Every physician attending pregnant women in the State for conditions relating to
their pregnancy during the period of gestation and/or at delivery shall, in the
case of every woman so attended, take or cause to be taken a sample of blood of
such woman at the time of first examination and take or cause to be taken a
sample of blood of the woman or from the umbilical cord of the infant at the
time of delivery of a live infant, and shall submit such sample to an approved
laboratory for a standard serological test for syphilis. Every other person
permitted by law to attend pregnant women in the State, but not permitted by law
to take blood samples, shall cause a sample of blood of such pregnant women or
postpartum woman or infant, as the case may be, to be taken by a physician duly
licensed to practice medicine and surgery and have such sample submitted to an
approved laboratory for a standard serological test for syphilis.
N.J.S.A. 26:4-49.2
26:4-49.2. STANDARD SEROLOGICAL TEST; DUTY OF STATE DEPARTMENT OF HEALTH
For the purpose of this act a standard serological test shall be a test for
syphilis approved by the State Department of Health, and shall be made at a
laboratory licensed in syphilis serology by the department, or by a laboratory
in this State approved to make such tests by said department, or at a laboratory
outside this State approved by said department, or the health department of the
state or territory of the United States or District of Columbia wherein it is
located, or at a laboratory of the Armed Forces of the United States or the
United States Public Health Services. Such laboratory tests as are required by
this act may, at the option of the department, be performed in the laboratories
of the State Department of Health without charge.
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NEW MEXICO
N. M. S. A. 1978, § 24-1-10
§ 24-1-10. PREGNANCY; SEROLOGICAL TEST FOR SYPHILIS
1. Every physician examining a pregnant woman for conditions relating to her
pregnancy during the period of gestation or at delivery or both shall take
or cause to be taken a sample of blood of such woman at the time of first
examination.
2. All such blood samples shall be submitted to the state public health
laboratory for a standard serological test for syphilis.
3. The standard serological test shall be a test for syphilis approved by the
director of the department. Such serological tests shall be made on request
without charge by the department.
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NEW YORK
§ 2308. SEXUALLY TRANSMITTED DISEASE; PREGNANT WOMEN; BLOOD TEST FOR SYPHILIS
1. Every physician attending pregnant women in the state shall in the case of
every woman so attended take or cause to be taken a sample of blood of such
woman at the time of first examination, and submit such sample to an
approved laboratory for a standard serological test for syphilis.
2. Every other person permitted by law to attend upon pregnant women in the
state but not permitted by law to take blood tests, shall cause a sample of
the blood of such pregnant woman to be taken promptly by a duly licensed
physician and submitted to an approved laboratory for a standard serological
test for syphilis.
3. The term “approved laboratory” means a laboratory approved for the purpose
as herein provided by the department, or in the city of New York by the
department of health of such city.
4. A standard serological test for syphilis is one recognized as such by the
department or in the city of New York by the department of health of such
city.
§ 2308-A. SEXUALLY TRANSMITTED DISEASES; TESTS FOR SEXUALLY TRANSMITTED DISEASES
1. The administrative officer or other person in charge of a clinic or other
facility providing gynecological, obstetrical, genito-urological,
contraceptive, sterilization or termination of pregnancy services or
treatment shall require the staff of such clinic or facility to offer to
administer to every resident of the state of New York coming to such clinic
or facility for such services or treatment, appropriate examinations or
tests for the detection of sexually transmitted diseases.
2. Each physician providing gynecological, obstetrical, genito-urological,
contraceptive, sterilization, or termination of pregnancy services or
treatment shall offer to administer to every resident of the state of New
York coming to such physician for such services or treatment, appropriate
examinations or tests for the detection of sexually transmitted diseases.
10 NYCRR 69-2.2*
SECTION 69-2.2. CORD BLOOD TEST FOR SYPHILIS
Every responsible physician or birth attendant shall acquire from all infants
born, whether alive or dead after 22 weeks gestation, a sample of blood from the
umbilical cord and submit it to an approved laboratory for standard serological
tests for syphilis. If body blood from the mother is tested for syphilis at the
time of birth, the cord blood test requirement shall be waived if the infant’s
body blood is tested after any positive test result of the mother’s blood.
*10 NYCRR 69-2.2 requires testing of the infant’s cord blood at delivery. While
this law did not meet our coding criteria of being a test of the woman, it may
nevertheless be relevant for purposes of congenital syphilis prevention.
