Part III. Reporting of Disease
12VAC5-90-80. Lists of diseases that shall be reported.
A. The persons enumerated in 12VAC5-90-90 shall report the following named diseases, toxic effects, and conditions pursuant to this chapter. A condition identified by an asterisk (*) requires immediate communication to the local health department by the most rapid means available upon suspicion or confirmation, as defined in subsection C of this section. Other conditions shall be reported within three days of suspected or confirmed diagnosis, unless otherwise specified in this section. Neonatal Abstinence Syndrome shall be reported as specified in subsection E of this section. Coronavirus disease 2019 (SARS-CoV-2) shall be reported as specified in subsection I of the section.
Amebiasis (Entamoeba histolytica)
*Anthrax (Bacillus anthracis)
Arboviral infections (e.g., CHIK, dengue, EEE, LAC, SLE, WNV, Zika)
Babesiosis (Babesia spp.)
*Botulism (Clostridium botulinum)
*Brucellosis (Brucella spp.)
Campylobacteriosis (Campylobacter spp.)
Candida auris, infection or colonization
Carbapenemase-producing organism, infection, or colonization
Chancroid (Haemophilus ducreyi)
Chickenpox (Varicella virus)
Chlamydia trachomatis infection
*Cholera (Vibrio cholerae O1 or O139)
*Coronavirus infection, severe (e.g., SARS-CoV, MERS-CoV)
Coronavirus disease 2019 (COVID-19 or SARS-CoV-2)
Cryptosporidiosis (Cryptosporidium spp.)
Cyclosporiasis (Cyclospora spp.)
*Diphtheria (Corynebacterium diphtheriae)
*Disease caused by an agent that may have been used as a weapon
Ehrlichiosis/Anaplasmosis (Ehrlichia spp., Anaplasma phagocytophilum)
Giardiasis (Giardia spp.)
Gonorrhea (Neisseria gonorrhoeae)
Granuloma inguinale (Calymmatobacterium granulomatis)
*Haemophilus influenzae infection, invasive
Hantavirus pulmonary syndrome
Hemolytic uremic syndrome (HUS)
*Hepatitis A
Hepatitis B (acute and chronic)
Hepatitis C (acute and chronic)
Hepatitis, other acute viral
Human immunodeficiency virus (HIV) infection
Influenza, laboratory-confirmed
*Influenza-associated deaths if younger than 18 years of age
Lead, reportable blood levels
Legionellosis (Legionella spp.)
Leprosy (Hansen's disease) (Mycobacterium leprae)
Leptospirosis (Leptospira interrogans)
Listeriosis (Listeria monocytogenes)
Lyme disease (Borrelia spp.)
Lymphogranuloma venereum (Chlamydia trachomatis)
Malaria (Plasmodium spp.)
*Measles (Rubeola)
*Meningococcal disease (Neisseria meningitidis)
Mumps
Neonatal abstinence syndrome (NAS)
Ophthalmia neonatorum
*Orthopoxviruses (e.g., Monkeypox virus, Variola virus, Vaccinia disease or adverse event)
*Outbreaks, all (including foodborne, health care-associated, occupational, toxic substance-related, waterborne, and any other outbreak)
*Pertussis (Bordetella pertussis)
*Plague (Yersinia pestis)
*Poliovirus infection, including poliomyelitis
*Psittacosis (Chlamydophila psittaci)
*Q fever (Coxiella burnetii)
*Rabies, human and animal
Rabies treatment, post-exposure
*Rubella, including congenital rubella syndrome
Salmonellosis (Salmonella spp.)
Shiga toxin-producing Escherichia coli infection
Shigellosis (Shigella spp.)
Spotted fever rickettsiosis (Rickettsia spp.)
Streptococcal disease, Group A, invasive or toxic shock
Streptococcus pneumoniae infection, invasive if younger than five years of age
Syphilis (Treponema pallidum) report *congenital, *primary, *secondary, and other
Tetanus (Clostridium tetani)
Toxic substance-related illness
Trichinosis (Trichinellosis) (Trichinella spiralis)
*Tuberculosis, active disease (Mycobacterium tuberculosis complex)
Tuberculosis infection
*Tularemia (Francisella tularensis)
*Typhoid/Paratyphoid infection (Salmonella Typhi, Salmonella Paratyphi)
*Unusual occurrence of disease of public health concern
Vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus infection
*Vibriosis (Vibrio spp.)
