State Immunization Laws for Healthcare
Workers and Patients

Immunization Assessment Requirements For
Hepatitis B

** Click on each result to read the abridged text of the state immunization law.

States	Hospital Employees	Ambulatory Care Facility Employees
AL	Yes[314]	Yes[317]
AK	No	No
AZ	No	No
AR	No[320]	No[326]
CA	No	No
CO	No	No
CT	No	No
DC	No	No
DE	No	No
FL	No	No
GA	No	Yes[545]
HI	No	No
ID	No	No
IL	No[340]	No
IN	No	No
IA	No	No
KS	No	No
KY	No	No
LA	No	No
ME	No	No
MA	No	No
MD	No	Yes[539]
MI	Yes[358]	Yes[360]
MN	No	No
MS	No	No
MO	No	No
MT	No	No
NE	No	No
NH	No	No
NJ	No	No
NM	No	No
NY	No[376]	No
NV	No[379]	No[388]
NC	No	No
ND	No	No
OH	No	Yes[526]
OK	No	No
OR	No	Yes[529]
PA	No	No
RI	No[399]	No[404]
SC	No	Yes[407]
SD	No[408]	No[413]
TN	No	No
TX	No	No
UT	No	Yes[428]
VT	No	No
VA	No	No
WA	Yes[547]	Yes[548]
WV	No	No
WI	No[438]	No[443]
WY	No	No

[314] For Alabama, see Ala. Admin. Code r. 420-5-5-.02(9)(d) and Ala. Admin. Code r. 420-5-5-.03, relating to “end stage renal disease and transplant centers.” Ala. Admin. Code r. 420-5-5-.02(9)(d) provides that new employees must be screened for HBsAg and anti-HBs before or at the time they enter the unit in order to determine their serologic status for surveillance purposes. Seronegative staff members must be tested at least once every 6 months for HBsAg and anti-HBs. Ala. Admin. Code r. 420-5-5-.03 provides that a pre-employment physical examination and a test for hepatitis, as indicated under Ala. Admin. Code r. 420-5-5-.02(9)(d) shall be required of all new employees. Provisions shall be made for re-examination at intervals not to exceed twelve months, and must be in accordance with Ala. Admin. Code r. 420-5-5-.02(9)(d).
[317] For Alabama, see Ala. Admin. Code r. 420-5-5.02(9)(d) and Ala. Admin. Code r. 420-5-5-.03, applying to “end stage renal disease and transplant centers.” Ala. Admin. Code r. 420-5-5-.02(9)(d) requires employees to be screened for HBsAg and anti-HBs before or at the time they enter the unit to determine their serologic status, and for seronegative staff members to be tested at least once every 6 months for HBsAg and anti-HBs. Ala. Admin. Code r. 420-5-5-.03 requires that a pre-employment test for hepatitis shall be required of all new employees. “Renal dialysis facilities” are defined as hospital and non-hospital based facilities, which provide end stage renal dialysis treatment but do not provide the full spectrum of diagnostic, therapeutic, and rehabilitative services for the care of renal dialysis patients. Ala. Admin. Code r. 420-5-5-.03 provides that a pre-employment physical examination and a test for hepatitis, as indicated under Ala. Admin. Code r. 420-5-5-.02(9)(d) shall be required of all new employees. Provisions shall be made for re-examination at intervals not to exceed twelve months, and must be in accordance with Ala. Admin. Code r. 420-5-5-.02(9)(d).
[320] For Arkansas, no statute or regulation specifically requires hospitals to assess the immunization status of employees for hepatitis B vaccine, influenza, or pneumococcal vaccine. However, see 007 05 CARR 002.18, requiring that, for “hospitals and related facilities,” there shall be policies and procedures for screening health care workers for communicable diseases in certain specified categories.
[326] For Arkansas, no statute or regulation specifically requires ambulatory care facilities to assess employees for hepatitis B, pneumococcal, or influenza vaccination. Note, however, 007 05 CARR 004.10, relating to “abortion facilities.” 007 05 CARR 004.10 provides that the facility must develop policies and procedures for screening health care workers for communicable diseases. Also note 007 05 CARR 002.18, requiring that, for “hospitals and related facilities,” there shall be policies and procedures for screening health care workers for communicable diseases in certain specified categories.
