SB2886 - 104th General Assembly
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| 1 | AN ACT concerning health. | |||||||||||||||||||
| 2 | Be it enacted by the People of the State of Illinois, | |||||||||||||||||||
| 3 | represented in the General Assembly: | |||||||||||||||||||
| 4 | Section 5. The Genetic Information Privacy Act is amended | |||||||||||||||||||
| 5 | by changing Sections 5, 10, 15, 20, 25, 30, 31, 31.1, 31.2, | |||||||||||||||||||
| 6 | 31.3, 31.5, 31.7, 31.8, 31.9, 31.10, and 50 as follows: | |||||||||||||||||||
| 7 | (410 ILCS 513/5) | |||||||||||||||||||
| 8 | Sec. 5. Legislative findings; intent. The General Assembly | |||||||||||||||||||
| 9 | finds that: | |||||||||||||||||||
| 10 | (1) The use of genetic testing, biomarker testing, or | |||||||||||||||||||
| 11 | both can be valuable to an individual. | |||||||||||||||||||
| 12 | (2) Despite existing laws, regulations, and | |||||||||||||||||||
| 13 | professional standards which require or promote voluntary | |||||||||||||||||||
| 14 | and confidential use of genetic testing and biomarker | |||||||||||||||||||
| 15 | testing information, many members of the public are | |||||||||||||||||||
| 16 | deterred from seeking genetic testing or biomarker testing | |||||||||||||||||||
| 17 | because of fear that test results will be disclosed | |||||||||||||||||||
| 18 | without consent in a manner not permitted by law or will be | |||||||||||||||||||
| 19 | used in a discriminatory manner. | |||||||||||||||||||
| 20 | (3) The public health will be served by facilitating | |||||||||||||||||||
| 21 | voluntary and confidential nondiscriminatory use of | |||||||||||||||||||
| 22 | genetic testing and biomarker testing information. | |||||||||||||||||||
| 23 | (4) The use of electronic health record systems and | |||||||||||||||||||
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| 1 | the exchange of patient records, both paper and | ||||||
| 2 | electronic, through secure means, including through secure | ||||||
| 3 | health information exchanges, should be encouraged to | ||||||
| 4 | improve patient health care and care coordination, | ||||||
| 5 | facilitate public health reporting, and control health | ||||||
| 6 | care costs, among other purposes. | ||||||
| 7 | (5) Limiting the use or disclosure of, and requests | ||||||
| 8 | for, protected health information to the minimum necessary | ||||||
| 9 | to accomplish an intended purpose, when being transmitted | ||||||
| 10 | by or on behalf of a covered entity under HIPAA, is a key | ||||||
| 11 | component of health information privacy. The disclosure of | ||||||
| 12 | genetic information or biomarkers, when allowed by this | ||||||
| 13 | Act, shall be performed in accordance with the minimum | ||||||
| 14 | necessary standard when required under HIPAA. | ||||||
| 15 | (Source: P.A. 98-1046, eff. 1-1-15.) | ||||||
| 16 | (410 ILCS 513/10) | ||||||
| 17 | Sec. 10. Definitions. As used in this Act: | ||||||
| 18 | "Biomarker" has the meaning ascribed to it in Section | ||||||
| 19 | 356z.46 of the Illinois Insurance Code. | ||||||
| 20 | "Biomarker testing" has the meaning ascribed to it in | ||||||
| 21 | Section 356z.46 of the Illinois Insurance Code. | ||||||
| 22 | "Business associate" has the meaning ascribed to it under | ||||||
| 23 | HIPAA, as specified in 45 CFR 160.103. | ||||||
| 24 | "Covered entity" has the meaning ascribed to it under | ||||||
| 25 | HIPAA, as specified in 45 CFR 160.103. | ||||||
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| 1 | "De-identified information" means health information that | ||||||
| 2 | is not individually identifiable as described under HIPAA, as | ||||||
| 3 | specified in 45 CFR 164.514(b). | ||||||
| 4 | "Disclosure" has the meaning ascribed to it under HIPAA, | ||||||
| 5 | as specified in 45 CFR 160.103. | ||||||
| 6 | "Employer" means the State of Illinois, any unit of local | ||||||
| 7 | government, and any board, commission, department, | ||||||
| 8 | institution, or school district, any party to a public | ||||||
| 9 | contract, any joint apprenticeship or training committee | ||||||
| 10 | within the State, and every other person employing employees | ||||||
| 11 | within the State. | ||||||
| 12 | "Employment agency" means both public and private | ||||||
| 13 | employment agencies and any person, labor organization, or | ||||||
| 14 | labor union having a hiring hall or hiring office regularly | ||||||
| 15 | undertaking, with or without compensation, to procure | ||||||
| 16 | opportunities to work, or to procure, recruit, refer, or place | ||||||
| 17 | employees. | ||||||
| 18 | "Family member" means, with respect to an individual, (i) | ||||||
| 19 | the spouse of the individual; (ii) a dependent child of the | ||||||
| 20 | individual, including a child who is born to or placed for | ||||||
| 21 | adoption with the individual; (iii) any other person | ||||||
| 22 | qualifying as a covered dependent under a managed care plan; | ||||||
| 23 | and (iv) all other individuals related by blood or law to the | ||||||
| 24 | individual or the spouse or child described in subsections (i) | ||||||
| 25 | through (iii) of this definition. | ||||||
| 26 | "Genetic information" has the meaning ascribed to it under | ||||||
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| 1 | HIPAA, as specified in 45 CFR 160.103. | ||||||
| 2 | "Genetic monitoring" means the periodic examination of | ||||||
| 3 | employees to evaluate acquired modifications to their genetic | ||||||
| 4 | material, such as chromosomal damage or evidence of increased | ||||||
| 5 | occurrence of mutations that may have developed in the course | ||||||
| 6 | of employment due to exposure to toxic substances in the | ||||||
| 7 | workplace in order to identify, evaluate, and respond to | ||||||
| 8 | effects of or control adverse environmental exposures in the | ||||||
| 9 | workplace. | ||||||
| 10 | "Genetic services" has the meaning ascribed to it under | ||||||
| 11 | HIPAA, as specified in 45 CFR 160.103. | ||||||
| 12 | "Genetic testing" and "genetic test" have the meaning | ||||||
| 13 | ascribed to "genetic test" under HIPAA, as specified in 45 CFR | ||||||
