Privacy Act of 1974; Report of Modified or Altered System, 49931-49940 [05-16890]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 70, Number 164 (Thursday, August 25, 2005)]
[Notices]
[Pages 49931-49940]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-16890]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Privacy Act of 1974; Report of Modified or Altered System

AGENCY: Indian Health Service (IHS), HHS.

ACTION: Notice of proposed modification or Alteration to a System of 
Records (SOR).

-----------------------------------------------------------------------

SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to modify or alter an SOR, ``Health, Medical and 
Billing Records (formerly known as the Health and Medical Records 
Systems),'' System No. 09-17-0001. We propose to include contract 
health service records, as an additional category of individuals 
covered by the system, which consists of medical records to eligible 
American Indians and Alaska Native (AI/AN) people that supplements the 
health care resources available with the purchase of medical care and 
services that are not available within the IHS direct care system which 
may include, but not limited to, basic and specialty health care 
services from local and community health care providers, including 
hospital care, physician services, outpatient care, laboratory, dental, 
radiology, pharmacy, and transportation services. Under the Purpose of 
the system, we propose to include several new purposes that are in line 
with the Health Insurance Portability and Accountability Act (HIPAA) 
Privacy Rule provisions which were incorporated into the published IHS 
Notice of Privacy Practices (NPP) and to include debt collection 
activities. We are proposing to modify/alter/delete several published 
routine uses, as explained, to accommodate for program and statutory 
changes as indicated: Number 1 is modified/altered by separating the 
medical treatment, payment and health care operations into two separate 
routine uses 1 and 2 to include payment, billing, third-party 
reimbursement and debt collection activities; numbers 3, 4 and 11 are 
to include business associate agreement language to comply with HIPAA 
Privacy standards and renumbered as 5, 6 and 12 respectively; number 5 
is to include a special requirement notice for sensitive protected 
health information (PHI) such as alcohol/drug abuse, HIV/AIDS, STD or 
mental health patient information and renumbered as 7; number 6 is to 
reflect changes in research disclosures to comply with HIPAA Privacy 
standards and renumbered as 8; number 7 is to include various cases of 
abuses, neglect, sexual assault and domestic violence and emphasis on 
meeting the requirements of 42 CFR part 2 and renumbered as 9; number 8 
is to clarify the disclosures regarding suspected cases of child abuse 
and renumbered as 10; number 9 is modified to include legal proceedings 
related to administrative claims and the inclusive provision of the 
Department of Health and Human Services (DHHS)/Office of General 
Counsel (OGC)

[[Page 49932]]

representation in litigation matters and renumbered as 11; number 10 is 
modified to include business associate agreement language to comply 
with HIPAA Privacy standards and is renumbered as 5; numbers 12 and 16 
are modified and incorporated into one proposed routine use 13 with 
minor edits; number 14 is modified to reflect the permitted use/
disclosure requirements of 45 CFR 164.502(g) and remains as 14; number 
15 is modified with some minor edits to reflect current changes to 
enable efficient administration of health care operations and planning 
and delivery of patient medical care and renumbered as 18; and number 
16 is being deleted and incorporated into the proposed routine use 13.
    We propose to add 10 new routine uses to provide disclosures of 
records when all requirements are met: number 2, to provide disclosure 
for third-part reimbursement, fiscal intermediary functions and debt 
collection activities; number 3, to provide disclosures to state 
Medicaid agencies or other entities acting pursuant to a contract with 
Centers for Medicare & Medicaid Services (CMS) for fraud and abuse 
control efforts to the extent required by law or under an agreement 
between IHS and respective state Medicaid agency or other entities; 
number 16, to an individual having authority to act on behalf of an 
incompetent individual concerning health care decisions to the extent 
permitted under 45 CFR 164.502(g); number 17, information may be used 
or disclosed from an IHS facility directory unless the individual 
objects to the disclosure and may provide the religious affiliation 
only to members of the clergy; number 18, information may be disclosed 
to a relative, a close personal friend, or any other person identified 
by the individual that is directly relevant to that person's 
involvement with their care or payment for health care and may be used 
or disclosed to notify family member, personal representative, or other 
person responsible for the individual's care, of their location, 
general condition or death; number 20, to provide records to Federal 
and non-Federal protection and advocacy organizations for investigating 
incidents of abuse and neglect of individuals with development 
disabilities as defined in 42 U.S.C. 10801-10805(a)(4) and 42 CFR 
51.41-46 to the extent authorized by law and the conditions of 45 CFR 
1386.22(a)(2) are met; number 21, disclosure to a correctional 
institution or a law enforcement official, during the period of time 
the individual is either an inmate or is otherwise in lawful custody, 
for the provision of health care to the individual or for health and 
safety purposes; number 22, disclosure to the Social Security 
Administration (SSA) for validation of Social Security Number(s) (SSNs) 
purposes only; number 23, disclosure of relevant health care 
information may be made to funeral director or representatives of 
funeral homes to allow for necessary arrangements; number 24, 
disclosure to a public or private covered entity that is authorized by 
law or charter to assist in disaster relief efforts. Routine use 
previously numbered 13 is deleted as being no longer applicable to the 
system. Routine uses previously numbered 2, 3, 4, 5, 6, 7, 8, 9, 11, 
12, and 15 have been renumbered as 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, 
and 19 respectively.
    The security classification previously reported as ``None'' will 
remain. We have modified the language in the routine uses to provide 
clarification to IHS' intention to disclose individual-specific 
information contained in this system. The routine uses will then be 
prioritized and reordered according to their usage. We will also take 
the opportunity to update any sections of the system notice to provide 
clarity on the changing environment to include for digital records and 
the initiative of transitioning from a paper-based record to a 
computerized-based or electronic medical record.