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NORTH CAROLINA
10A NCAC 41A.0204
.0204 CONTROL MEASURES–SEXUALLY TRANSMITTED DISEASES
a. Local health departments shall provide diagnosis, testing, treatment,
follow-up, and preventive services for syphilis, gonorrhea, chlamydia,
nongonococcal urethritis, mucopurulent cervicitis, chancroid,
lymphogranuloma venereum, and granuloma inguinale. These services shall be
provided upon request and at no charge to the patient.
b. Persons infected with, exposed to, or reasonably suspected of being infected
with gonorrhea, chlamydia, non-gonococcal urethritis, and mucopurulent
cervicitis shall:
1. Refrain from sexual intercourse until examined and diagnosed and
treatment is completed, and all lesions are healed;
2. Be tested, treated, and re-evaluated in accordance with the STD Treatment
Guidelines published by the U.S. Public Health Service. The
recommendations contained in the STD Treatment Guidelines are the
required control measures for testing, treatment, and follow-up for
gonorrhea, chlamydia, nongonococcal urethritis, and mucopurulent
cervicitis, and are incorporated by reference including subsequent
amendments and editions. A copy of this publication is on file for public
viewing with the and a copy may be obtained free of charge by writing the
Division of Public Health, 1915 Mail Service Center, Raleigh, North
Carolina 27699-1915, and requesting a copy. However, urethral Gram stains
may be used for diagnosis of males rather than gonorrhea cultures unless
treatment has failed;
3. Notify all sexual partners from 30 days before the onset of symptoms to
completion of therapy that they must be evaluated by a physician or local
health department.
c. Persons infected with, exposed to, or reasonably suspected of being infected
with syphilis, lymphogranuloma venereum, granuloma inguinale, and chancroid
shall:
1. Refrain from sexual intercourse until examined and diagnosed and
treatment is completed, and all lesions are healed;
2. Be tested, treated, and re-evaluated in accordance with the STD Treatment
Guidelines published by t h e U.S. Public Health Service. The
recommendations contained in the STD Treatment Guidelines are the
required control measures for testing, treatment, and follow-up for
syphilis, lymphogranuloma venereum, granuloma inguinale, and chancroid,
except that chancroid cultures are not required;
3. Give names to a disease intervention specialist employed by the local
health department or by the Division of Public Health for contact tracing
of all sexual partners and others as listed in this Rule:
A. for syphilis:
i. congenital–parents and siblings;
ii. primary–all partners from three months before the onset of
symptoms to completion of therapy and healing of lesions;
iii. secondary–all partners from six months before the onset of
symptoms to completion of therapy and healing of lesions; and
iv. latent–all partners from 12 months before the onset of symptoms
to completion of therapy and healing of lesions and, in addition,
for women with late latent, spouses and children;
B. for lymphogranuloma venereum:
i. if there is a primary lesion and no buboes, all partners from 30
days before the onset of symptoms to completion of therapy and
healing of lesions; and
ii. if there are buboes all partners from six months before the onset
of symptoms to completion of therapy and healing of lesions;
C. for granuloma inguinale–all partners from three months before the
onset of symptoms to completion of therapy and healing of lesions; and
D. or chancroid–all partners from ten days before the onset of symptoms
to completion of therapy and healing of lesions.
d. All persons evaluated or reasonably suspected of being infected with any
sexually transmitted disease shall be tested for syphilis, encouraged to be
tested confidentially for HIV, and counseled about how to reduce the risk of
acquiring sexually transmitted disease, including the use of condoms.
e. All pregnant women shall be tested for syphilis, chlamydia and gonorrhea at
the first prenatal visit. All pregnant women shall be tested for syphilis
between 28 and 30 weeks of gestation and at delivery. Hospitals shall
determine the syphilis serologic status of the mother prior to discharge of
the newborn so that if necessary the newborn can be evaluated and treated as
provided in (c)(2) of this rule. Pregnant women 25 years of age and younger
shall be tested for chlamydia and gonorrhea in the third trimester or at
delivery if the woman was not tested in the third trimester.
f. Any woman who delivers a stillborn infant shall be tested for syphilis.
g. All newborn infants shall be treated prophylactically against gonococcal
ophthalmia neonatorum in accordance with the STD Treatment Guidelines
published by the U.S. Public Health Service. The recommendations contained
in the STD Treatment Guidelines are the required prophylactic treatment
against gonococcal ophthalmia neonatorum.