| 14 | 160.103. "Genetic testing" includes direct-to-consumer | ||||||
| 15 | commercial genetic testing. | ||||||
| 16 | "Health care operations" has the meaning ascribed to it | ||||||
| 17 | under HIPAA, as specified in 45 CFR 164.501. | ||||||
| 18 | "Health care professional" means (i) a licensed physician, | ||||||
| 19 | (ii) a licensed physician assistant, (iii) a licensed advanced | ||||||
| 20 | practice registered nurse, (iv) a licensed dentist, (v) a | ||||||
| 21 | licensed podiatric physician, (vi) a licensed genetic | ||||||
| 22 | counselor, or (vii) an individual certified to provide genetic | ||||||
| 23 | testing by a state or local public health department. | ||||||
| 24 | "Health care provider" has the meaning ascribed to it | ||||||
| 25 | under HIPAA, as specified in 45 CFR 160.103. | ||||||
| 26 | "Health facility" means a hospital, blood bank, blood | ||||||
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| 1 | center, sperm bank, or other health care institution, | ||||||
| 2 | including any "health facility" as that term is defined in the | ||||||
| 3 | Illinois Finance Authority Act. | ||||||
| 4 | "Health information exchange" or "HIE" means a health | ||||||
| 5 | information exchange or health information organization that | ||||||
| 6 | exchanges health information electronically. In certain | ||||||
| 7 | circumstances, in accordance with HIPAA, an HIE will be a | ||||||
| 8 | business associate. | ||||||
| 9 | "Health oversight agency" has the meaning ascribed to it | ||||||
| 10 | under HIPAA, as specified in 45 CFR 164.501. | ||||||
| 11 | "HIPAA" means the Health Insurance Portability and | ||||||
| 12 | Accountability Act of 1996, Public Law 104-191, as amended by | ||||||
| 13 | the Health Information Technology for Economic and Clinical | ||||||
| 14 | Health Act of 2009, Public Law 111-05, and any subsequent | ||||||
| 15 | amendments thereto and any regulations promulgated thereunder. | ||||||
| 16 | "Insurer" means (i) an entity that is subject to the | ||||||
| 17 | jurisdiction of the Director of Insurance and (ii) a managed | ||||||
| 18 | care plan. | ||||||
| 19 | "Labor organization" includes any organization, labor | ||||||
| 20 | union, craft union, or any voluntary unincorporated | ||||||
| 21 | association designed to further the cause of the rights of | ||||||
| 22 | union labor that is constituted for the purpose, in whole or in | ||||||
| 23 | part, of collective bargaining or of dealing with employers | ||||||
| 24 | concerning grievances, terms or conditions of employment, or | ||||||
| 25 | apprenticeships or applications for apprenticeships, or of | ||||||
| 26 | other mutual aid or protection in connection with employment, | ||||||
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| 1 | including apprenticeships or applications for apprenticeships. | ||||||
| 2 | "Licensing agency" means a board, commission, committee, | ||||||
| 3 | council, department, or officers, except a judicial officer, | ||||||
| 4 | in this State or any political subdivision authorized to | ||||||
| 5 | grant, deny, renew, revoke, suspend, annul, withdraw, or amend | ||||||
| 6 | a license or certificate of registration. | ||||||
| 7 | "Limited data set" has the meaning ascribed to it under | ||||||
| 8 | HIPAA, as described in 45 CFR 164.514(e)(2). | ||||||
| 9 | "Managed care plan" means a plan that establishes, | ||||||
| 10 | operates, or maintains a network of health care providers that | ||||||
| 11 | have entered into agreements with the plan to provide health | ||||||
| 12 | care services to enrollees where the plan has the ultimate and | ||||||
| 13 | direct contractual obligation to the enrollee to arrange for | ||||||
| 14 | the provision of or pay for services through: | ||||||
| 15 | (1) organizational arrangements for ongoing quality | ||||||
| 16 | assurance, utilization review programs, or dispute | ||||||
| 17 | resolution; or | ||||||
| 18 | (2) financial incentives for persons enrolled in the | ||||||
| 19 | plan to use the participating providers and procedures | ||||||
| 20 | covered by the plan. | ||||||
| 21 | A managed care plan may be established or operated by any | ||||||
| 22 | entity including a licensed insurance company, hospital or | ||||||
| 23 | medical service plan, health maintenance organization, limited | ||||||
| 24 | health service organization, preferred provider organization, | ||||||
| 25 | third party administrator, or an employer or employee | ||||||
| 26 | organization. | ||||||
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| 1 | "Minimum necessary" means HIPAA's standard for using, | ||||||
| 2 | disclosing, and requesting protected health information found | ||||||
| 3 | in 45 CFR 164.502(b) and 164.514(d). | ||||||
| 4 | "Nontherapeutic purpose" means a purpose that is not | ||||||
| 5 | intended to improve or preserve the life or health of the | ||||||
| 6 | individual whom the information concerns. | ||||||
| 7 | "Organized health care arrangement" has the meaning | ||||||
| 8 | ascribed to it under HIPAA, as specified in 45 CFR 160.103. | ||||||
| 9 | "Patient safety activities" has the meaning ascribed to it | ||||||
| 10 | under 42 CFR 3.20. | ||||||
| 11 | "Payment" has the meaning ascribed to it under HIPAA, as | ||||||
| 12 | specified in 45 CFR 164.501. | ||||||
| 13 | "Person" includes any natural person, partnership, | ||||||
| 14 | association, joint venture, trust, governmental entity, public | ||||||
| 15 | or private corporation, health facility, or other legal | ||||||
| 16 | entity. | ||||||
| 17 | "Protected health information" has the meaning ascribed to | ||||||
| 18 | it under HIPAA, as specified in 45 CFR 164.103. | ||||||
| 19 | "Research" has the meaning ascribed to it under HIPAA, as | ||||||
| 20 | specified in 45 CFR 164.501. | ||||||
| 21 | "State agency" means an instrumentality of the State of | ||||||
| 22 | Illinois and any instrumentality of another state which | ||||||
| 23 | pursuant to applicable law or a written undertaking with an | ||||||
| 24 | instrumentality of the State of Illinois is bound to protect | ||||||
| 25 | the privacy of genetic information of Illinois persons or | ||||||
| 26 | biomarkers of Illinois persons. | ||||||