DATES: Effective Dates: The Report of Intent to Amend a System of 
Records Notice and an advance copy of the system notice have been sent 
to the Chair of the House Committee on Government Reform and Oversight, 
the Chair of the Senate Committee on Governmental Affairs, and the 
Administrator, Office of Information and Regulatory Affairs, Office of 
Management and Budget (OMB). To ensure that all parties have adequate 
time in which to comment, the modified system of records, including 
routine uses, will become effective 40 days from the publication of the 
notice, or from the date it was submitted to OMB and the Congress, 
whichever is later, unless IHS receives comments that require 
alterations to this notice.

ADDRESSES: The public should address comments to: Mr. William Tibbitts, 
IHS Privacy Act Officer, Division of Regulatory, Records Access and 
Policy Liaison, 801 Thompson Avenue, TMP 450, Rockville, MD 20852-1627; 
call non-toll free (301) 443-1116; send via facsimile to (301) 443-
2316, or send your e-mail requests, comments, and return address to: 
wtibbitt@hqe.ihs.gov.

FOR FURTHER INFORMATION CONTACT: Ms. Patricia Gowan, IHS Lead Health 
Information Management (HIM) Consultant, Office of Clinical and 
Preventative Services, Reyes Building, 801 Thompson Avenue, Suite 314, 
Rockville, MD 20852-1627, Telephone (301) 443-2522.

SUPPLEMENTARY INFORMATION:
    A. Major Alteration of 09-17-0001, ``Indian Health Service Health 
and Medical Records Systems, HHS/IHS/OHP'': IHS provides care and 
treatment to patients at IHS health care facilities and under contract. 
Whenever possible, IHS seeks reimbursement through third-party payers 
such as Medicare, Medicaid, and private insurers. IHS is proposing to 
alter the existing system of records as follows:
    1. IHS is changing the title of the system from ``Health and 
Medical Records System, HHS/IHS/OHP,'' to ``Medical, Health, and 
Billing Records System, HHS/IHS/OCPS,'' to clarify that IHS also uses 
the records in the system to process, document, and monitor third-party 
payment billing and reimbursement claims, in addition to debt 
collection activities.
    2. IHS is proposing to include contract health service records as 
an additional category of individuals covered by the system.
    3. IHS is proposing to include several new purposes that are in 
line with the Health Insurance Portability and Accountability Act 
(HIPAA) Privacy Rule provisions. These seven (7) new purposes are as 
follow: (1) To provide information to organ procurement organizations 
or other entities engaged in the procurement, banking, or 
transplantation of organs to facilitate organ, eye, or tissue donation 
and transplant. (2) To provide information to individuals about 
treatment alternatives or other types of health-related benefits and 
services. (3) To provide information to the Food and Drug 
Administration (FDA) in connection with an FDA-regulated product or 
activity. (4) To provide information to correctional institutions as 
necessary for health and safety purposes. (5) To provide information to 
governmental authorities (e.g., social service or protective services 
agencies) on victims of abuse, neglect, sexual assault or domestic 
violence. (6) To provide information to the National Archives and 
Records Administration in records management inspections conducted 
under the authority of 44 U.S.C. 2901 et seq. (7) To provide relevant 
health care information to funeral directors or representatives of 
funeral homes to allow necessary arrangements prior to and in

[[Page 49933]]