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OHIO
R.C. § 3701.49
3701.49 DUTY IN CASE PHYSICIAN IS NOT IN ATTENDANCE
If any pregnant woman is attended during the period of gestation by any person
authorized to attend pregnant women, other than a licensed physician, but who is
not permitted to take test specimens, then such authorized person shall notify
immediately the health commissioner of the city or general health district of
the residence of such pregnant woman. The health commissioner shall cause the
test specimens to be taken of such pregnant woman for the purpose of the
standard syphilis and gonorrhea tests. Such taking of specimens is subject to
section 3701.50 of the Revised Code relating to the condition of the pregnant
woman.
R.C. § 3701.50
3701.50 DUTY OF PHYSICIAN TO SUBMIT SAMPLE FOR TESTS; WAIVER
Every physician who attends any pregnant woman for conditions relating to
pregnancy during the period of gestation shall take specimens of such woman at
the time of first examination or within ten days thereof, and shall submit such
specimens to an approved laboratory for standard syphilis and gonorrhea tests.
If, in the opinion of the physician attending such woman, her condition does not
permit the taking of specimens for submission to an approved laboratory, then no
specimens shall be taken prior to delivery. If no specimens are taken prior to
delivery because of the woman’s condition, then such specimens shall be taken as
soon after delivery as the physician deems it advisable.
The health commissioner of the city or general health district, wherein any
person required to be tested for syphilis and gonorrhea under this section or
section 3701.49 of the Revised Code resides, may waive the requirements of such
sections if the commissioner is satisfied by written affidavit or other written
proof that the tests required are contrary to the tenets or practices of the
religious creed of which the person is an adherent, and that the public health
and welfare would not be injuriously affected by such waiver.
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OKLAHOMA
63 OKL.ST.ANN. § 1-515
§ 1-515. PREGNANT WOMEN–TESTS FOR SYPHILIS
1. Every physician, physician assistant, or Advanced Practice Registered Nurse
attending a pregnant woman in this state during gestation shall, in the case
of each woman so attended, take or cause to be taken a sample of blood of
such woman, and shall submit such sample to an approved laboratory for a
standard serological test for syphilis, when indicated by current guidance
of the Centers for Disease Control and Prevention.
2. Every other person permitted by law to attend upon pregnant women in the
state but not permitted by law to take blood tests shall cause a sample of
the blood of such pregnant woman to be taken by a duly licensed physician,
physician assistant, or Advanced Practice Registered Nurse, licensed to
practice in this state, and submitted to an approved laboratory for a
standard serological test for syphilis.
3. The term “approved laboratory” shall mean a laboratory approved for the
purposes of this section by the State Commissioner of Health. A standard
serological test for syphilis shall be one recognized as such by the
Commissioner. Such laboratory tests shall be made, on request, without
charge by the State Department of Health.
63 OKL.ST.ANN. § 1-516.1
§ 1-516.1. EXEMPTION
None of the provisions of this act shall apply to any person who, as an exercise
of religious freedom, administers to or treats the sick or suffering by
spiritual means or prayer, nor to any person who, because of religious belief,
in good faith selects and depends upon such spiritual means or prayer for the
treatment or cure of disease.
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OREGON
O.R.S. § 433.017
433.017. PREGNANT WOMEN; MANDATORY BLOOD TESTS
1. A licensed physician, physician assistant licensed under ORS 677.505 to 525,
naturopathic physician licensed under ORS chapter 685 or nurse practitioner
licensed under ORS 678.375 to 678.390 attending a pregnant woman in this
state for conditions relating to her pregnancy during the period of
gestation or at the time of delivery shall, as required by rule of the
Oregon Health Authority, take or cause to be taken a sample of blood of
every woman so attended at the time of the first professional visit or
within 10 days thereafter. The blood specimen obtained under this subsection
must be submitted to a licensed laboratory for tests related to any
infectious condition which may affect a pregnant woman or fetus, as the
authority shall by rule require, including but not limited to an HIV test as
defined in ORS 433.045.
2. Every other person permitted by law to attend a pregnant woman in this
state, but not permitted by law to take blood samples, shall, as required by
rule of the authority, cause a sample of blood of such pregnant woman to be
taken by a licensed physician, physician assistant licensed under ORS
677.505 to 525, naturopathic physician licensed under ORS chapter 685 or
nurse practitioner licensed under ORS 678.375 to 678.390 and have such
sample submitted to a licensed laboratory for the tests described under
subsection (1) of this section.