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| 1 | "Treatment" has the meaning ascribed to it under HIPAA, as | ||||||
| 2 | specified in 45 CFR 164.501. | ||||||
| 3 | "Use" has the meaning ascribed to it under HIPAA, as | ||||||
| 4 | specified in 45 CFR 160.103, where context dictates. | ||||||
| 5 | (Source: P.A. 103-508, eff. 8-4-23; 104-417, eff. 8-15-25.) | ||||||
| 6 | (410 ILCS 513/15) | ||||||
| 7 | Sec. 15. Confidentiality of genetic information. | ||||||
| 8 | (a) Except as otherwise provided in this Act, biomarker | ||||||
| 9 | testing, information derived from biomarker testing, genetic | ||||||
| 10 | testing, and information derived from genetic testing are is | ||||||
| 11 | confidential and privileged and may be released only to the | ||||||
| 12 | individual tested and to persons specifically authorized, in | ||||||
| 13 | writing in accordance with Section 30, by that individual to | ||||||
| 14 | receive the information. Except as otherwise provided in | ||||||
| 15 | subsection (b) and in Section 30, this information shall not | ||||||
| 16 | be admissible as evidence, nor discoverable in any action of | ||||||
| 17 | any kind in any court, or before any tribunal, board, agency, | ||||||
| 18 | or person pursuant to Part 21 of Article VIII of the Code of | ||||||
| 19 | Civil Procedure. No liability shall attach to any hospital, | ||||||
| 20 | physician, or other health care provider for compliance with | ||||||
| 21 | the provisions of this Act including a specific written | ||||||
| 22 | release by the individual in accordance with this Act. | ||||||
| 23 | (b) When a biological sample is legally obtained by a | ||||||
| 24 | peace officer for use in a criminal investigation or | ||||||
| 25 | prosecution, information derived from genetic testing of that | ||||||
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| 1 | sample may be disclosed for identification purposes to | ||||||
| 2 | appropriate law enforcement authorities conducting the | ||||||
| 3 | investigation or prosecution and may be used in accordance | ||||||
| 4 | with Section 5-4-3 of the Unified Code of Corrections. The | ||||||
| 5 | information may be used for identification purposes during the | ||||||
| 6 | course of the investigation or prosecution with respect to the | ||||||
| 7 | individual tested without the consent of the individual and | ||||||
| 8 | shall be admissible as evidence in court. | ||||||
| 9 | The information shall be confidential and may be disclosed | ||||||
| 10 | only for purposes of criminal investigation or prosecution. | ||||||
| 11 | Genetic testing and genetic information derived thereof | ||||||
| 12 | shall be admissible as evidence and discoverable, subject to a | ||||||
| 13 | protective order, in any actions alleging a violation of this | ||||||
| 14 | Act, seeking to enforce Section 30 of this Act through the | ||||||
| 15 | Illinois Insurance Code, alleging discriminatory genetic | ||||||
| 16 | testing or use of genetic information under the Illinois Human | ||||||
| 17 | Rights Act or the Illinois Civil Rights Act of 2003, or | ||||||
| 18 | requesting a workers' compensation claim under the Workers' | ||||||
| 19 | Compensation Act. | ||||||
| 20 | (c) If the subject of the information requested by law | ||||||
| 21 | enforcement is found innocent of the offense or otherwise not | ||||||
| 22 | criminally penalized, then the court records shall be expunged | ||||||
| 23 | by the court within 30 days after the final legal proceeding. | ||||||
| 24 | The court shall notify the subject of the information of the | ||||||
| 25 | expungement of the records in writing. | ||||||
| 26 | (d) Results of genetic testing that indicate that the | ||||||
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| 1 | individual tested is at the time of the test afflicted with a | ||||||
| 2 | disease, whether or not currently symptomatic, are not subject | ||||||
| 3 | to the confidentiality requirements of this Act. | ||||||
| 4 | (Source: P.A. 95-927, eff. 1-1-09.) | ||||||
| 5 | (410 ILCS 513/20) | ||||||
| 6 | Sec. 20. Use of genetic testing information for insurance | ||||||
| 7 | purposes. | ||||||
| 8 | (a) An insurer may not seek information derived from | ||||||
| 9 | genetic testing or biomarker testing for use in connection | ||||||
| 10 | with a policy of accident and health insurance. Except as | ||||||
| 11 | provided in subsection (c), an insurer that receives | ||||||
| 12 | information derived from genetic testing or biomarker testing, | ||||||
| 13 | regardless of the source of that information, may not use the | ||||||
| 14 | information for a nontherapeutic purpose as it relates to a | ||||||
| 15 | policy of accident and health insurance. | ||||||
| 16 | (b) An insurer shall not use or disclose protected health | ||||||
| 17 | information that is genetic information or a biomarker for | ||||||
| 18 | underwriting purposes. For purposes of this Section, | ||||||
| 19 | "underwriting purposes" means, with respect to an insurer: | ||||||
| 20 | (1) rules for, or determination of, eligibility | ||||||
| 21 | (including enrollment and continued eligibility) for, or | ||||||
| 22 | determination of, benefits under the plan, coverage, or | ||||||
| 23 | policy (including changes in deductibles or other | ||||||
| 24 | cost-sharing mechanisms in return for activities such as | ||||||
| 25 | completing a health risk assessment or participating in a | ||||||
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| 1 | wellness program); | ||||||
| 2 | (2) the computation of premium or contribution amounts | ||||||
| 3 | under the plan, coverage, or policy (including discounts, | ||||||
| 4 | rebates, payments in kind, or other premium differential | ||||||
| 5 | mechanisms in return for activities, such as completing a | ||||||
| 6 | health risk assessment or participating in a wellness | ||||||
| 7 | program); | ||||||
| 8 | (3) the application of any pre-existing condition | ||||||
| 9 | exclusion under the plan, coverage, or policy; and | ||||||
| 10 | (4) other activities related to the creation, renewal, | ||||||
| 11 | or replacement of a contract of health insurance or health | ||||||
| 12 | benefits. | ||||||