*Viral hemorrhagic fever
*Yellow fever
Yersiniosis (Yersinia spp.)
B. A laboratory director shall report test results indicative of and specific for the diseases, infections, microorganisms, conditions, and toxic effects specified in this subsection for humans. Tests include microbiological culture, isolation, or identification; assays for specific antibodies; and identification of specific antigens, toxins, or nucleic acid sequences. Additional condition-specific requirements are noted in this subsection and subsection D of this section. A condition identified by an asterisk (*) requires immediate communication to the local health department by the most rapid means available upon suspicion or confirmation, as defined in subsection C of this section. Other conditions shall be reported within three days of suspected or confirmed diagnosis.
Amebiasis (Entamoeba histolytica)
*Anthrax (Bacillus anthracis)
Arboviral infection, for example, CHIK, dengue, EEE, LAC, SLE, WNV, or Zika
Babesiosis (Babesia spp.)
*Botulism (Clostridium botulinum)
*Brucellosis (Brucella spp.)
Campylobacteriosis (Campylobacter spp.)
Candida auris - Include available antimicrobial susceptibility findings in report.
Carbapenemase-producing organism - Include available antimicrobial susceptibility findings in report.
Chancroid (Haemophilus ducreyi)
Chickenpox (Varicella virus)
Chlamydia trachomatis infection
*Cholera (Vibrio cholerae O1 or O139)
*Coronavirus infection, severe (e.g., SARS-CoV, MERS-CoV)
Coronavirus disease 2019 (COVID-19 or SARS-CoV-2)
Cryptosporidiosis (Cryptosporidium spp.)
Cyclosporiasis (Cyclospora spp.)
*Diphtheria (Corynebacterium diphtheriae)
Ehrlichiosis/Anaplasmosis (Ehrlichia spp., Anaplasma phagocytophilum)
Giardiasis (Giardia spp.)
Gonorrhea (Neisseria gonorrhoeae) - Include available antimicrobial susceptibility findings in report.
*Haemophilus influenzae infection, invasive
Hantavirus pulmonary syndrome
*Hepatitis A
Hepatitis B (acute and chronic) - For all hepatitis B patients, also report available results of serum alanine aminotransferase (ALT) and all available results from the hepatitis panel.
Hepatitis C (acute and chronic) - For all patients with any positive HCV test, also report all results of HCV viral load tests, including undetectable viral loads and report available results of serum alanine aminotransferase (ALT) and all available results from the hepatitis panel.
Hepatitis, other acute viral - Any finding indicative of acute infection with hepatitis D, E, or other cause of viral hepatitis. For any reportable hepatitis finding, submit all available results from the hepatitis panel.
Human immunodeficiency virus (HIV) infection - For HIV-infected patients, report all results of CD4 and HIV viral load tests, including undetectable viral loads. For HIV-infected patients, report all HIV genetic nucleotide sequence data associated with HIV drug resistance tests by electronic submission. For children younger than three years of age, report all tests regardless of the test findings (e.g., negative or positive).
Influenza, laboratory-confirmed - By culture, antigen detection by direct fluorescent antibody (DFA), or nucleic acid detection.
Lead, reportable blood levels - All lead results from tests of venous or capillary blood performed by a laboratory certified by the Centers for Medicare and Medicaid Services in accordance with 42 USC § 263a, the Clinical Laboratory Improvement Amendment of 1988 (CLIA-certified).
Legionellosis (Legionella spp.)
Leptospirosis (Leptospira interrogans)
Listeriosis (Listeria monocytogenes), invasive or if associated with miscarriage or stillbirth from placental or fetal tissue
Lyme disease (Borrelia spp.)
Malaria (Plasmodium spp.)
*Measles (Rubeola)
*Meningococcal disease (Neisseria meningitidis), invasive - Include identification of gram-negative diplococci.