[340] For Illinois, while no regulation specifically requires hospitals to assess the immunization status of any employees for hepatitis B, pneumococcal or influenza vaccine, see Ill. Admin. Code tit. 77, § 250.450, providing that each hospital shall develop an employee health program that includes an assessment of the employee’s immunization status at the time of employment. This requirement only applies to those institutions covered by the definition of “hospital” set forth in 210 Ill. Comp. Stat. Ann. § 85/3. 210 Ill. Comp. Stat. Ann. § 85/3 defines a “hospital” as any institution, place, building, or agency, public or private, whether organized for profit or not, devoted primarily to the maintenance and operation of facilities for the diagnosis and treatment or care of 2 or more unrelated persons admitted for overnight stay or longer in order to obtain medical, including obstetric, psychiatric and nursing, care of illness, disease, injury, infirmity, or deformity.	Top of Page
[358] For Michigan, see Mich. Admin. Code r. 325.70015 pertaining to immunization documentation requirements for Category A employees. Mich. Admin. Code r. 325.70015 states that an employer shall ensure that medical records contain a copy of the employee’s hepatitis B status and a copy of the medical history and results of all physical examinations, medical testing, and follow-up procedures as they relate to the employee’s ability to receive vaccination. Mich. Admin. Code r. 325.70003 defines Category A as consisting of occupations that require procedures or other occupation-related tasks that involve exposure or reasonably anticipated exposure to blood or other potentially infectious material or that involve a likelihood for spills or splashes of blood or other potentially infectious material.
[360] For Michigan, see Mich. Admin. Code r. 325.70015 pertaining to immunization documentation requirements for Category A employees. Mich. Admin. Code r. 325.70015 states that an employer shall ensure that medical records contain a copy of the employee’s hepatitis B status and a copy of the medical history and results of all physical examinations, medical testing, and follow-up procedures as they relate to the employee’s ability to receive vaccination. Mich. Admin. Code r. 325.70003 defines Category A as consisting of occupations that require procedures or other occupation-related tasks that involve exposure or reasonably anticipated exposure to blood or other potentially infectious material or that involve a likelihood for spills or splashes of blood or other potentially infectious material.
[376] For New York, no statute or regulation specifically requires hospitals to assess employees for hepatitis B vaccine. However, see N.Y. Comp. Codes R. & Regs. tit. 12, § 800.3, applying the occupational exposure requirements of 29 CFR § 1910.1030 to employers of public employees. § 1910.1030 provides that following the report of an exposure incident, the employee shall make immediately available to the exposed employee a confidential medical evaluation and follow-up, including collection and testing of blood for HBV serological status. For a definition of an “exposure incident,” see 29 CFR § 1910.1030(b).
[379] For Nevada, no statute or regulation requires any hospital to assess the immunization status of any hospital employee for hepatitis B, influenza, or pneumococcal vaccine. Note, however, Nev. Admin. Code ch. 441A, § 375, relating to “medical facilities.” Nev. Admin. Code ch. 441A, § 375 provides that, before initial employment, a person employed in a medical facility or a facility for the dependent shall have a Mantoux tuberculin skin test, including persons with a history of bacillus Calmette-Guerin vaccination.	Top of Page
[388] For Nevada, no statute or regulation requires any ambulatory care facility to assess the immunization status of any employee for hepatitis B, influenza, or pneumococcal vaccine. Note, however, Nev. Admin. Code ch. 441A, § 375, relating to “medical facilities.” Nev. Admin. Code ch. 441A, § 375 provides that, before initial employment, a person employed in a medical facility or a facility for the dependent shall have a Mantoux tuberculin skin test, including persons with a history of bacillus Calmette-Guerin vaccination.
[399] For Rhode Island, no statute or regulation requires any hospital to assess the immunization status of any employee for influenza, pneumococcal or hepatitis B vaccine. Note, however, R.I. Code R. 14-090-018 13.5, relating to “rehabilitation hospitals,” R.I. Code R. 14-090-007, relating to “hospitals,” and R.I. Code R. 14-000-028, relating to “health care facilities.” R.I. Code R. 14-090-018 13.5, R.I. Code R. 14-090-007 and R.I. Code R. 14-000-028 provide that upon hire and prior to delivering services, a pre-employment health screening shall be required for each individual who has or may have direct contact with a patient in the “rehabilitation hospitals,” “hospitals” or “health care facilities”. Such health screening shall be conducted in accordance with the Rules and Regulations Pertaining to Immunization, Testing, and Health Screening for Health Care Workers (R23-17-HCW). R.I. Code R. 14-000-028 (promulgated under the authority of Chapters 23-17 and 23-17.7 of the General Laws of Rhode Island) provides that evidence that the health care worker is free of active tuberculosis based on the results of a negative two-step tuberculin skin test is required. If the test is positive, or a previous one is known to have been positive, a licensed care practitioner’s certification that the HCW is free of active disease shall be required.