| 13 | "Underwriting purposes" does not include determinations of | ||||||
| 14 | medical appropriateness where an individual seeks a benefit | ||||||
| 15 | under the plan, coverage, or policy. | ||||||
| 16 | This subsection (b) does not apply to insurers that are | ||||||
| 17 | issuing a long-term care policy, excluding a nursing home | ||||||
| 18 | fixed indemnity plan. | ||||||
| 19 | (c) An insurer may consider the results of genetic testing | ||||||
| 20 | or biomarker testing in connection with a policy of accident | ||||||
| 21 | and health insurance if the individual voluntarily submits the | ||||||
| 22 | results and the results are favorable to the individual. | ||||||
| 23 | (d) An insurer that possesses information derived from | ||||||
| 24 | genetic testing or biomarker testing may not release the | ||||||
| 25 | information to a third party, except as specified in this Act. | ||||||
| 26 | (e) A company providing direct-to-consumer commercial | ||||||
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| 1 | genetic testing or biomarker testing is prohibited from | ||||||
| 2 | sharing any genetic test information or biomarker information | ||||||
| 3 | or other personally identifiable information about a consumer | ||||||
| 4 | with any health or life insurance company without written | ||||||
| 5 | consent from the consumer. | ||||||
| 6 | (Source: P.A. 101-132, eff. 1-1-20.) | ||||||
| 7 | (410 ILCS 513/25) | ||||||
| 8 | Sec. 25. Use of genetic testing information or biomarker | ||||||
| 9 | testing information by employers. | ||||||
| 10 | (a) An employer, employment agency, labor organization, | ||||||
| 11 | and licensing agency shall treat genetic testing, and genetic | ||||||
| 12 | information, biomarker testing, and biomarkers in such a | ||||||
| 13 | manner that is consistent with the requirements of federal | ||||||
| 14 | law, including but not limited to the Genetic Information | ||||||
| 15 | Nondiscrimination Act of 2008, the Americans with Disabilities | ||||||
| 16 | Act, Title VII of the Civil Rights Act of 1964, the Family and | ||||||
| 17 | Medical Leave Act of 1993, the Occupational Safety and Health | ||||||
| 18 | Act of 1970, the Federal Mine Safety and Health Act of 1977, or | ||||||
| 19 | the Atomic Energy Act of 1954. | ||||||
| 20 | (b) An employer may release genetic testing or biomarker | ||||||
| 21 | testing information only in accordance with this Act. | ||||||
| 22 | (c) An employer, employment agency, labor organization, | ||||||
| 23 | and licensing agency shall not directly or indirectly do any | ||||||
| 24 | of the following: | ||||||
| 25 | (1) solicit, request, require, or purchase biomarker | ||||||
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| 1 | testing, biomarkers, genetic testing, or genetic | ||||||
| 2 | information of a person or a family member of the person, | ||||||
| 3 | or administer a genetic test or biomarker test to a person | ||||||
| 4 | or a family member of the person as a condition of | ||||||
| 5 | employment, preemployment application, labor organization | ||||||
| 6 | membership, or licensure; | ||||||
| 7 | (2) affect the terms, conditions, or privileges of | ||||||
| 8 | employment, preemployment application, labor organization | ||||||
| 9 | membership, or licensure, or terminate the employment, | ||||||
| 10 | labor organization membership, or licensure of any person | ||||||
| 11 | because of biomarker testing, biomarkers, genetic testing, | ||||||
| 12 | or genetic information with respect to the employee or | ||||||
| 13 | family member, or information about a request for or the | ||||||
| 14 | receipt of genetic testing or biomarker testing by such | ||||||
| 15 | employee or family member of such employee; | ||||||
| 16 | (3) limit, segregate, or classify employees in any way | ||||||
| 17 | that would deprive or tend to deprive any employee of | ||||||
| 18 | employment opportunities or otherwise adversely affect the | ||||||
| 19 | status of the employee as an employee because of biomarker | ||||||
| 20 | testing, biomarkers, genetic testing, or genetic | ||||||
| 21 | information with respect to the employee or a family | ||||||
| 22 | member, or information about a request for or the receipt | ||||||
| 23 | of biomarker testing, biomarkers, genetic testing, or | ||||||
| 24 | genetic information by such employee or family member of | ||||||
| 25 | such employee; and | ||||||
| 26 | (4) retaliate through discharge or in any other manner | ||||||
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| 1 | against any person alleging a violation of this Act or | ||||||
| 2 | participating in any manner in a proceeding under this | ||||||
| 3 | Act. | ||||||
| 4 | (d) An agreement between a person and an employer, | ||||||
| 5 | prospective employer, employment agency, labor organization, | ||||||
| 6 | or licensing agency, or its employees, agents, or members | ||||||
| 7 | offering the person employment, labor organization membership, | ||||||
| 8 | licensure, or any pay or benefit in return for taking a genetic | ||||||
| 9 | test or biomarker test is prohibited. | ||||||
| 10 | (e) An employer shall not use biomarker testing, | ||||||
| 11 | biomarkers, genetic information, or genetic testing in | ||||||
| 12 | furtherance of a workplace wellness program benefiting | ||||||
| 13 | employees unless (1) health or genetic services are offered by | ||||||
| 14 | the employer, (2) the employee provides written authorization | ||||||
| 15 | in accordance with Section 30 of this Act, (3) only the | ||||||
| 16 | employee or family member if the family member is receiving | ||||||
| 17 | genetic services and the licensed health care professional or | ||||||
| 18 | licensed genetic counselor involved in providing such services | ||||||
| 19 | receive individually identifiable information concerning the | ||||||
| 20 | results of such services, and (4) any individually | ||||||
| 21 | identifiable information is only available for purposes of | ||||||
| 22 | such services and shall not be disclosed to the employer | ||||||
| 23 | except in aggregate terms that do not disclose the identity of | ||||||
| 24 | specific employees. An employer shall not penalize an employee | ||||||