Mumps
*Mycobacterial diseases - (See 12VAC5-90-225 ) Report any of the following:
1. Acid fast bacilli;
2. M. tuberculosis complex or any other mycobacteria; or
3. Antimicrobial susceptibility results for M. tuberculosis complex.
*Orthopoxviruses (e.g., Monkeypox virus, Variola virus, Vaccinia disease or adverse event)
*Pertussis (Bordetella pertussis)
*Plague (Yersinia pestis)
*Poliovirus infection
*Psittacosis (Chlamydophila psittaci)
*Q fever (Coxiella burnetii)
*Rabies, human and animal
*Rubella
Salmonellosis (Salmonella spp.)
Shiga toxin-producing Escherichia coli infection
Shigellosis (Shigella spp.)
Spotted fever rickettsiosis (Rickettsia spp.)
Streptococcal disease, Group A, invasive or toxic shock
Streptococcus pneumoniae infection, invasive if younger than five years of age
*Syphilis (Treponema pallidum)
Toxic substance-related illness - By blood or urine laboratory findings above the normal range, including heavy metals, pesticides, and industrial-type solvents and gases. When applicable and available, report speciation of metals when blood or urine levels are elevated in order to differentiate the chemical species (elemental, organic, or inorganic).
Trichinosis (Trichinellosis) (Trichinella spiralis)
Tuberculosis infection
*Tularemia (Francisella tularensis)
*Typhoid/Paratyphoid infection (Salmonella Typhi, Salmonella Paratyphi A, Salmonella Paratyphi B, Salmonella Paratyphi C)
Vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus infection - Include available antimicrobial susceptibility findings in report.
*Vibriosis (Vibrio spp., Photobacterium damselae, Grimontia hollisae), other than toxigenic Vibrio cholera O1 or O139, which are reportable as cholera
*Viral hemorrhagic fever
*Yellow fever
Yersiniosis (Yersinia spp.)
C. Certain of the diseases in the list of reportable diseases because of their extremely contagious nature, potential for greater harm, or availability of a specific intervention that must be administered in a timely manner require immediate identification and control. Reporting of persons confirmed or suspected of having these diseases, listed in this subsection, shall be made immediately by the most rapid means available, preferably by telephone to the local health department. (These same diseases are also identified by an asterisk (*) in subsections A and B, where applicable, of this section.)
Anthrax (Bacillus anthracis)
Botulism (Clostridium botulinum)
Brucellosis (Brucella spp.)
Cholera (Vibrio cholerae O1 or O139)
Coronavirus infection, severe (e.g., SARS-CoV, MERS-CoV)
Diphtheria (Corynebacterium diphtheriae)
Disease caused by an agent that may have been used as a weapon
Haemophilus influenzae infection, invasive
Hepatitis A
Influenza-associated deaths if younger than 18 years of age
Influenza A, novel virus
Measles (Rubeola virus)
Meningococcal disease (Neisseria meningitidis)
Outbreaks, all
Orthopoxviruses (e.g., Monkeypox virus, Variola virus, Vaccinia disease or adverse event)
Pertussis (Bordetella pertussis)
Plague (Yersinia pestis)
Poliovirus infection, including poliomyelitis
Psittacosis (Chlamydophila psittaci)
Q fever (Coxiella burnetii)
Rabies, human and animal
Rubella, including congenital rubella syndrome
Syphilis, congenital, primary, and secondary (Treponema pallidum)
Tuberculosis, active disease (Mycobacterium tuberculosis complex)
Tularemia (Francisella tularensis)
Typhoid/Paratyphoid infection (Salmonella Typhi, Salmonella Paratyphi (all types))
Unusual occurrence of disease of public health concern
Vibriosis (Vibrio spp., Photobacterium damselae, Grimontia hollisae), other than toxigenic Vibrio cholerae O1 or O139, which are reportable as cholera
Viral hemorrhagic fever
Yellow fever
D. A laboratory identifying evidence of any of the conditions in this subsection shall notify the local health department of the positive culture or other positive test result within the timeframes specified in subsection B of this section and submit the initial isolate (preferred) within five days or the clinical specimen within two days of a positive result to the Division of Consolidated Laboratory Services or other public health laboratory where specified in this subsection. A specimen or isolate must be identified with the patient and physician information required in 12VAC5-90-90 C.
