Sources & Methodology

1. Overview — Why a Tiered Hierarchy

Public health information in the United States lives in many places. The same fact — say, the fee for a certified copy of a death certificate, or the rule for a religious exemption to a school immunization mandate — can be reported by the state department of health, the federal CDC, an academic publication, a journalist, a third-party blog, and a private commercial site, and these reports may not all agree. We work from a tiered source hierarchy where higher-tier sources govern when sources conflict. This page sets out the tiers and lists the specific sources in each.

Every state guide on department-of-health.org/ is built from the relevant state department of health's own .gov page, not from third-party summaries. Local (county or city) health departments are sourced equivalently when local jurisdiction applies. Examples of Tier 1 sources:

Every U.S. state, the District of Columbia, and U.S. territories (Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, Northern Mariana Islands) have their own state-level department of health, all sourced equivalently. The above is a representative selection of the largest agencies.

• HIPAA Privacy Rule & Security Rule — 45 C.F.R. Parts 160 and 164
• Public Health Service Act — 42 U.S.C. § 201 et seq.
• Social Security Act, Title XVIII (Medicare) and Title XIX (Medicaid) — 42 U.S.C. §§ 1395, 1396 et seq.
• Safe Drinking Water Act (SDWA) — 42 U.S.C. § 300f et seq.
• Federal Food, Drug, and Cosmetic Act (FFDCA) — 21 U.S.C. § 301 et seq.
• Emergency Medical Treatment and Active Labor Act (EMTALA) — 42 U.S.C. § 1395dd
• Title V Maternal and Child Health Block Grant — 42 U.S.C. § 701 et seq.
• Affordable Care Act (ACA) — Pub. L. 111–148; 42 U.S.C. § 18001 et seq.
• Children’s Online Privacy Protection Act (COPPA) — 15 U.S.C. §§ 6501–6506
• Fair Credit Reporting Act (FCRA) — 15 U.S.C. § 1681 et seq.
• Digital Millennium Copyright Act (DMCA) — 17 U.S.C. § 512
• Americans with Disabilities Act (ADA), Title III — 42 U.S.C. § 12181 et seq.
• Section 504 of the Rehabilitation Act — 29 U.S.C. § 794
• Section 508 of the Rehabilitation Act — 29 U.S.C. § 794d
• 21st Century Communications and Video Accessibility Act (CVAA)
• Centers for Medicare & Medicaid Services Conditions of Participation — 42 C.F.R. Parts 482 (hospitals), 483 (long-term care), 416 (ASCs), 484 (home health), 418 (hospice)

• State public-health codes — varying state statutes establishing the department of health’s authority
• State vital records statutes — eligibility, fees, processing, sealed-record rules, genealogy thresholds
• State public-records / sunshine laws — request workflow, fee schedule, exemptions, response timeline
• State food code adoption — typically based on the FDA Food Code 2022 with state-specific amendments
• State Medicaid statutes — eligibility, covered services, MCO contracts, Medicaid Fraud Control Unit authority
• State healthcare facility licensing acts — hospital, ASC, nursing home, home health, hospice, assisted living, residential care
• State immunization mandates and exemption rules — school and child-care immunization requirements; medical, religious, and (where applicable) philosophical exemption procedures
• State communicable-disease reporting rules — reportable conditions, mandatory reporter framework, time-sensitivity tiers
• State drinking water primacy — state regulations enforcing SDWA under EPA oversight
• State environmental health rules — lead poisoning prevention, indoor air, septic, well water, radon, beach water quality
• State professional licensing acts — where overlapping with health professions licensed within the DOH
• State long-term care ombudsman statutes — every state operates an Ombudsman program under Older Americans Act authority

• JAMA — Journal of the American Medical Association
• NEJM — New England Journal of Medicine
• MMWR — Morbidity and Mortality Weekly Report (CDC)
• American Journal of Public Health (AJPH) — APHA publication
• Health Affairs — health policy journal
• Public Health Reports — official journal of the U.S. Public Health Service
• Government Accountability Office (GAO) reports — federal program audits
• HHS Office of Inspector General (OIG) audit reports — federal healthcare program oversight
• National Academies of Sciences, Engineering, and Medicine — consensus reports on public-health topics

8. Verification Workflow — Seven Steps Before Anything Goes Live

1. Identify the right authoritative source. State DOH page on the .gov domain, cross-checked against ASTHO at astho.org; for local agencies, against NACCHO directory.
2. Verify the URL is live. A human editor clicks every link before publication and confirms the destination is the actual page.
3. Dial-test phone numbers. Main line, vital records line, complaint hotline, healthcare facility licensing line.
4. Verify addresses against agency contact pages and USPS ZIP+4 lookup. Vital records, main agency, and facility licensing addresses are often different — each captured separately.
5. Document procedures from the agency’s own published rules. Vital records request workflow, inspection complaint workflow, IIS request workflow, healthcare facility complaint workflow.
6. Cross-reference federal layer. Where federal agencies (CMS, FDA, OCR, OIG) intersect, the federal portal is documented as the authoritative cross-reference.
7. Editor sign-off. A second editor reviews end-to-end, including a fresh read of the not-medical-advice and not-legal-advice notices.

9. FCRA Framework Reminder

Information on the site is general informational content drawn from public records and authoritative public sources. It is not a "consumer report" under the Fair Credit Reporting Act (15 U.S.C. § 1681 et seq.) and department-of-health.org/ is not a Consumer Reporting Agency. Do not use any content on this site to make employment, credit, insurance, tenant-screening, or healthcare-credentialing decisions covered by the FCRA. For those purposes, use a CRA licensed for that purpose.

10. Sources We Avoid

• Anonymous user-generated review sites for facts about agency contacts, fees, or procedures — those sites can be useful for crowd impressions but are not authoritative for procedural fact
• Social media posts as standalone authority — agency social media accounts are valuable for breaking notices but every claim is cross-checked to the agency’s own .gov page
• Commercial vital-records expediting services as authority on state vital records rules — these are commercial intermediaries, not the state agency, and their pages frequently misstate state rules to favour their own service
• Other directory aggregator sites — we work to the original agency source, not to other directories that may themselves be working from stale data
• Pseudoscience, anti-vaccine, or anti-public-health publications — these are not authoritative for any factual claim and are not used
• Unverified third-party blogs and news aggregators — used only for context and never as sole source for current portal URLs, contacts, or fees