| 25 | who does not disclose his or her genetic information or | ||||||
| 26 | biomarkers or does not choose to participate in a program | ||||||
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| 1 | requiring disclosure of the employee's genetic information or | ||||||
| 2 | biomarkers. | ||||||
| 3 | (f) Nothing in this Act shall be construed to prohibit | ||||||
| 4 | biomarker testing or genetic testing of an employee who | ||||||
| 5 | requests a biomarker test or genetic test and who provides | ||||||
| 6 | written authorization, in accordance with Section 30 of this | ||||||
| 7 | Act, from taking a biomarker test or genetic test for the | ||||||
| 8 | purpose of initiating a workers' compensation claim under the | ||||||
| 9 | Workers' Compensation Act. | ||||||
| 10 | (g) A purchase of commercially and publicly available | ||||||
| 11 | documents, including newspapers, magazines, periodicals, and | ||||||
| 12 | books but not including medical databases or court records or | ||||||
| 13 | inadvertently requesting family medical history by an | ||||||
| 14 | employer, employment agency, labor organization, and licensing | ||||||
| 15 | agency does not violate this Act. | ||||||
| 16 | (h) Nothing in this Act shall be construed to prohibit an | ||||||
| 17 | employer that conducts DNA analysis for law enforcement | ||||||
| 18 | purposes as a forensic laboratory and that includes such | ||||||
| 19 | analysis in the Combined DNA Index System pursuant to the | ||||||
| 20 | federal Violent Crime Control and Law Enforcement Act of 1994 | ||||||
| 21 | from requesting or requiring genetic testing or genetic | ||||||
| 22 | information of such employer's employees, but only to the | ||||||
| 23 | extent that such genetic testing or genetic information is | ||||||
| 24 | used for analysis of DNA identification markers for quality | ||||||
| 25 | control to detect sample contamination. | ||||||
| 26 | (i) Nothing in this Act shall be construed to prohibit an | ||||||
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| 1 | employer from requesting or requiring genetic information to | ||||||
| 2 | be used for genetic monitoring of the biological effects of | ||||||
| 3 | toxic substances in the workplace, but only if (1) the | ||||||
| 4 | employer provides written notice of the genetic monitoring to | ||||||
| 5 | the employee; (2) the employee provides written authorization | ||||||
| 6 | under Section 30 of this Act or the genetic monitoring is | ||||||
| 7 | required by federal or State law; (3) the employee is informed | ||||||
| 8 | of individual monitoring results; (4) the monitoring is in | ||||||
| 9 | compliance with any federal genetic monitoring regulations or | ||||||
| 10 | State genetic monitoring regulations under the authority of | ||||||
| 11 | the federal Occupational Safety and Health Act of 1970; and | ||||||
| 12 | (5) the employer, excluding any health care provider, health | ||||||
| 13 | care professional, or health facility that is involved in the | ||||||
| 14 | genetic monitoring program, receives the results of the | ||||||
| 15 | monitoring only in aggregate terms that do not disclose the | ||||||
| 16 | identity of specific employees. | ||||||
| 17 | (j) Despite lawful acquisition of biomarker testing, | ||||||
| 18 | biomarkers, genetic testing, or genetic information under | ||||||
| 19 | subsections (e) through (i) of this Section, an employer, | ||||||
| 20 | employment agency, labor organization, and licensing agency | ||||||
| 21 | still may not use or disclose the biomarker test, biomarkers, | ||||||
| 22 | genetic test, or genetic information in violation of this Act. | ||||||
| 23 | (k) Except as provided in subsections (e), (f), (h), and | ||||||
| 24 | (i) of this Section, a person shall not knowingly sell to or | ||||||
| 25 | interpret for an employer, employment agency, labor | ||||||
| 26 | organization, or licensing agency, or its employees, agents, | ||||||
| |||||||
| |||||||
| 1 | or members, a biomarker test or genetic test of an employee, | ||||||
| 2 | labor organization member, or license holder, or of a | ||||||
| 3 | prospective employee, member, or license holder. | ||||||
| 4 | (Source: P.A. 100-396, eff. 1-1-18.) | ||||||
| 5 | (410 ILCS 513/30) | ||||||
| 6 | Sec. 30. Disclosure of person tested and test results. | ||||||
| 7 | (a) No person may disclose or be compelled to disclose the | ||||||
| 8 | identity of any person upon whom a genetic test or biomarker | ||||||
| 9 | test is performed or the results of a genetic test or biomarker | ||||||
| 10 | test in a manner that permits identification of the subject of | ||||||
| 11 | the test, except to the following persons: | ||||||
| 12 | (1) The subject of the test or the subject's legally | ||||||
| 13 | authorized representative. This paragraph does not create | ||||||
| 14 | a duty or obligation under which a health care provider | ||||||
| 15 | must notify the subject's spouse or legal guardian of the | ||||||
| 16 | test results, and no such duty or obligation shall be | ||||||
| 17 | implied. No civil liability or criminal sanction under | ||||||
| 18 | this Act shall be imposed for any disclosure or | ||||||
| 19 | nondisclosure of a test result to a spouse by a physician | ||||||
| 20 | acting in good faith under this paragraph. For the purpose | ||||||
| 21 | of any proceedings, civil or criminal, the good faith of | ||||||
| 22 | any physician acting under this paragraph shall be | ||||||
| 23 | presumed. | ||||||
| 24 | (2) Any person designated in a specific written | ||||||
| 25 | legally effective authorization for release of the test | ||||||
| |||||||
| |||||||
| 1 | results executed by the subject of the test or the | ||||||
| 2 | subject's legally authorized representative. | ||||||
| 3 | (3) An authorized agent or employee of a health | ||||||
| 4 | facility or health care provider if the health facility or | ||||||
| 5 | health care provider itself is authorized to obtain the | ||||||
| 6 | test results, the agent or employee provides patient care, | ||||||
| 7 | and the agent or employee has a need to know the | ||||||
| 8 | information in order to conduct the tests or provide care | ||||||
| 9 | or treatment. | ||||||