Anthrax (Bacillus anthracis)
Botulism (Clostridium botulinum)
Brucellosis (Brucella sp.)
Candida auris
Candida haemulonii
Carbapenem-resistant Enterobacterales
Carbapenem-resistant Pseudomonas aeruginosa
Cholera (Vibrio cholerae O1 or O139)
Coronavirus infection, severe (e.g., SARS-CoV, MERS-CoV)
Diphtheria (Corynebacterium diphtheriae)
Haemophilus influenzae infection, invasive
Influenza, unsubtypeable
Listeriosis (Listeria monocytogenes)
Meningococcal disease (Neisseria meningitidis)
Pertussis (Bordetella pertussis)
Plague (Yersinia pestis)
Poliovirus infection
Q fever (Coxiella burnetii)
Salmonellosis (Salmonella spp.)
Shiga toxin-producing E. coli infection. A laboratory that identifies a Shiga toxin but does not perform simultaneous culture for Shiga toxin-producing E. coli should forward all positive stool specimens or positive enrichment broths to the Division of Consolidated Laboratory Services for confirmation and further characterization.
Shigellosis (Shigella spp.)
Streptococcal disease, Group A, invasive
Tuberculosis. A laboratory identifying Mycobacterium tuberculosis complex (see 12VAC5-90-225) shall submit a representative and viable sample of the initial culture to the Division of Consolidated Laboratory Services or other laboratory designated by the board to receive the specimen.
Tularemia (Francisella tularensis)
Typhoid/Paratyphoid infection (Salmonella Typhi, Salmonella Paratyphi (all types))
Vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus infection
Vibriosis (Vibrio spp., Photobacterium damselae, Grimontia hollisae)
Yersiniosis (Yersinia spp.)
Other diseases as may be requested by the health department.
E. A physician or director of a medical care facility shall report neonatal abstinence syndrome if a newborn has been diagnosed with neonatal abstinence syndrome, a condition characterized by clinical signs of withdrawal from exposure to prescribed or illicit drugs. A report shall be submitted within one month of diagnosis by entering the information into the Department of Health's online Confidential Morbidity Report portal (https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/).
F. The occurrence of an outbreak or cluster of any illness that may represent a group expression of an illness that may be of public health concern shall be reported to the local health department immediately by the most rapid means available, preferably by telephone.
G. Toxic substance-related illnesses, including pesticide and heavy metal poisoning or illness resulting from exposure to an occupational dust or fiber or radioactive substance, shall be reported.
If the illness is verified or suspected and presents an emergency or a serious threat to public health or safety, the report of such illness shall be made immediately by the most rapid means available, preferably by telephone.
H. An unusual or emerging condition of public health concern shall be reported to the local health department immediately by the most rapid means available, preferably by telephone. In addition, the commissioner or the commissioner's designee may establish surveillance systems for diseases or conditions that are not on the list of reportable diseases to identify cases (delineate the magnitude of the situation), to identify the mode of transmission and risk factors for the disease, and to identify and implement appropriate action to protect public health. A person reporting information at the request of the department for special surveillance or other epidemiological studies shall be immune from liability as provided by § 32.1-38 of the Code of Virginia.
I. A physician or medical care facility director shall report coronavirus disease 2019, also known as COVID-19, if a person who is infected with SARS-CoV-2 or who is suspected of having COVID-19 is treated or examined, hospitalized, or admitted into the intensive care unit. A physician or medical care facility director shall report the person's name, telephone number, address, age, date of birth, race, ethnicity, sex, and pregnancy status; name of disease diagnosed or suspected; the medical record number (if applicable); the date of onset of illness; available laboratory tests and results; and the name, address, and telephone number of the physician and medical facility where the examination was made. A case report shall be submitted within three days of the suspicion or confirmation of disease by entering the information into the Department of Health online Confidential Morbidity Report portal at https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/ or via electronic case reporting (https://www.vdh.virginia.gov/meaningful-use/meaningful-use-submissions-of-electronic-case-reports/).