anticipation of an individual's impending death.
    4. IHS is proposing to modify/alter/delete several published 
routine uses and to include ten (10) new routine uses when all 
requirements have been met. IHS is modifying/altering routine use 
1 by separating the medical treatment, payment, and health 
care operations to routine uses 1 and 2 respectively; 
routine uses 2 is renumbered as 4; routine uses 
3 and 4 are modified to include business associate 
agreement language to comply with HIPAA Privacy standards and 
renumbered as 6 and 7 respectively; routine use 
5 is altered to include a special requirement notice for 
sensitive protected health information (PHI) as such alcohol/drug 
abuse, HIV/AIDS, STD or mental health patient information and 
renumbered as 8; routine use 6 is modified/altered to 
reflect changes in research disclosures to comply with HIPAA Privacy 
standards and renumbered as 9; routine use 7 is 
modified/altered to include various cases of abuses, neglect, sexual 
assault and domestic violence with an emphasis on 42 CFR part 2 and 
renumbered as 10; routine use 8 is modified to 
clarify the disclosure under (a) and (b) with no statutory language 
change on child abuse and the deletion of statutory citation of 42 CFR 
Part 2 and renumbered as 11; routine use 9 is 
modified to include legal proceedings related to administrative claims 
and the inclusive provision of the DHHS/Office of General Counsel (OGC) 
representation in litigation matters and renumbered as 12; 
routine use 10 was modified/altered to reflect statutory 
requirement and renumbered as 5; routine use 11 is 
modified to include business associate agreement language to comply 
with the HIPAA Privacy standards and altered to eliminate the safeguard 
requirements of the Privacy Act and was renumbered as 13; 
routine uses 12 and 16 were modified and incorporated 
into one proposed routine use disclosure with minor edits and to 
efficiently administer health care operations and to assist in the 
planning and delivery of patient's medical care and renumbered as 
14; routine use 13 was deleted as no longer 
applicable to the purpose and function of IHS; routine use 14 
is modified to reflect the permitted use/disclosure requirement of 45 
CFR 164.502(g) citation and renumbered as 15; routine use 
15 is modified with some minor edits to reflect current 
changes and remains as 15; and routine use 16 is 
being deleted and incorporated into the new routine use 13.
    IHS is proposing to add ten (10) new routine uses as follows: 
routine use 2 is to provide disclosure for third-party 
reimbursement, fiscal intermediary functions, and debt collection 
activities; routine use 3 is to provide state agencies or 
other entities acting pursuant to a contract with CMS for fraud and 
abuse control efforts to the extent required by law or under an 
agreement between IHS and respective state Medicaid agency or other 
entities; routine use 16 is to provide an individual having 
authority to act on behalf of an incompetent individual concerning 
health care decisions to the extent permitted under 45 CFR 164.502(g); 
routine use 17 is that certain protected health information 
may be used or disclosed from an IHS facility directory unless the 
individual objects to the disclosure and IHS may provide the religious 
affiliation only to members of the clergy to the extent permitted under 
45 CFR 164.510; routine use 18 is that relevant protected 
health information may be disclosed to a relative, a close personal 
friend, or any other person identified by the individual with their 
care or payment for health care. Information may be used or disclosed 
to notify family members, personal representative, or other person 
responsible for the individual's care, of their location, general 
condition or death; routine use 20 to Federal and non-Federal 
protection and advocacy organization for purpose of investigating 
incidents of abuse and neglect of individuals with development 
disabilities as defined in 42 U.S.C. 10801-10805(a)(4) and 42 CFR 
51.41-46 to the extent authorized by law and the conditions of 45 CFR 
1386.22(a)(2) are met; routine use 21 is for disclosure to a 
correctional institution or a law enforcement official, during the 
period of time the individual is either an inmate or is otherwise in 
lawful custody, for the provision of health care to the individual or 
for health and safety purposes; routine use 22 is for 
disclosure to the Social Security Administration for validation of 
SSN(s) purposes only; routine use 23 is that disclosure of 
relevant health care information may be made to funeral director or 
representatives of funeral homes to allow for necessary arrangements; 
and routine use 24 is for disclosure to a public or private 
covered entity that is authorized by law or charter to assist in 
disaster relief efforts.
    In addition to updating and making editorial corrections to improve 
the clarity of the system notice, this alteration requires the updating 
of the system manager listing, and revisions of the Categories of 
Records, Purposes, Authority, Safeguard, Retention and Disposal, 
Notification and Access Procedures sections.

    Dated: August 15, 2005.
Charles W. Grim,
Assistant Surgeon General, Director, Indian Health Service.
09-17-0001

System name:
    Medical, Health, and Billing Records Systems, HHS/IHS/OCPS.

Security classification:
    None.

System location:
    Indian Health Service (IHS) hospitals, health centers, school 
health centers, health stations, field clinics, Service Units, IHS Area 
Offices (Appendix 1), and Federal Archives and Records Centers 
(Appendix 2). Automated, electronic and computerized records, including 
Patient Care Component (PCC) records, are stored at the Information 
Technology Support Center (ITSC), IHS, located in Albuquerque, New 
Mexico (Appendix 1). Records may also be located at contractor sites. A 
current list of contractor sites is available by writing to the 
appropriate System Manager (Area or Service Unit Director/Chief 
Executive Officer) at the address shown in Appendix 1.

Categories of individuals covered by the system:
    Individuals, including both IHS beneficiaries and non-
beneficiaries, who are examined/treated on an inpatient and/or 
outpatient basis by IHS staff and/or contract health care providers 
(including tribal contractors).

Categories of records in the system:

    Note: Records relating to claims by and against the Department 
of Health and Human Services (DHHS) are maintained in the 
Administrative Claims System, 09-90-0062, HHS/OS/OGC. Such claims 
include those arising under the Federal Torts Claims Act, Military 
Personnel and Civilian Employees Claims Act, Federal Claims 
Collection Act, Federal Medical Care Recovery Act, and Act for 
Waiver of Overpayment of Pay.