| 10 | (4) A health facility, health care provider, or health | ||||||
| 11 | care professional that procures, processes, distributes, | ||||||
| 12 | or uses: | ||||||
| 13 | (A) a human body part from a deceased person with | ||||||
| 14 | respect to medical information regarding that person; | ||||||
| 15 | or | ||||||
| 16 | (B) semen provided prior to the effective date of | ||||||
| 17 | this Act for the purpose of artificial insemination. | ||||||
| 18 | (5) Health facility staff committees for the purposes | ||||||
| 19 | of conducting program monitoring, program evaluation, or | ||||||
| 20 | service reviews. | ||||||
| 21 | (6) In the case of a minor under 18 years of age, the | ||||||
| 22 | health care provider, health care professional, or health | ||||||
| 23 | facility who ordered the test shall make a reasonable | ||||||
| 24 | effort to notify the minor's parent or legal guardian if, | ||||||
| 25 | in the professional judgment of the health care provider, | ||||||
| 26 | health care professional, or health facility, notification | ||||||
| |||||||
| |||||||
| 1 | would be in the best interest of the minor and the health | ||||||
| 2 | care provider, health care professional, or health | ||||||
| 3 | facility has first sought unsuccessfully to persuade the | ||||||
| 4 | minor to notify the parent or legal guardian or after a | ||||||
| 5 | reasonable time after the minor has agreed to notify the | ||||||
| 6 | parent or legal guardian, the health care provider, health | ||||||
| 7 | care professional, or health facility has reason to | ||||||
| 8 | believe that the minor has not made the notification. This | ||||||
| 9 | paragraph shall not create a duty or obligation under | ||||||
| 10 | which a health care provider, health care professional, or | ||||||
| 11 | health facility must notify the minor's parent or legal | ||||||
| 12 | guardian of the test results, nor shall a duty or | ||||||
| 13 | obligation be implied. No civil liability or criminal | ||||||
| 14 | sanction under this Act shall be imposed for any | ||||||
| 15 | notification or non-notification of a minor's test result | ||||||
| 16 | by a health care provider, health care professional, or | ||||||
| 17 | health facility acting in good faith under this paragraph. | ||||||
| 18 | For the purpose of any proceeding, civil or criminal, the | ||||||
| 19 | good faith of any health care provider, health care | ||||||
| 20 | professional, or health facility acting under this | ||||||
| 21 | paragraph shall be presumed. | ||||||
| 22 | (b) All information and records held by a State agency, | ||||||
| 23 | local health authority, or health oversight agency pertaining | ||||||
| 24 | to genetic information or biomarkers shall be strictly | ||||||
| 25 | confidential and exempt from copying and inspection under the | ||||||
| 26 | Freedom of Information Act. The information and records shall | ||||||
| |||||||
| |||||||
| 1 | not be released or made public by the State agency, local | ||||||
| 2 | health authority, or health oversight agency and shall not be | ||||||
| 3 | admissible as evidence nor discoverable in any action of any | ||||||
| 4 | kind in any court or before any tribunal, board, agency, or | ||||||
| 5 | person and shall be treated in the same manner as the | ||||||
| 6 | information and those records subject to the provisions of | ||||||
| 7 | Part 21 of Article VIII of the Code of Civil Procedure except | ||||||
| 8 | under the following circumstances: | ||||||
| 9 | (A) when made with the written consent of all | ||||||
| 10 | persons to whom the information pertains; | ||||||
| 11 | (B) when authorized by Section 5-4-3 of the | ||||||
| 12 | Unified Code of Corrections; | ||||||
| 13 | (C) when made for the sole purpose of implementing | ||||||
| 14 | the Newborn Metabolic Screening Act and rules; or | ||||||
| 15 | (D) when made under the authorization of the | ||||||
| 16 | Illinois Parentage Act of 2015. | ||||||
| 17 | Disclosure shall be limited to those who have a need to | ||||||
| 18 | know the information, and no additional disclosures may be | ||||||
| 19 | made. | ||||||
| 20 | (c) Disclosure by an insurer in accordance with the | ||||||
| 21 | requirements of the Article XL of the Illinois Insurance Code | ||||||
| 22 | shall be deemed compliance with this Section. | ||||||
| 23 | (Source: P.A. 98-1046, eff. 1-1-15; 99-85, eff. 1-1-16.) | ||||||
| 24 | (410 ILCS 513/31) | ||||||
| 25 | Sec. 31. Uses and disclosures for treatment, payment, and | ||||||
| |||||||
| |||||||
| 1 | health care operations. Notwithstanding Sections 30 and 35 of | ||||||
| 2 | this Act, a covered entity may, without a patient's consent: | ||||||
| 3 | (1) use or disclose genetic information or biomarkers | ||||||
| 4 | for its own treatment, payment, or health care operations; | ||||||
| 5 | (2) disclose genetic information or biomarkers for | ||||||
| 6 | treatment activities of a health care provider; | ||||||
| 7 | (3) disclose genetic information or biomarkers to | ||||||
| 8 | another covered entity or health care provider for the | ||||||
| 9 | payment activities of the entity that receives the | ||||||
| 10 | information; | ||||||
| 11 | (4) disclose genetic information or biomarkers to | ||||||
| 12 | another covered entity for health care operations | ||||||
| 13 | activities of the entity that receives the information, if | ||||||
| 14 | each entity has or had a relationship with the individual | ||||||
| 15 | who is the subject of the genetic information or | ||||||
| 16 | biomarkers being requested, the genetic information or | ||||||
| 17 | biomarkers pertains to such relationship, and the | ||||||
| 18 | disclosure is for the purpose of (A) conducting quality | ||||||
| 19 | assessment and improvement activities, including outcomes | ||||||
| 20 | evaluation and development of clinical guidelines, | ||||||
| 21 | provided that the obtaining of generalizable knowledge is | ||||||
| 22 | not the primary purpose of any studies resulting from such | ||||||
| 23 | activities; patient safety activities; population-based | ||||||
| 24 | activities relating to improving health or reducing health | ||||||
| 25 | care costs, protocol development, case management, and | ||||||
