(1) Each licensed health care provider in attendance at any birth occurring outside a hospital or health care facility shall file a report with the department that documents:
(a) the newborn's full name, date of birth, gender, mother's maiden name, and the location of the newborn's birth;
(b) that the education protocol and educational materials developed by the department on newborn hearing screening were provided to the parents of the newborn;
(c) that referral information has been provided to the newborn's parents which identifies the hospitals, health care facilities, and other health care providers in the area that are able to provide hearing screenings for newborns.
(d) that the newborn's primary care provider, if other than the health care provider attending the birth, has been notified that newborn hearing screening has been provided to the newborn's parents.
(2) The report shall be made to the department by the 15th day of each month for the babies delivered in the previous month on a form available from the Department of Public Health and Human Services, Newborn Screening Program, Children's Special Health Services Section, Family and Community Health Bureau.