3. In all cases under subsections (1) and (2) of this section the physician,
physician assistant, naturopathic physician or nurse practitioner shall
request consent of the patient to take a blood sample. A sample may not be
taken without the patient’s consent.
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PENNSYLVANIA
§ 521.13. PRENATAL EXAMINATION FOR SYPHILIS
a. Every physician who attends, treats or examines any pregnant woman for
conditions relating to pregnancy, during the period of gestation or at
delivery, shall take or cause to be taken, unless the woman dissents, a
sample of blood of such woman at the time of first examination, or within
fifteen days thereof, and shall submit the sample to an approved laboratory
for an approved serological test for syphilis. All other persons permitted
by law to attend pregnant women, but not permitted by law to take blood
samples, shall, unless the woman dissents, likewise cause a sample of the
blood of every such pregnant woman attended by them to be taken by a
physician licensed to practice in this Commonwealth and submit it to an
approved laboratory for an approved serological test. In the event of
dissent, it shall be the duty of the physician to explain to the pregnant
woman the desirability of such a test. The serological test required by this
section shall be made, without charge by the department, upon the request of
the physician submitting the sample, if he submits a certificate that the
patient is unable to pay.
b. In reporting every birth and fetal death, physicians and others required to
make such reports shall state upon the certificate whether or not the blood
test required by this section was made. If the test was made, the date of
the test shall be given. If the test was not made, it shall be stated
whether it was not made because, in the opinion of the physician, the test
was not advisable or because the woman dissented.
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RHODE ISLAND
GEN.LAWS 1956, § 23-11-8
§ 23-11-8. BLOOD TEST OF PREGNANT WOMEN
It shall be the duty of every physician engaged in prenatal attendance upon a
pregnant woman to obtain a blood specimen of that pregnant woman within thirty
(30) days after the first professional visit. That blood specimen shall be
submitted to the laboratory of the state department of health, or to a
laboratory approved by the department, for the performance of a Wassermann or
other standard laboratory blood test for syphilis. Any violation of the
provisions of this section shall constitute a misdemeanor and that physician
shall be fined not less than ten dollars ($10.00) nor more than one hundred
dollars ($100) for each offense.
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SOUTH CAROLINA
CODE 1976 § 44-29-120
§ 44-29-120. SEROLOGICAL BLOOD TESTS FOR PREGNANT WOMEN.
Every physician attending a pregnant woman in the State for conditions relating
to her pregnancy during the period of gestation or at delivery shall, in the
case of every woman so attended, take or cause to be taken a sample of blood of
such woman at the time of his first examination or within three days thereafter
and shall submit such sample to an approved laboratory for a standard
serological test for syphilis, rubella, Rh factor and a hemoglobin
determination, if the latter test is not performed by the physician’s staff.
Such an approved laboratory must participate in an appropriate proficiency
testing program approved by the Department of Health and Environmental Control.
Every person, other than a physician, permitted by law to attend pregnant women
in the State, but not permitted by law to take blood samples, shall cause a
sample of blood of each such pregnant woman to be taken by a physician duly
licensed to practice medicine and surgery, registered nurse, laboratory
technician or other person authorized to take blood for blood tests and have
such sample submitted to an approved laboratory for a standard serological test
for syphilis, rubella, Rh factor and a hemoglobin determination, if the latter
test is not performed by the physician’s staff. Any person who violates any of
the provisions of this section shall be guilty of a misdemeanor and, upon
conviction, shall be punished by a fine of not more than one hundred dollars or
imprisonment for not more than thirty days. The provisions of this section shall
not apply to any person who submits a sworn affidavit stating that she objects
to the tests herein required on grounds such tests conflict with her religious
tenets or beliefs.
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SOUTH DAKOTA
SDCL § 34-23-9
34-23-9. ATTENDING PHYSICIAN TO TAKE BLOOD SAMPLE FROM PREGNANT WOMAN–SUBMISSION
TO OFFICE OF LABORATORY SERVICES FOR TESTING
Each physician attending a pregnant woman in this state during gestation shall,
in the case of each woman so attended, take or cause to be taken a sample of
blood of such woman at the time of the first examination, and submit such sample
for standard serological tests for syphilis to the Office of Laboratory Services
or such other laboratories cooperating with, and approved by, the Department of
Health.