| 26 | care coordination, contacting of health care providers and | ||||||
| |||||||
| |||||||
| 1 | patients with information about treatment alternatives; | ||||||
| 2 | and related functions that do not include treatment; (B) | ||||||
| 3 | reviewing the competence or qualifications of health care | ||||||
| 4 | professionals or health care providers, evaluating | ||||||
| 5 | practitioner and provider performance, health plan | ||||||
| 6 | performance, conducting training programs in which | ||||||
| 7 | students, trainees, or practitioners in areas of health | ||||||
| 8 | care learn under supervision to practice or improve their | ||||||
| 9 | skills as health care providers, training of non-health | ||||||
| 10 | care professionals, accreditation, certification, | ||||||
| 11 | licensing, or credentialing activities; or (C) health care | ||||||
| 12 | fraud and abuse detection or compliance; and | ||||||
| 13 | (5) disclose genetic information or biomarkers to | ||||||
| 14 | other participants in an organized health care arrangement | ||||||
| 15 | in which the covered entity is also a participant for any | ||||||
| 16 | health care operations activities of the organized health | ||||||
| 17 | care arrangement. | ||||||
| 18 | (Source: P.A. 98-1046, eff. 1-1-15.) | ||||||
| 19 | (410 ILCS 513/31.1) | ||||||
| 20 | Sec. 31.1. Uses and disclosures for health oversight | ||||||
| 21 | activities. | ||||||
| 22 | (a) Notwithstanding Sections 30 and 35 of this Act, a | ||||||
| 23 | covered entity may disclose genetic information or biomarkers, | ||||||
| 24 | without a patient's consent, to a health oversight agency for | ||||||
| 25 | health oversight activities authorized by law, including | ||||||
| |||||||
| |||||||
| 1 | audits, civil, administrative, or criminal investigations; | ||||||
| 2 | inspections; licensure or disciplinary actions; civil | ||||||
| 3 | administrative or criminal proceedings or actions; or other | ||||||
| 4 | activities necessary for appropriate oversight of (i) the | ||||||
| 5 | health care system; (ii) government benefit programs for which | ||||||
| 6 | health information is relevant to beneficiary eligibility; | ||||||
| 7 | (iii) entities subject to government regulatory programs for | ||||||
| 8 | which health information is necessary for determining | ||||||
| 9 | compliance with program standards; or (iv) entities subject to | ||||||
| 10 | civil rights laws for which health information is necessary | ||||||
| 11 | for determining compliance. | ||||||
| 12 | (b) For purposes of the disclosures permitted by this | ||||||
| 13 | Section, a health oversight activity does not include an | ||||||
| 14 | investigation or other activity in which the individual is the | ||||||
| 15 | subject of the investigation or activity and such | ||||||
| 16 | investigation or other activity does not arise out of and is | ||||||
| 17 | not directly related to (i) the receipt of health care; (ii) a | ||||||
| 18 | claim for public benefits related to health; or (iii) | ||||||
| 19 | qualification for, or receipt of, public benefits or services | ||||||
| 20 | when a patient's health is integral to the claim for public | ||||||
| 21 | benefits or services, except that, if a health oversight | ||||||
| 22 | activity or investigation is conducted in conjunction with an | ||||||
| 23 | oversight activity or investigation relating to a claim for | ||||||
| 24 | public benefits not related to health, the joint activity or | ||||||
| 25 | investigation is considered a health oversight activity for | ||||||
| 26 | purposes of this Section. | ||||||
| |||||||
| |||||||
| 1 | (c) If a covered entity is also a health oversight agency, | ||||||
| 2 | the covered entity may use genetic information or biomarkers | ||||||
| 3 | for health oversight activities permitted by this Section. | ||||||
| 4 | (Source: P.A. 98-1046, eff. 1-1-15.) | ||||||
| 5 | (410 ILCS 513/31.2) | ||||||
| 6 | Sec. 31.2. Uses and disclosures for public health | ||||||
| 7 | activities. Notwithstanding Sections 30 and 35 of this Act, | ||||||
| 8 | genetic information or biomarkers may be disclosed without a | ||||||
| 9 | patient's consent for public health activities and purposes to | ||||||
| 10 | the Department, when the Department is authorized by law to | ||||||
| 11 | collect or receive such information for the purpose of | ||||||
| 12 | preventing or controlling disease, injury, or disability, | ||||||
| 13 | including, but not limited to, the reporting of disease, | ||||||
| 14 | injury, vital events such as birth or death, and the conduct of | ||||||
| 15 | public health surveillance, public health investigations, and | ||||||
| 16 | public health interventions. | ||||||
| 17 | (Source: P.A. 98-1046, eff. 1-1-15.) | ||||||
| 18 | (410 ILCS 513/31.3) | ||||||
| 19 | Sec. 31.3. Business associates. | ||||||
| 20 | (a) Notwithstanding Sections 30 and 35 of this Act, a | ||||||
| 21 | covered entity may, without a patient's consent, disclose a | ||||||
| 22 | patient's genetic information or biomarkers to a business | ||||||
| 23 | associate and may allow a business associate to create, | ||||||
| 24 | receive, maintain, or transmit protected health information on | ||||||
| |||||||
| |||||||
| 1 | its behalf, if the covered entity obtains, through a written | ||||||
| 2 | contract or other written agreement or arrangement that meets | ||||||
| 3 | the applicable requirements of 45 CFR 164.504(e), satisfactory | ||||||
| 4 | assurance that the business associate will appropriately | ||||||
| 5 | safeguard the information. A covered entity is not required to | ||||||
| 6 | obtain such satisfactory assurances from a business associate | ||||||
| 7 | that is a subcontractor. | ||||||
| 8 | (b) A business associate may disclose protected health | ||||||
| 9 | information to a business associate that is a subcontractor | ||||||
| 10 | and may allow the subcontractor to create, receive, maintain, | ||||||
| 11 | or transmit protected health information on its behalf, if the | ||||||
| 12 | business associate obtains satisfactory assurances, in | ||||||
| 13 | accordance with 45 CFR 164.504(e)(1)(i), that the | ||||||
| 14 | subcontractor will appropriately safeguard the information. | ||||||