    1. Health and medical records containing examination, diagnostic 
and treatment data, proof of IHS eligibility, social data (such as 
name, address, date of birth, Social Security Number (SSN), tribe), 
laboratory test results, and dental, social service, domestic violence, 
sexual abuse and/or assault, mental health, and nursing information.
    2. Follow-up registers of individuals with a specific health 
condition or a particular health status such as cancer, diabetes, 
communicable diseases,

[[Page 49934]]

suspected and confirmed abuse and neglect, immunizations, suicidal 
behavior, or disabilities.
    3. Logs of individuals provided health care by staff of specific 
hospital or clinic departments such as surgery, emergency, obstetric 
delivery, medical imaging, and laboratory.
    4. Surgery and/or disease indices for individual facilities that 
list each relevant individual by the surgery or disease.
    5. Monitoring strips and tapes such as fetal monitoring strips and 
EEG and EKG tapes.
    6. Third-party reimbursement and billing records containing name, 
address, date of birth, dates of service, third party insurer claim 
numbers, SSN, health plan name, insurance number, employment status, 
and other relevant claim information necessary to process and validate 
third-party reimbursement claims.
    7. Contract Health Service (CHS) records containing name, address, 
date of birth, dates of care, Medicare or Medicaid claim numbers, SSN, 
health plan name, insurance number, employment status, and other 
relevant claim information necessary to determine CHS eligibility and 
to process CHS claims.

Authority for maintenance of the system:
    Departmental Regulations (5 U.S.C. 301); Privacy Act of 1974 (5 
U.S.C. 552a); Federal Records Act (44 U.S.C. 2901); Section 321 of the 
Public Health Service Act, as amended (42 U.S.C. 248); Section 327A of 
the Public Health Service Act, as amended (42 U.S.C. 254a); Snyder Act 
(25 U.S.C. 13); Indian Health Care Improvement Act (25 U.S.C. 1601 et 
seq.); and the Transfer Act of 1954 (42 U.S.C. 2001-2004).

Purposes:
    The purposes of this system are:
    1. To provide a description of an individual's diagnosis, treatment 
and outcome, and to plan for immediate and future care of the 
individual.
    2. To provide statistical data to IHS officials in order to 
evaluate health care programs and to plan for future needs.
    3. To serve as a means of communication among members of the health 
care team who contribute to the individual's care; e.g., to integrate 
information from field visits with records of treatment in IHS 
facilities and with non-IHS health care providers.
    4. To serve as the official documentation of an individual's health 
care.
    5. To contribute to continuing education of IHS staff to improve 
the delivery of health care services.
    6. For disease surveillance purposes. For example:
    (a) The Centers for Disease Control and Prevention may use these 
records to monitor various communicable diseases;
    (b) The National Institutes of Health may use these records to 
review the prevalence of particular diseases (e.g., malignant 
neoplasms, diabetes mellitus, arthritis, metabolism, and digestive 
diseases) for various ethnic groups of the United States; or
    (c) Those public health authorities that are authorized by law may 
use these records to collect or receive such information for purposes 
of preventing or controlling disease, injury, or disability, including, 
but not limited to, the reporting of disease, injury, vital events such 
as birth or death and the conduct of public health surveillance, 
investigations, and interventions.
    7. To compile and provide aggregated program statistics. Upon 
request of other components of DHHS, IHS will provide statistical 
information, from which individual/personal identifiers have been 
removed, such as:
    (a) To the National Committee on Vital and Health Statistics for 
its dissemination of aggregated health statistics on various ethnic 
groups;
    (b) To the Assistant Secretary for Planning and Evaluation, Health 
Policy to keep a record of the number of sterilizations provided by 
Federal funding;
    (c) To the Centers for Medicare & Medicaid Services (CMS) to 
document IHS health care covered by the Medicare and Medicaid programs 
for third-party reimbursement; or
    (d) To the Office of Clinical Standards and Quality, CMS to 
determine the prevalence of end-stage renal disease among the American 
Indian and Alaska Native (AI/AN) population and to coordinate 
individual care.
    8. To process and collect third-party claims and facilitate fiscal 
intermediary functions and to process debt collection activities.
    9. To improve the IHS national patient care database by means of 
obtaining and verifying an individual's SSN with the Social Security 
Administration (SSA).
    10. To provide information to organ procurement organizations or 
other entities engaged in the procurement, banking, or transplantation 
of organs to facilitate organ, eye, or tissue donation and transplant.
    11. To provide information to individuals about treatment 
alternatives or other types of health-related benefits and services.
    12. To provide information to the Food and Drug Administration 
(FDA) in connection with an FDA-regulated product or activity.
    13. To provide information to correctional institutions as 
necessary for health and safety purposes.
    14. To provide information to governmental authorities (e.g., 
social services or protective services agencies) on victims of abuse, 
neglect, sexual assault or domestic violence.
    15. To provide information to the National Archives and Records 
Administration in records management inspections conducted under the 
authority of 44 U.S.C 2901 et seq.
    16. To provide relevant health care information to funeral 
directors or representatives of funeral homes to allow necessary 
arrangements prior to and in anticipation of an individual's impending 
death.