J. A laboratory director, including a director of another entity that holds Clinical Laboratory Improvement Amendments Certificates of Waiver, shall report a positive SARS-CoV-2 test within three days of identification of evidence of disease. The report shall include the source of the specimen and the laboratory method and result; the name, telephone number, email address, address, age, date of birth, race, ethnicity, sex, and pregnancy status (if known) of the person from whom the specimen was obtained; and the name, address, and telephone number of the physician at whose request and medical facility at which the examination was made. A report shall be made by entering information into the department's available portal for laboratory reporting at https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/ or via electronic laboratory reporting at http://www.vdh.virginia.gov/meaningful-use/submissionofreportablelabresults.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 3.1, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Volume 18, Issue 9, eff. December 18, 2001; Volume 20, Issue 21, eff. July 28, 2004; Volume 23, Issue 15, eff. May 2, 2007; Volume 25, Issue 11, eff. March 4, 2009; Errata, 25:12 VA.R. 2293 February 16, 2009; amended, Virginia Register Volume 27, Issue 13, eff. March 28, 2011; Volume 33, Issue 2, eff. October 20, 2016; Volume 34, Issue 7, eff. December 27, 2017; Errata, 34:8 VA.R. 831 December 11, 2017; Volume 35, Issue 4, eff. November 14, 2018; Volume 36, Issue 6, eff. December 26, 2019; Volume 39, Issue 9, eff. January 18, 2023; Volume 41, Issue 26, eff. September 10, 2025.
12VAC5-90-90. Those required to report.
A. A physician who treats or examines any person who is suffering from or who is suspected of having a reportable disease or condition shall report, at a minimum, that person's name, telephone number, address, age, date of birth, race, ethnicity, sex, and pregnancy status for females; name of disease diagnosed or suspected; the date of onset of illness; available laboratory tests and results; and the name, address, and telephone number of the physician and medical facility where the examination was made. A physician may designate someone to report on the physician's behalf, but the physician shall ensure that the appropriate report is made. A physician, designee, or organization making a report as authorized in this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia. The physician shall send the report within the timeframes specified in 12VAC5-90-80 to the local health department serving the jurisdiction in which the facility is located via the Virginia Department of Health's online Confidential Morbidity Report portal at https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/ or a CDC or VDH disease-specific surveillance form.
B. A laboratory director shall report a laboratory examination of a clinical specimen that yields evidence of a disease listed in 12VAC5-90-80 B. A laboratory director shall report results that are performed in-house or referred to a reference laboratory, with the following exception: if the laboratory director ascertains that the reference laboratory that tests a specimen reports to the department electronically, then the reference laboratory findings do not need to be reported by the laboratory of origin.
C. A report from a laboratory director shall give the source of the specimen and the laboratory method and result; the name, address, age, date of birth, race, ethnicity, sex, and pregnancy status for females (if known) of the person from whom the specimen was obtained; and the name, address, and telephone number of the physician at whose request and medical facility at which the examination was made. If the influenza virus is isolated, the type shall be reported, if available. A laboratory director shall make the report within the timeframes specified in 12VAC5-90-80 to the local health department serving the jurisdiction in which the laboratory is located via the department's online Confidential Morbidity Report portal or on the laboratory's own form, including a computer-generated report if it includes the required information. A laboratory director may make the required reports by means of secure electronic transmission upon agreement of the laboratory director and the department. A laboratory director shall submit a report of HIV genetic nucleotide sequence data associated with HIV drug resistance tests electronically. A person making a report as authorized in this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia.
D. If a clinical specimen yields evidence indicating the presence of a select agent or toxin as defined in 42 CFR Part 73, the laboratory director shall contact the Division of Consolidated Laboratory Services and arrange to forward an isolate for confirmation. If a select agent or toxin has been confirmed in a clinical specimen, the laboratory director shall consult with Division of Consolidated Laboratory Services or CDC regarding isolate transport or destruction.
E. A laboratory operating within a medical care facility shall be considered to be in compliance with the requirement to notify the local health department if the director of the medical care facility assumes the reporting responsibility; however, the laboratory director shall still submit isolates to the Division of Consolidated Laboratory Services or other designated laboratory as noted in 12VAC5-90-80 D unless the laboratory has submitted an exemption request that has been approved by the department.