[404] For Rhode Island, no statute or regulation requires any ambulatory care facility to assess the immunization status of any employee for influenza, pneumococcal or hepatitis B vaccine. Note, however, R.I. Code R. 14-090-031, relating to “physician ambulatory surgery centers” and “podiatry ambulatory surgery centers,” R.I. Code R. 14-090-030, relating to “school based health centers,” R.I. Code R. 14-090-029, relating to “physician office settings providing surgical treatments,” R.I. Code R. 14-090-012, relating to “kidney disease treatment centers,” R.I. Code R. 14-090-010, relating to “freestanding emergency care facilities,” R.I. Code R. 14-090-009, relating to “birth centers,” R.I. Code R. 14-090-006, relating to “freestanding ambulatory surgical centers,” R.I. Code R. 14-090-004, relating to “licensed organized ambulatory care facilities,” and R.I. Code R. 14-000-028, relating to “health care facilities.” R.I. Code R. 14-090-031, R.I. Code R. 14-090-030, R.I. Code R. 14-090-029, R.I. Code R. 14-090-012, R.I. Code R. 14-090-010, R.I. Code R. 14-090-009, R.I. Code R. 14-090-006, R.I. Code R. 14-090-004 and R.I. Code R. 14-000-028 provide that upon hire and prior to delivering services, a pre-employment health screening shall be required for each individual who has or may have direct contact with a patient. Such health screening shall be conducted in accordance with the Rules and Regulations Pertaining to Immunization, Testing, and Health Screening for Health Care Workers (R23-17-HCW). R.I. Code R. 14-000-028 (promulgated under the authority of Chapters 23-17 and 23-17.7 of the General Laws of Rhode Island) provides that evidence that the health care worker is free of active tuberculosis based on the results of a negative two-step tuberculin skin test is required. If the test is positive, or a previous one is known to have been positive, a licensed care practitioner’s certification that the HCW is free of active disease shall be required.
[407] For South Carolina, see S.C. Code Regs. 61-97, relating to “renal dialysis facilities.” S.C. Code Regs. 61-97, section 305 (relating to ‘Personnel’) provides that employees shall have a physical examination within one year prior to employment and a test for the hepatitis B surface antigen (HBsAg) must be performed within one month prior to patient contact. Also, section 409 of S.C. Code Regs. 61-97 (relating to ‘Infection Control’) requires that all potential employees shall be screened for HBsAg prior to patient contact. This initial screening determines the individual’s serologic status for surveillance purposes. Thereafter, routine serologic testing to monitor for hepatitis B infection shall be conducted in accordance with the person’s HBsAg and HBsAb status as determined by the initial screening. “Renal dialysis facilities” are defined in S.C. Code Regs. 61-97 as an outpatient facility which offers staff-assisted dialysis or training and support services for self-dialysis to end-stage renal disease patients. A facility may be composed of one or more fixed buildings, mobile units, or a combination.	Top of Page
[408] For South Dakota, no statute or regulation explicitly requires any hospital to assess the immunization status of any employees for pneumococcal, influenza, or hepatitis B vaccine. However, note S.D. Admin. R. 44:04:04:06, relating to “medical facilities.” S.D. Admin. R. 44:04:04:06 provides that personnel must be evaluated by a licensed health care professional for freedom from reportable communicable diseases which pose a threat to others before assignment of duties or within 14 days after employment, including an assessment of previous vaccinations and tuberculin skin tests.
[413] For South Dakota, no statute or regulation explicitly requires any ambulatory care facility to assess the immunization status of any employees for pneumococcal, influenza, or hepatitis B vaccine. However, note S.D. Admin. R. 44:04:04:06, relating to “medical facilities.” S.D. Admin. R. 44:04:04:06 provides that personnel must be evaluated by a licensed health care professional for freedom from reportable communicable diseases which pose a threat to others before assignment of duties or within 14 days after employment, including an assessment of previous vaccinations and tuberculin skin tests.
[428] For Utah, see Utah Admin. Code R432-650-6, relating to personnel health in end stage renal disease facilities. Utah Admin. Code R432-650-6 provides that each ESRD facility must test all employees who provide direct patient care for hepatitis B and for tuberculosis within the first two weeks of beginning employment.