| 15 | (Source: P.A. 98-1046, eff. 1-1-15.) | ||||||
| 16 | (410 ILCS 513/31.5) | ||||||
| 17 | Sec. 31.5. Use and disclosure of information to an HIE. | ||||||
| 18 | Notwithstanding the provisions of Section 30 and 35 of this | ||||||
| 19 | Act, a covered entity may, without a patient's consent, | ||||||
| 20 | disclose the identity of any patient upon whom a test is | ||||||
| 21 | performed and such patient's genetic information or biomarkers | ||||||
| 22 | from a patient's record to a HIE if the disclosure is a | ||||||
| 23 | required or permitted disclosure to a business associate or is | ||||||
| 24 | a disclosure otherwise required or permitted under this Act. | ||||||
| 25 | An HIE may, without a patient's consent, use or disclose such | ||||||
| |||||||
| |||||||
| 1 | information to the extent it is allowed to use or disclose such | ||||||
| 2 | information as a business associate in compliance with 45 CFR | ||||||
| 3 | 164.502(e) or for such other purposes as are specifically | ||||||
| 4 | allowed under this Act. | ||||||
| 5 | (Source: P.A. 98-1046, eff. 1-1-15.) | ||||||
| 6 | (410 ILCS 513/31.7) | ||||||
| 7 | Sec. 31.7. Establishment and disclosure of limited data | ||||||
| 8 | sets and de-identified information. | ||||||
| 9 | (a) A covered entity may, without a genetic information | ||||||
| 10 | test or biomarker test subject's consent, create, use, and | ||||||
| 11 | disclose a limited data set using information subject to this | ||||||
| 12 | Act or disclose information subject to this Act to a business | ||||||
| 13 | associate for the purpose of establishing a limited data set. | ||||||
| 14 | The creation, use, and disclosure of such a limited data set | ||||||
| 15 | must comply with the requirements set forth under HIPAA. | ||||||
| 16 | (b) A covered entity may, without a genetic information | ||||||
| 17 | test or biomarker test subject's consent, create, use, and | ||||||
| 18 | disclose de-identified information using information subject | ||||||
| 19 | to this Act or disclose information subject to this Act to a | ||||||
| 20 | business associate for the purpose of de-identifying the | ||||||
| 21 | information. The creation, use, and disclosure of such | ||||||
| 22 | de-identified information must comply with the requirements | ||||||
| 23 | set forth under HIPAA. A covered entity or a business | ||||||
| 24 | associate may disclose information that is de-identified in | ||||||
| 25 | accordance with HIPAA. | ||||||
| |||||||
| |||||||
| 1 | (c) The recipient of de-identified information shall not | ||||||
| 2 | re-identify de-identified information using any public or | ||||||
| 3 | private data source. | ||||||
| 4 | (Source: P.A. 98-1046, eff. 1-1-15.) | ||||||
| 5 | (410 ILCS 513/31.8) | ||||||
| 6 | Sec. 31.8. HIE opt out. Section 9.6 of the Mental Health | ||||||
| 7 | and Developmental Disabilities Confidentiality Act is | ||||||
| 8 | incorporated herein by reference. In addition to the | ||||||
| 9 | requirements set out in Section 9.6 of the Mental Health and | ||||||
| 10 | Developmental Disabilities Confidentiality Act, at the time of | ||||||
| 11 | a patient's first encounter for genetic testing or biomarker | ||||||
| 12 | testing with a health care provider, health care professional, | ||||||
| 13 | or health facility that participates in an HIE, or, in the | ||||||
| 14 | event of a medical emergency that makes it impossible, as soon | ||||||
| 15 | thereafter as is practicable, the patient shall receive | ||||||
| 16 | meaningful disclosure regarding the HIE in which the health | ||||||
| 17 | care provider, health care professional, or health facility | ||||||
| 18 | participates and shall be afforded an opportunity to opt out | ||||||
| 19 | of disclosure of the patient's health information through the | ||||||
| 20 | HIE. | ||||||
| 21 | (Source: P.A. 98-1046, eff. 1-1-15.) | ||||||
| 22 | (410 ILCS 513/31.9) | ||||||
| 23 | Sec. 31.9. Research. Genetic information or biomarkers may | ||||||
| 24 | be disclosed for research, in accordance with the requirements | ||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 1 | set forth under HIPAA. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2 | (Source: P.A. 98-1046, eff. 1-1-15.) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 3 | (410 ILCS 513/31.10) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 4 | Sec. 31.10. Minimum necessary. When using or disclosing | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 5 | genetic-related or biomarker-related information under this | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 6 | Act, a covered entity shall do so in accordance with the | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 7 | minimum necessary standard under HIPAA. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 8 | (Source: P.A. 98-1046, eff. 1-1-15.) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 9 | (410 ILCS 513/50) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 10 | Sec. 50. Home rule. Any home rule unit of local | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 11 | government, any non-home rule municipality, or any non-home | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 12 | rule county within the unincorporated territory of the county | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 13 | may enact ordinances, standards, rules, or regulations that | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 14 | protect biomarker testing, biomarkers, genetic information, | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 15 | and genetic testing in a manner or to an extent equal to or | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 16 | greater than the protection provided in this Act. This Section | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 17 | is a limitation on the concurrent exercise of home rule power | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 18 | under subsection (i) of Section 6 of Article VII of the | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 19 | Illinois Constitution. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 20 | (Source: P.A. 95-927, eff. 1-1-09.) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