Routine uses of records maintained in the system, including categories 
of users and the purposes of such uses:
    This system of records contains individually identifiable health 
information. The DHHS Privacy Act Regulations (45 CFR Part 5b) and the 
Privacy Rule (45 CFR Parts 160 and 164) issued pursuant to the Health 
Insurance Portability and Accountability Act (HIPAA) of 1996 apply to 
most health information maintained by IHS. Those regulations may place 
additional procedural requirements on the uses and disclosures of such 
information beyond those found in the Privacy Act of 1974 or mentioned 
in this system of records notice. An accounting of all disclosures of a 
record made pursuant to the following routine uses will be made and 
maintained by IHS for five years or for the life of the records, 
whichever is longer.


    Note: Special requirements for alcohol and drug abuse patients: 
If an individual receives treatment or a referral for treatment for 
alcohol or drug abuse, then the Confidentiality of Alcohol and Drug 
Abuse Patient Records Regulations, 42 CFR Part 2 may apply. In 
general, under these regulations, the only disclosures of the 
alcohol or drug abuse record that may be made without patient 
consent are: (1) To meet medical emergencies (42 CFR 2.51), (2) for 
research, audit, evaluation and examination (42 CFR 2.52 and 2.53), 
(3) pursuant to a court order (42 CFR 2.61-2.67), and (4) pursuant 
to a qualified service organization agreement, as defined in 42 CFR 
2.11. In all other situations, written consent of the individual is 
usually required prior to disclosure of alcohol or drug abuse 
information under the routine uses listed below.

    1. Records may be disclosed to Federal and non-Federal (public or

[[Page 49935]]

private) health care providers that provide health care services to IHS 
individuals for purposes of planning for or providing such services, or 
reporting results of medical examination and treatment.
    2. Records may be disclosed to Federal, state, local or other 
authorized organizations that provide third-party reimbursement or 
fiscal intermediary functions for the purposes of billing or collecting 
third-party reimbursements. Relevant records may be disclosed to debt 
collection agencies under a business associate agreement arrangement 
directly or through a third party.
    3. Records may be disclosed to state agencies or other entities 
acting pursuant to a contract with CMS, for fraud and abuse control 
efforts, to the extent required by law or under an agreement between 
IHS and respective state Medicaid agency or other entities.
    4. Records may be disclosed to school health care programs that 
serve AI/AN for the purpose of student health maintenance.
    5. Records may be disclosed to the Bureau of Indian Affairs (BIA) 
or its contractors under an agreement between IHS and the BIA relating 
to disabled AI/AN children for the purposes of carrying out its 
functions under the Individuals with Disabilities Education Act 
(IDEAS), 20 U.S.C.1400, et seq.
    6. Records may be disclosed to organizations deemed qualified by 
the Secretary of DHHS and under a business associate agreement to carry 
out quality assessment/improvement, medical audits, utilization review 
or to provide accreditation or certification of health care facilities 
or programs.
    7. Records may be disclosed under a business associate agreement to 
individuals or authorized organizations sponsored by IHS, such as the 
National Indian Women's Resource Center, to conduct analytical and 
evaluation studies.
    8. Disclosure may be made to a congressional office from the record 
of an individual in response to an inquiry from the congressional 
office made at the request of that individual. An authorization, Form 
IHS 810, is required for the disclosure of sensitive protected health 
information (PHI) (e.g., alcohol/drug abuse patient information, human 
immunodeficiency virus (HIV)/AIDS, STD, or mental health) that is 
maintained in the medical record.
    9. Records may be disclosed for research purposes to the extent 
permitted by:
    (a) Determining that the use(s) or disclosure(s) are met under 45 
CFR 164.512(i), or
    (b) Determining that the use(s) or disclosure(s) are met under 45 
CFR 164.514(a) through (c) for de-identified PHI, and 5 U.S.C. 
552a(b)(5), or
    (c) Determining that the requirements of 45 CFR 164.514(e) for 
limited data sets, and 5 U.S.C. 552a(b)(5) are met.
    10. Information from records, such as information concerning the 
commission of crimes, suspected cases of abuse (including child, elder 
and sexual abuse), neglect, sexual assault or domestic violence, 
births, deaths, alcohol or drug abuse, immunizations, cancer, or the 
occurrence of communicable diseases, may be disclosed to public health 
authorities or other appropriate government authorities, as authorized 
by Federal, state, Tribal or local law or regulation of the 
jurisdiction in which the facility is located.


    Note: In Federally conducted or assisted alcohol or drug abuse 
programs, under 42 CFR Part 2, disclosure of patient information for 
purposes of criminal investigations must be authorized by court 
order issued under 42 CFR Part 2.65, except that reports of 
suspected child abuse may be made to the appropriate state or local 
authorities under state law.