SDCL § 34-23-10
34-23-10. BLOOD SAMPLE AND TESTING WHEN PREGNANT WOMAN NOT ATTENDED BY PHYSICIAN
Every person other than a physician permitted by law to attend upon pregnant
women in the state but not permitted by law to take blood tests, shall cause a
sample of the blood of such pregnant woman to be taken by a duly licensed
physician and submitted for standard serological tests for syphilis to the
Office of Laboratory Services or such other laboratories cooperating with, and
approved by, the Department of Health.
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TENNESSEE
T. C. A. § 68-5-602
§ 68-5-602. EXAMINATION OF PREGNANT WOMEN; TAKING OF BLOOD DURING FIRST EXAM;
HEPATITIS B TREATMENT
a. Every physician, surgeon, or other person permitted by law to attend a
pregnant woman during gestation shall, in the case of each woman so
attended, take or cause to be taken a sample of the blood of the woman at
the time of first examination and visit or within ten (10) days after the
first examination. If the first visit is at the time of delivery, or after
delivery, the standard serological test required by this subsection (a)
shall be performed at that time. The blood sample shall be sent to a
laboratory approved by the department for testing for syphilis infection,
rubella immunity, and hepatitis B surface antigen (HBsAg). In the same
manner, a sample of blood shall be taken during or after the twenty-eighth
week of gestation for a woman whom the attending physician determines to be
at high risk of hepatitis B or syphilis according to the current standards
of care. This second sample shall be sent to a laboratory approved by the
department for testing for syphilis infection and HBsAg only. Additional
testing for rubella immunity is not required in subsequent pregnancies once
a positive result is verified or a documented history of vaccination against
rubella is available. However, all pregnant women shall be tested for
syphilis and hepatitis B during an early prenatal visit in each pregnancy. A
positive test for syphilis and hepatitis B shall be reported to the local
health department in accordance with this chapter, and regulations governing
the control of communicable diseases in Tennessee.
b. Every person attending a pregnant woman who is not permitted by law to take
blood samples shall cause a sample of blood to be taken by a health provider
permitted by law to take the samples at the time of first examination and
visit or within ten (10) days after the first examination. These samples
shall be submitted to the same approved laboratories for testing for
syphilis infection and HBsAg. If no rubella immunity is documented, testing
for rubella is required.
c. Infants born to HBsAg-postive mothers shall receive, in a timely manner, the
appropriate treatment as recognized by the centers for disease control.
d. This part shall not apply to any female who files with the attending medical
authority a signed, written statement that taking a sample of blood or
receiving other preventive measures conflict with the female’s religious
tenets and practices affirmed under the penalties of perjury.
T. C. A. § 68-5-603
§ 68-5-603. FREE TESTING
a. Upon request, the laboratory tests required by this part shall be made
without charge in the laboratories of the department.
b. This section shall not be interpreted to mean that the department’s
laboratories shall be the only laboratory approved to perform these tests.
T. C. A. § 68-5-607
§ 68-5-607. CRIMES AND OFFENSES
a. 1. Any person who misrepresents any of the facts called for by the
serological examination, or who in any way alters the determination of a
serological examination, commits a Class C misdemeanor.
2. It is the duty of the district attorney general to prosecute the suit
when requested by the commissioner, the county health officer or local
board of health.
b. Any physician or representative of a laboratory who willfully and knowingly
misrepresents, falsifies, or issues false information under this part
commits a Class C misdemeanor.
c. It is the duty of the district attorney general in whose jurisdiction an
offense is committed to institute proceedings against violators of this
part.
d. It is the duty of the commissioner to give all assistance necessary for the
enforcement of this part to the district attorney general representing the
county in which proceedings may be instituted.
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TEXAS
V.T.C.A., HEALTH & SAFETY CODE § 81.090
§ 81.090. DIAGNOSTIC TESTING DURING PREGNANCY AND AFTER BIRTH
(a) A physician or other person permitted by law to attend a pregnant woman
during gestation or at delivery of an infant shall:
1. take or cause to be taken a sample of the woman’s blood or other appropriate
specimen at the first examination and visit;
2. submit the sample to an appropriately certified laboratory for diagnostic
testing approved by the United States Food and Drug Administration for:
A. syphilis;
B. HIV infection; and
C. hepatitis B infection; and
3. retain a report of each case for nine months and deliver the report to any
successor in the case.
