Every physician licensed by the department of health attending on or called in to evaluate a patient whom he or she believes to be suffering from an occupational disease or condition identified by the department of health in regulation as a reportable occupational disease shall within thirty (30) days of that attendance or evaluation send to the department of health a report, on a form acceptable to the director of health, stating: (1) Name, address, and occupation of patient. (2) Name, address, and business of employer. (3) Nature of disease. (4) Any other information that may be reasonably required by the department of health.
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