    11. Information may be disclosed from these records regarding 
suspected cases of child abuse to:
    (a) Federal, state or Tribal agencies that need to know the 
information in the performance of their duties, and
    (b) Members of community child protection teams for the purposes of 
investigating reports of suspected child abuse, establishing a 
diagnosis, formulating or monitoring a treatment plan, and making 
recommendations to the appropriate court. Community child protection 
teams are comprised of representatives of Tribes, the Bureau of Indian 
Affairs, child protection service agencies, the judicial system, law 
enforcement agencies and IHS.
    12. IHS may disclose information from these records in litigations 
and/or proceedings related to an administrative claim when:
    (a) IHS has determined that the use of such records is relevant and 
necessary to the litigation and/or proceedings related to an 
administrative claim and would help in the effective representation of 
the affected party listed in subsections (i) through (iv) below, and 
that such disclosure is compatible with the purpose for which the 
records were collected. Such disclosure may be made to the DHHS/Office 
of General Counsel (OGC) and/or Department of Justice (DOJ), pursuant 
to an agreement between IHS and OGC, when any of the following is a 
party to litigation and/or proceedings related to an administrative 
claim or has an interest in the litigation and/or proceedings related 
to an administrative claim:
    (i) DHHS or any component thereof; or
    (ii) Any DHHS employee in his or her official capacity; or
    (iii) Any DHHS employee in his or her individual capacity where the 
DOJ (or DHHS, where it is authorized to do so) has agreed to represent 
the employee; or
    (iv) The United States or any agency thereof (other than DHHS) 
where DHHS/OGC has determined that the litigation and/or proceedings 
related to an administrative claim is likely to affect DHHS or any of 
its components.
    (b) In the litigation and/or proceedings related to an 
administrative claim described in subsection (a) above, information 
from these records may be disclosed to a court or other tribunal, or to 
another party before such tribunal in response to an order of a court 
or administrative tribunal, provided that the covered entity discloses 
only the information expressly authorized by such order.
    13. Records may be disclosed under a business associate agreement 
to an IHS contractor for the purpose of computerized data entry, 
medical transcription, duplication services, or maintenance of records 
contained in this system.
    14. Records may be disclosed under a personal services contract or 
other agreement to student volunteers, individuals working for IHS, and 
other individuals performing functions for IHS who do not technically 
have the status of agency employees, if they need the records in the 
performance of their agency functions.
    15. Records regarding specific medical services provided to an 
unemancipated minor individual may be disclosed to the unemancipated 
minor's parent or legal guardian who previously consented to those 
specific medical services, to the extent permitted under 45 CFR 
164.502(g).
    16. Records may be disclosed to an individual having authority to 
act on behalf of an incompetent individual concerning health care 
decisions, to the extent permitted under 45 CFR 164.502(g).
    17. Information may be used or disclosed from an IHS facility 
directory in response to an inquiry about a named individual from a 
member of the general public to establish the individual's presence 
(and location when needed for visitation purposes) or to report the 
individual's condition while hospitalized (e.g., satisfactory or 
stable),

[[Page 49936]]