(a-1) A physician or other person permitted by law to attend a pregnant woman
during gestation or at delivery of an infant shall:
1. take or cause to be taken a sample of the woman’s blood or other appropriate
specimen at an examination in the third trimester of the pregnancy, but not
earlier than the 28th week of the pregnancy;
2. submit the sample to an appropriately certified laboratory for a diagnostic
test approved by the United States Food and Drug Administration for syphilis
and HIV infection; and
3. retain a report of each case for nine months and deliver the report to any
successor in the case.
(b) A successor is presumed to have complied with this section if the successor
in good faith obtains a record that indicates compliance with Subsections (a)
and (a-1), if applicable.
(c) A physician or other person in attendance at a delivery shall:
1. take or cause to be taken a sample of blood or other appropriate specimen
from the mother on admission for delivery; and
2. submit the sample to an appropriately certified laboratory for diagnostic
testing approved by the United States Food and Drug Administration for
hepatitis B infection and syphilis.
(c-1) If the physician or other person in attendance at the delivery does not
find in the woman’s medical records results from the diagnostic test for
syphilis and HIV infection performed under Subsection (a-1), the physician or
person shall:
1. take or cause to be taken a sample of blood or other appropriate specimen
from the mother;
2. submit the sample to an appropriately certified laboratory for diagnostic
testing approved by the United States Food and Drug Administration for
syphilis and HIV infection; and
3. instruct the laboratory to expedite the processing of the HIV test so that
the results are received less than six hours after the time the sample is
submitted.
(c-2) If the physician or other person responsible for the newborn child does
not find in the woman’s medical records results from a diagnostic test for
syphilis and HIV infection performed under Subsection (a-1), and the diagnostic
test for syphilis and HIV infection was not performed before delivery under
Subsection (c-1), the physician or other person responsible for the newborn
child shall:
1. take or cause to be taken a sample of blood or other appropriate specimen
from the newborn child less than two hours after the time of birth;
2. submit the sample to an appropriately certified laboratory for a diagnostic
test approved by the United States Food and Drug Administration for syphilis
and HIV infection; and
3. instruct the laboratory to expedite the processing of the HIV test so that
the results are received less than six hours after the time the sample is
submitted.
(d) Repealed by Acts 2009, 81st Leg., ch. 1124, § 7.
(e) Repealed by Acts 2009, 81st Leg., ch. 1124, § 7.
(f) Repealed by Acts 2009, 81st Leg., ch. 1124, § 7.
(g) Repealed by Acts 1993, 73rd Leg., ch. 30, § 3, eff. Sept. 1, 1993.
(h) Repealed by Acts 2009, 81st Leg., ch. 1124, § 7.
(i) Before conducting or causing to be conducted a diagnostic test for HIV
infection under this section, the physician or other person shall advise the
woman that the result of a test taken under this section is confidential as
provided by Subchapter F,1 but that the test is not anonymous. The physician or
other person shall explain the difference between a confidential and an
anonymous test to the woman and that an anonymous test may be available from
another entity. The physician or other person shall make the information
available in another language, if needed, and if resources permit. The
information shall be provided by the physician or another person, as needed, in
a manner and in terms understandable to a person who may be illiterate if
resources permit.
(j) The result of a test for HIV infection under Subsection (a)(2)(B), (a-1),
(c-1), or (c-2) is a test result for purposes of Subchapter F.
(k) Before the sample is taken, the health care provider shall distribute to the
patient printed materials about AIDS, HIV, hepatitis B, and syphilis. A health
care provider shall verbally notify the patient that an HIV test shall be
performed if the patient does not object. If the patient objects, the patient
shall be referred to an anonymous testing facility or instructed about anonymous
testing methods. The health care provider shall note on the medical records that
the distribution of printed materials was made and that verbal notification was
given. The materials shall be provided to the health care provider by the
department and shall be prepared and designed to inform the patients about:
1. the incidence and mode of transmission of AIDS, HIV, hepatitis B, and
syphilis;
2. how being infected with HIV, AIDS, hepatitis B, or syphilis could affect the
health of their child;
3. the available cure for syphilis;
4. the available treatment to prevent maternal-infant HIV transmission; and
5. methods to prevent the transmission of the HIV virus, hepatitis B, and
syphilis.
(l) A physician or other person may not conduct a diagnostic test for HIV
infection under Subsection (a)(2)(B), (a-1), or (c-1) if the woman objects. A
physician or other person may not conduct a diagnostic test for HIV infection
under Subsection (c-2) if a parent, managing conservator, or guardian objects.