F. A person in charge of a medical care facility shall make a report to the local health department serving the jurisdiction where the facility is located of the occurrence in or admission to the facility of a patient with a reportable disease listed in 12VAC5-90-80 A unless the person in charge of a medical care facility has evidence that the occurrence has been reported by a physician. A person making a report as authorized in this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia. The requirement to report shall include all inpatient, outpatient, and emergency care departments within the medical care facility. A report shall contain the patient's name, address, age, date of birth, race, ethnicity, sex, and, if the patient is female, pregnancy status; name of disease being reported; available laboratory tests and results; the date of admission; medical record number; date expired (if applicable); and attending physician. A report shall be made within the timeframes specified in 12VAC5-90-80 to the local health department serving the jurisdiction in which the facility is located via the Virginia Department of Health's online Confidential Morbidity Report portal at https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/ or a CDC or VDH disease-specific surveillance form. The person in charge of the medical facility may make the reports by means of secure electronic transmission upon agreement of the medical care facility and the department.
G. A person in charge of a medical care facility may assume the reporting responsibility on behalf of the director of the laboratory operating within the facility.
H. The person in charge of a residential or day program, service, or facility licensed or operated by any agency of the Commonwealth or a school, child care center, or summer camp as defined in § 35.1-1 of the Code of Virginia shall report immediately to the local health department the presence or suspected presence in the person in charge's program, service, facility, school, child care center, or summer camp of persons who have common symptoms suggesting an outbreak situation. The person in charge shall report additional information, including identifying and contact information for individuals with communicable diseases of public health concern or individuals who are involved in outbreaks that occur in the person in charge's facilities, as necessary to facilitate public health investigation and disease control. Identifying and contact information, at minimum, shall include a name and telephone number. A person making a report pursuant to this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia.
I. The local health director shall forward a report of a disease or report of evidence of a disease that has been made on a resident of the local health director's jurisdiction to the Office of Epidemiology within three days of receipt. The report shall be submitted immediately by the most rapid means available if the disease is one requiring rapid communication, as required in 12VAC5-90-80 C. Rapid reporting shall be confirmed in writing and submitted to the Office of Epidemiology, by either a paper report or entry into a shared secure electronic disease surveillance system, within three days. A local health director shall immediately forward to the appropriate local health director a disease report on an individual residing in the appropriate local health director's jurisdiction or to the Office of Epidemiology if the individual resides outside Virginia. The Office of Epidemiology shall notify other state health departments of reported illnesses in residents of the other state and shall notify CDC as necessary and appropriate.
J. In accordance with § 32.1-37.1 of the Code of Virginia, a person in charge of a hospital, nursing facility or nursing home, assisted living facility, or correctional facility shall, at the time of transferring custody of a dead body to a person practicing funeral services, notify the person practicing funeral services or the person practicing funeral services's agent if the dead person was known to have had, immediately prior to death, an infectious disease which may be transmitted through exposure to any bodily fluids. These include any of the following infectious diseases:
Coronavirus, severe (e.g., SARS-CoV, MERS-CoV)
Creutzfeldt-Jakob disease
Human immunodeficiency virus (HIV) infection
Hepatitis B (acute and chronic)
Hepatitis C (acute and chronic)
Rabies
Smallpox (Variola virus)
Syphilis, infectious (Treponema pallidum)
Tuberculosis, active disease (Mycobacterium tuberculosis complex)
Vaccinia, disease or adverse event
Viral hemorrhagic fever
K. Pursuant to 12VAC5-421-80, a food employee or conditional employee shall notify the person in charge of the food establishment when diagnosed with certain diseases that are transmissible through food, and the person in charge of the food establishment shall notify the department.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 3.2, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Errata, 15:8 VA.R. 1099 January 4, 1999; amended, Virginia Register Volume 20, Issue 21, eff. July 28, 2004; Volume 23, Issue 15, eff. May 2, 2007; Volume 27, Issue 13, eff. March 28, 2011; Volume 33, Issue 2, eff. October 20, 2016; Volume 36, Issue 6, eff. December 26, 2019; Volume 39, Issue 9, eff. January 18, 2023; Volume 41, Issue 26, eff. September 10, 2025.