[438] For Wisconsin, no statute or regulation requires any hospital to assess the immunization status of any hospital employee for hepatitis B, influenza, or pneumococcal vaccine. Note, however, Wis. Adm. Code § 124.07, requiring the hospital’s employee health program to include a preemployment health assessment for all prospective employees and for all persons who provide contractual services to the hospital who will have frequent and direct contact with patients. The assessment shall include a history of immunizations. The hospital’s employee health program shall include, for volunteers, the taking of a health history of communicable diseases and immunizations before they may assume duties which involve direct patient care. Wis. Stat. § 50.33 defines a “hospital” as any building, structure, institution or place devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment of and medical or surgical care for 3 or more nonrelated individuals, hereinafter designated patients, suffering from illness, disease, injury or disability, whether physical or mental, and including pregnancy and regularly making available at least clinical laboratory services, and diagnostic X-ray services and treatment facilities for surgery, or obstetrical care, or other definitive medical treatment. “Hospital” may include, but not in limitation thereof by enumeration, related facilities such as outpatient facilities, nurses, interns and resident’s quarters, training facilities and central service facilities operated in connection with hospitals. “Hospital” includes “special hospitals” or those hospital facilities that provide a limited type of medical or surgical care, including orthopedic hospitals, children’s hospitals, critical access hospitals, mental hospitals, psychiatric hospitals or maternity hospitals. This requirement only applies to those institutions covered by the definition of “hospital” set forth in Wis. Admin. Code § 124.07.	Top of Page
[443] For Wisconsin, no statute or regulation requires any ambulatory care facility to assess the immunization status of any employee for hepatitis B, influenza, or pneumococcal vaccine. Note, however, Wis. Adm. Code § 124.07, requiring the hospital’s employee health program to include a pre-employment health assessment for all prospective employees and for all persons who provide contractual services to the hospital who will have frequent and direct contact with patients. The assessment shall include a history of immunizations. The hospital’s employee health program shall include, for volunteers, the taking of a health history of communicable diseases and immunizations before they may assume duties which involve direct patient care. “Hospitals” includes “special hospitals” or those hospital facilities that provide a limited type of medical or surgical care, including orthopedic hospitals, children’s hospitals, critical access hospitals, mental hospitals, psychiatric hospitals or maternity hospitals. Because the definition of “hospital” does not restrict covered facilities to those providing 24-hour care, this chart assumes that the definition of “hospital” includes those facilities defined as “ambulatory care facilities” within the meaning provided by this chart.
[526] For Ohio, see Ohio Admin. Code § 3701-83-23.4, providing that each dialysis center shall conduct routine surveillance of patients and staff for hepatitis B using the most sensitive test methods available. Patients and new employees must be screened for hepatitis B surface antigen and hepatitis B surface antibody before or at the time they enter the unit in order to determine their serologic status for surveillance purposes. Ohio Admin. Code § 3701-83-23 defines a dialysis center as a facility that provides chronic maintenance dialysis to end stage renal disease patients on an outpatient basis, including the provision of dialysis services in the patient's place of residence, but that does not include: (1) a hospital or other entity that performs dialysis services that are reviewed and accredited or certified as part of the hospital's accreditation or certification as required by § 3727.02 of the Revised Code; or (2) home dialysis.
[529] For Oregon, see Or. Admin. R. 333-700-0100, relating to patient care staff in outpatient renal dialysis facilities. Or. Admin. R. 333-700-0100 provides that the facility shall maintain a personnel record for each staff member which includes but is not limited to documentation of, among other things, health status to include testing for tuberculosis exposure and HbSAg testing according to CDC guidelines. Outpatient renal dialysis facilities are defined in Or. Admin. R. 333-700-0005 as facilities licensed to provide end stage renal disease services on an outpatient basis.
[539] For Maryland, see MD. Regs. Code tit. 10, § 30.03, relating to transmissible diseases. MD. Regs. Code tit. 10, § 30.03.03 provides that dialysis facilities and transplant centers shall document testing to demonstrate active immunity by appropriate antibody titers, and that hepatitis testing shall be conducted on patients and staff according to the Control of Communicable Diseases Manual.	Top of Page
[545] For Georgia, see Ga. Comp. R. & Regs. r. 290-9-9-.16, relating to “end stage renal disease facilities.” Ga. Comp. R. & Regs. r. 290-9-9-.16(3) states that facility policies and procedures shall require all employees to be tested upon employment and at least annually for hepatitis B virus and tuberculosis infection and any other infectious diseases which the Centers for Disease Control have deemed to be endemic to the area served.
[547] For Washington, see Wash. Admin. Code § 296-823-17005 pertaining to establishing and maintaining medical records. Wash. Admin. Code § 296-823-17005 states that employers must establish and maintain an accurate medical record for each employee with occupational exposure, and that this record must include a copy of the employee’s hepatitis B vaccination status, including the dates of all hepatitis B vaccinations. Wash. Admin. Code § 296-823-100 specifies that this chapter applies to all employers who have employees with occupational exposure to blood or other potentially infectious material.
[548] For Washington, see Wash. Admin. Code § 296-823-17005 pertaining to establishing and maintaining medical records. Wash. Admin. Code § 296-823-17005 states that employers must establish and maintain an accurate medical record for each employee with occupational exposure, and that this record must include a copy of the employee’s hepatitis B vaccination status, including the dates of all hepatitis B vaccinations. Wash. Admin. Code § 296-823-100 specifies that this chapter applies to all employers who have employees with occupational exposure to blood or other potentially infectious material.

Disclaimer: The purpose of this database is to provide researchers, policymakers, and state and local public health practitioners with descriptive information concerning state immunization-related law. No part of this legal analysis involves providing legal advice or answering specific questions of law on behalf of any person or organization.