unless the individual objects to disclosure of this information. IHS 
may provide the religious affiliation only to members of the clergy.
    18. Information may be disclosed to a relative, a close personal 
friend, or any other person identified by the individual that is 
directly relevant to that person's involvement with the individual's 
care or payment for health care.
    Information may also be used or disclosed in order to notify a 
family member, personal representative, or other person responsible for 
the individual's care, of the individual's location, general condition 
or death.
    If the individual is present for, or otherwise available prior to, 
a use or disclosure, and is competent to make health care decisions;
    (a) May use or disclose after the facility obtains the individual's 
consent,
    (b) Provides the individual with the opportunity to object and the 
individual does not object, or
    (c) It could reasonably infer, based on professional judgment, that 
the individual does not object.
    If the individual is not present, or the opportunity to agree or 
object cannot practicably be provided due to incapacity or emergent 
circumstances, an IHS health care provider may determine, based on 
professional judgment, whether disclosure is in the individual's best 
interest, and if so, may disclose only what is directly relevant to the 
individual's health care.
    19. Information concerning exposure to the HIV may be disclosed, to 
the extent authorized by Federal, state or Tribal law, to the sexual 
and/or needle-sharing partner(s) of a subject individual who is 
infected with HIV under the following circumstances:
    (a) The information has been obtained in the course of clinical 
activities at IHS facilities;
    (b) IHS has made reasonable efforts to counsel and encourage the 
subject individual to provide information to the individual's sexual or 
needle-sharing partner(s);
    (c) IHS determines that the subject individual is unlikely to 
provide the information to the sexual or needle-sharing partner(s) or 
that the provision of such information cannot reasonably be verified; 
and
    (d) The notification of the partner(s) is made, whenever possible, 
by the subject individual's physician or by a professional counselor 
and shall follow standard counseling practices.
    (e) IHS has advised the partner(s) to whom information is disclosed 
that they shall not re-disclose or use such information for a purpose 
other than that for which the disclosure was made.
    20. Records may be disclosed to Federal and non-Federal protection 
and advocacy organizations that serve AI/AN for the purpose of 
investigating incidents of abuse and neglect of individuals with 
developmental disabilities (including mental disabilities), as defined 
in 42 U.S.C. Sec. Sec.  10801-10805(a)(4) and 42 CFR Sec. Sec.  51.41-
46, to the extent that such disclosure is authorized by law and the 
conditions of 45 CFR Sec.  1386.22(a)(2) are met.
    21. Records of an individual may be disclosed to a correctional 
institution or a law enforcement official, during the period of time 
the individual is either an inmate or is otherwise in lawful custody, 
for the provision of health care to the individual or for health and 
safety purposes. Disclosure may be made upon the representation of 
either the institution or a law enforcement official that disclosure is 
necessary for the provision of health care to the individual, for the 
health and safety of the individual and others (e.g., other inmates, 
employees of the correctional facility, transport officers), and for 
facility administration and operations. This routine use applies only 
for as long as the individual remains in lawful custody, and does not 
apply once the individual is released on parole or placed on either 
probation or on supervised release, or is otherwise no longer in lawful 
custody.
    22. Records including patient name, date of birth, SSN, gender and 
other identifying information may be disclosed to the SSA as is 
reasonably necessary for the purpose of conducting an electronic 
validation of the SSN(s) maintained in the record to the extent 
required under an agreement between IHS and SSA.
    23. Disclosure of relevant health care information may be made to 
funeral directors or representatives of funeral homes in order to allow 
them to make necessary arrangements prior to and in anticipation of an 
individual's impending death.
    24. Records may be disclosed to a public or private covered entity 
that is authorized by law or charter to assist in disaster relief 
efforts (e.g., the Red Cross and the Federal Emergency Management 
Administration), for purposes of coordinating information with other 
similar entities concerning an individual's health care, payment for 
health care, notification of the individual's whereabouts and his or 
her health status or death.

Policies and practices for storing, retrieving, accessing, retaining, 
and disposing of records in the system:
Storage:
    File folders, ledgers, card files, microfiche, microfilm, computer 
tapes, disk packs, digital photo discs, and automated, computer-based 
or electronic files.

Retrievability:
    Indexed by name, record number, and SSN and cross-indexed.

Safeguards:
    Safeguards apply to records stored on-site and off-site.
    1. Authorized Users: Access is limited to authorized IHS personnel, 
volunteers, IHS contractors, subcontractors, and other business 
associates in the performance of their duties. Examples of authorized 
personnel include: Medical records personnel, business office 
personnel, contract health staff, health care providers, authorized 
researchers, medical audit personnel, health care team members, and 
legal and administrative personnel on a need to know basis.
    2. Physical Safeguards: Records are kept in locked metal filing 
cabinets or in a secured room or in other monitored areas accessible to 
authorized users at all times when not actually in use during working 
hours and at all times during non-working hours. Magnetic tapes, disks, 
other computer equipment (e.g., pc workstations) and other forms of 
personal data are stored in areas where fire and life safety codes are 
strictly enforced. Telecommunication equipment (e.g., computer 
terminal, servers, modems and disks) of the Resource and Patient 
Management System (RPMS) are maintained in locked rooms during non-
working hours. Network (Internet or Intranet) access of authorized 
individual(s) to various automated and/or electronic programs or 
computers (e.g., desktop, laptop, handheld or other computer types) 
containing protected personal identifiers or personal health 
information (PHI) is reviewed periodically and controlled for 
authorizations, accessibility levels, expirations or denials, including 
passwords, encryptions or other devices to gain access. Combinations 
and/or electronic passcards on door locks are changed periodically and 
whenever an IHS employee resigns, retires or is reassigned.
    3. Procedural Safeguards: Within each facility a list of personnel 
or categories of personnel having a demonstrable need for the records 
in the performance of their duties has been developed and

[[Page 49937]]

