(d) Notification letters shall be sent to the designated officer at the municipal or private provider agencies listed on the ambulance run sheet. Except in municipalities with a population over 1,000,000, a list attached to the ambulance run sheet must contain all municipal and private provider agency personnel who have provided any pre-hospital care immediately prior to transport. In municipalities with a population over 1,000,000, the ambulance run sheet must contain the company number or unit designation number for any fire department personnel who have provided any pre-hospital care immediately prior to transport. The letter shall state the names of crew members listed on the attachment to the ambulance run sheet and the name of the communicable disease diagnosed, but shall not contain the patient's name. Upon receipt of such notification letter, the applicable private provider agency or the designated infectious disease control officer of a municipal fire department or fire protection district shall contact all personnel involved in the pre-hospital or inter-hospital care and transport of the patient. Such notification letter may, but is not required to, consist of the following form: NOTIFICATION LETTER
(NAME OF HOSPITAL)
(ADDRESS)
TO:...... (Name of Organization)
FROM:..... (Infection Control Coordinator)
DATE:.....
As required by Section 6.08 of the Illinois Hospital Licensing Act,..... (name of hospital) is hereby providing notification that the following crew members or agencies transported or provided pre-hospital care to a patient on..... (date), and the transported patient was later diagnosed as having..... (name of communicable disease):..... (list of crew members if known). The Hospital Licensing Act requires you to maintain this information as a confidential medical record. Disclosure of this information may therefore result in civil liability for the individual or company breaching the patient's confidentiality, or both.
If you have any questions regarding this patient, please contact me at..... (telephone number), between..... (hours).
Questions regarding exposure or the financial aspects of obtaining medical care should be directed to your employer.