(m) If a screening test and a confirmatory test conducted under this section
show that the woman is or may be infected with HIV, hepatitis B, or syphilis,
the physician or other person who submitted the sample for the test shall
provide or make available to the woman disease-specific information on the
disease diagnosed, including:
1. information relating to treatment of HIV infection, acquired immune
deficiency syndrome, hepatitis B, or syphilis, which must be in another
language, if needed, and must be presented, as necessary, in a manner and in
terms understandable to a person who may be illiterate if resources permit;
and
2. counseling under Section 81.109, if HIV infection or AIDS is diagnosed.
(n) A physician or other person may comply with the requirements of Subsection
(m)(1) by referring the woman to an entity that provides treatment for
individuals infected with the disease diagnosed.
(o) In this section, “HIV” has the meaning assigned by Section 81.101.
(p) Not later than January 1 of each odd-numbered year, the department shall
report to the legislature the number of cases of early congenital syphilis and
of late congenital syphilis that were diagnosed in this state in the preceding
biennium.
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UTAH
U.C.A. 1953 § 26B-7-216
FORMERLY CITED AS UT ST § 26-6-20
§ 26B-7-216. SEROLOGICAL TESTING OF PREGNANT OR RECENTLY DELIVERED WOMEN
1. As used in this section, a “standard serological test” means a test for
syphilis approved by the department and made at an approved laboratory.
2. 1. Every licensed physician and surgeon attending a pregnant or recently
delivered woman for conditions relating to her pregnancy shall take or
cause to be taken a sample of blood of the woman at the time of first
examination or within 10 days thereafter.
2. The blood sample shall be submitted to an approved laboratory for a
standard serological test for syphilis.
3. The provisions of this section do not apply to any female who objects
thereto on the grounds that she is a bona fide member of a specified,
well recognized religious organization whose teachings are contrary to
the tests.
3. 1. Every other person attending a pregnant or recently delivered woman, who
is not permitted by law to take blood samples, shall within 10 days from
the time of first attendance cause a sample of blood to be taken by a
licensed physician or physician assistant.
2. The blood sample shall be submitted to an approved laboratory for a
standard serological test for syphilis.
4. 1. An approved laboratory is a laboratory approved by the department
according to its rules governing the approval of laboratories for the
purpose of this title.
2. In submitting the sample to the laboratory the physician or physician
assistant shall designate whether it is a prenatal test or a test
following recent delivery.
5. The laboratory shall transmit a detailed report of the standard serological
test, showing the result thereof to the physician or physician assistant.
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VERMONT
18 V.S.A. § 1102
§ 1102. TAKING BLOOD SAMPLES
A practitioner of medicine and surgery or osteopathy attending a pregnant
individual shall take samples of blood of such individual, if possible prior to
the third month of gestation, and submit the same to a laboratory approved by
the Commissioner for a standard serological test for syphilis. Every other
person permitted by law to take blood tests shall similarly cause a sample of
blood of a pregnant individual attended by the person to be taken by a duly
licensed practitioner of medicine and surgery or osteopathy and submit it to a
laboratory approved by the Commissioner for a standard serological test for
syphilis.
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VIRGINIA
VA CODE ANN. § 32.1-73
§ 32.1-73. FAILURE TO COMPLY WITH PROVISIONS; GROUNDS FOR REVOCATION OF LICENSE
OR PERMIT
The failure of any physician, nurse or midwife to comply with the provisions of
§ 32.1-60, § 32.1-62 or § 32.1-65 shall, in addition to any other penalty
prescribed by law, constitute grounds for revocation of the license or permit of
such physician, nurse or midwife by the board issuing such license or permit.
VA CODE ANN. § 32.1-60
§ 32.1-60. PRENATAL TESTS REQUIRED
Every physician, physician assistant, or advanced practice registered nurse
attending a pregnant woman during gestation shall examine and test such woman
for such venereal diseases as the Board may designate within 15 days after
beginning such attendance. Every other person permitted by law to attend upon
pregnant women but not permitted by law to make such examinations and tests
shall cause such examinations and tests to be made by a licensed physician,
licensed advanced practice registered nurse, or clinic. Serological tests
required by this section may be performed by the Department of General Services,
Division of Consolidated Laboratory Services (DCLS).
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WASHINGTON
WEST’S RCWA 70.24.090
70.24.090. PREGNANT WOMEN–TEST FOR SYPHILIS
Every physician attending a pregnant woman in the state of Washington during
gestation shall, in the case of each woman so attended, take or cause to be
taken a sample of blood of such woman at the time of first examination, and
submit such sample to an approved laboratory for a standard serological test for
syphilis. If the pregnant woman first presents herself for examination after the
fifth month of gestation the physician or other attendant shall in addition to
the above, advise and urge the patient to secure a medical examination and blood
test before the fifth month of any subsequent pregnancies.
WEST’S RCWA 70.24.080
70.24.080. PENALTY
Except as provided in RCW 70.24.025 and 70.24.027, any person who violates any
of the provisions of this chapter or any rule adopted by the board under this
chapter, or who fails or refuses to obey any lawful order issued by any state,
county or municipal health officer under this chapter shall be deemed guilty of
a gross misdemeanor punishable as provided under RCW 9A.20.021.
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WEST VIRGINIA
W. VA. CODE, § 16-4A-2
§ 16-4A-2. ATTENDING PHYSICIAN TO OBTAIN BLOOD SPECIMEN
Every physician engaging in attendance upon a pregnant woman in West Virginia
shall, as soon as he or she is engaged to attend a woman and has reasonable
grounds for suspecting that pregnancy exists, acquaint such woman with the
provisions of this article and take or cause to be taken a specimen of blood
from such woman. This specimen shall be submitted to the state hygienic
laboratory or other laboratory approved by the state department of health as
required by the preceding section. If the woman is in a stage of gestation or
labor at the time that the diagnosis of pregnancy is made, which may make it
inadvisable to obtain the specimen, the specimen of blood shall be obtained
within ten days following delivery.
The state hygienic laboratory of the state health department shall perform the
serological tests required by law on all blood specimens taken from pregnant
women by physicians for examination. These tests shall be performed without
charge.
Upon request it shall be the duty of county and district health officers to draw
blood specimens from pregnant women for performing thereon a serologic test for
syphilis. This service shall be performed without charge.
In those areas where the services of a district or county health officer are not
available, the state health department shall assume the responsibility of
obtaining the required blood specimens without any charge to the pregnant women.
W. VA. CODE, § 16-4A-5
§ 16-4A-5. OFFENSES; PENALTY
Any physician or representative of a laboratory, making such examinations or
tests as are required by this article, or filing such birth or stillbirth
certificates, who shall knowingly misrepresent any of the facts called for in
the laboratory reports or birth or stillbirth certificate, or who otherwise
knowingly and wilfully[sic] shall violate any provision of this article, shall
be guilty of a misdemeanor and upon conviction thereof shall be subject to a
fine of not less than ten dollars nor more than fifty dollars.
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WYOMING
W.S.1977 § 35-4-501
§ 35-4-501. DEFINITION OF STANDARD SEROLOGICAL TEST; COST
For the purposes of this act [§§ 35-4-501 through 35-4-505], a standard
serological test shall be a test for syphilis approved by the state department
of health, and shall be performed in a laboratory approved by the state
department of health. Such laboratory tests as are required by this act shall be
performed on request without charge at the state department of health
laboratory.
W.S.1977 § 35-4-502
§ 35-4-502. DUTY OF ATTENDING PHYSICIAN
Every physician licensed to practice medicine attending a pregnant woman in the
state for conditions relating to her pregnancy during the period of gestation or
at delivery shall take, or cause to be taken, a sample of blood of such woman at
the time of her first professional visit or within ten (10) days thereafter. The
blood specimen thus obtained shall be submitted to an approved laboratory for a
standard serological test for syphilis. Every other person permitted by law to
attend pregnant women in the state but not permitted by law to take blood
samples, shall cause a sample of blood of such pregnant women to be taken by a
physician duly licensed to practice medicine and have such sample submitted to
an approved laboratory for a standard serological test for syphilis.
W.S.1977 § 35-4-504
§ 35-4-504. PENALTY
Any licensed physician and surgeon, or other person, engaged in attendance upon
a pregnant woman during the period of gestation and/or at delivery, or any
representative of a laboratory who violates the provisions of this act [§§
35-4-501 through 35-4-505] shall be guilty of a misdemeanor, and upon conviction
thereof shall be fined not to exceed one hundred dollars ($100.00); provided,
however, every licensed physician and surgeon or other person engaged in
attendance upon a pregnant woman during the period of gestation or at delivery,
who requests such specimen in accordance with the provisions of W.S. 35-4-502,
and whose request is refused, shall not be guilty of a misdemeanor.
Top of Page
Last Reviewed: November 1, 2023
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