is maintained. Procedures have been developed and implemented to review 
one-time requests for disclosure to personnel who may not be on the 
authorized user list. Proper charge-out procedures are followed for the 
removal of all records from the area in which they are maintained. 
Records may not be removed from the facility except in certain 
circumstances, such as compliance with a valid court order or shipment 
to the Federal Records Center(s). Persons who have a need to know are 
entrusted with records from this system of records and are instructed 
to safeguard the confidentiality of these records. These individuals 
are to make no further disclosure of the records except as authorized 
by the system manager and permitted by the Privacy Act and the HIPAA 
Privacy Rule as adopted, and to destroy all copies or to return such 
records when the need to know has expired. Procedural instructions 
include the statutory penalties for noncompliance.
    The following automated information systems (AIS) security 
procedural safeguards are in place for automated health and medical 
records maintained in the RPMS. A profile of automated systems security 
is maintained. Security clearance procedures for screening individuals, 
both Government and contractor personnel, prior to their participation 
in the design, operation, use or maintenance of IHS AIS are 
implemented. The use of current passwords and log-on codes are required 
to protect sensitive automated data from unauthorized access. Such 
passwords and codes are changed periodically. An automated or 
electronic audit trail is maintained and reviewed periodically. Only 
authorized IHS Division of Information Resources staff may modify 
automated files in batch mode. Personnel at remote terminal sites may 
only retrieve automated or electronic data. Such retrievals are 
password protected. Privacy Act requirements, HIPAA Privacy Rule and 
Security requirements and specified AIS security provisions are 
specifically included in contracts and agreements and the system 
manager or his/her designee oversee compliance with these contract 
requirements.
    4. Implementing Guidelines: DHHS Chapter 45-10 and supplementary 
Chapter PHS.hf: 45-10 of the General Administration Manual; DHHS, 
``Automated Information Systems Security Program Handbook,'' as 
amended; DHHS IRM Policy HHS-IRM-2000-0005, ``IRM Policy for IT 
Security for Remote Access'; OMB Circular A-130 ``Management of Federal 
Information Resources'; HIPAA Security Standards for the Protection of 
Electronic Protected Health Information, 45 CFR Sec. Sec.  164.302 
through 164.318; and E-Government Act of 2002 (Pub. L. 107-347, 44 
U.S.C. Ch 36).

Retention and disposal:
    Patient listings which may identify individuals are maintained in 
IHS Area and Program Offices permanently. Inactive records are held at 
the facility that provided health and billing services from three to 
seven years and then are transferred to the appropriate Federal Records 
Center. Monitoring strips and tapes (e.g., fetal monitoring strips, EEG 
and EKG tapes) that are not stored in the individual's official medical 
record are stored at the health facility for one year and are then 
transferred to the appropriate Federal Records Center. (See Appendix 2 
for Federal Records Center addresses.) In accordance with the records 
disposition authority approved by the Archivist of the United States, 
paper records are maintained for 75 years after the last episode of 
individual care except for billing records. The retention and disposal 
methods for billing records will be in accordance with the approved IHS 
Records Schedule. The disposal methods of paper medical and health 
records will be in accordance with the approved IHS Records Schedule. 
The electronic data consisting of the individual personal identifiers 
and PHI maintained in the RPMS or any subsequent revised IHS database 
system should be inactivated once the paper record is forwarded to the 
appropriate Federal Records Center.

System manager(s) and address:
    Policy Coordinating Official: Director, Office of Clinical and 
Preventive Services, Indian Health Service, Reyes Building, 801 
Thompson Avenue, Suite 300, Rockville, Maryland 20852-1627. See 
Appendix 1. The IHS Area Office Directors, Service Unit Directors/Chief 
Executive Officers and Facility Directors listed in Appendix 1 are 
System Managers.

Notification procedure:
General Procedure:
    Requests must be made to the appropriate System Manager (IHS Area, 
Program Office Director or Service Unit Director/Chief Executive 
Officer). A subject individual who requests a copy of, or access to, 
his or her medical record shall, at the time the request is made, 
designate in writing a responsible representative who will be willing 
to review the record and inform the subject individual of its contents. 
Such a representative may be an IHS health professional. When a subject 
individual is seeking to obtain information about himself/herself that 
may be retrieved by a different name or identifier than his/her current 
name or identifier, he/she shall be required to produce evidence to 
verify that he/she is the person whose record he/she seeks. No 
verification of identity shall be required where the record is one that 
is required to be disclosed under the Freedom of Information Act. Where 
applicable, fees for copying records will be charged in accordance with 
the schedule set forth in 45 CFR Part 5b.

Requests In Person:
    Identification papers with current photographs are preferred but 
not required. If a subject individual has no identification but is 
personally known to the designated agency employee, such employee shall 
make a written record verifying the subject individual's identity. If 
the subject individual has no identification papers, the responsible 
system manager or designated agency official shall require that the 
subject individual certify in writing that he/she is the individual 
whom he/she claims to be and that he/she understands that the knowing 
and willful request or acquisition of records concerning an individual 
under false pretenses is a criminal offense subject to a $5,000 fine. 
If an individual is unable to sign his/her name when required, he/she 
shall make his/her mark and have the mark verified in writing by two 
additional persons.

Requests By Mail:
    Written requests must contain the name and address of the 
requester, his/her date of birth and at least one other piece of 
information that is also contained in the subject record, and his/her 
signature for comparison purposes. If the written request does not 
contain sufficient information, the System Manager shall inform the 
requester in writing that additional, specified information is required 
to process the request.

Requests by Telephone:
    Since positive identification of the caller cannot be established, 
telephone requests are not honored.

Parents, Legal Guardians and Personal Representatives:
    Parents of minor children and legal guardians or personal 
representatives of legally incompetent individuals shall verify their 
own identification in the manner described above, as well as their 
relationship to the individual whose record is sought. A copy of the 
child's birth certificate or court order establishing legal 
guardianship may be

[[Page 49938]]

required if there is any doubt regarding the relationship of the 
individual to the patient.

Record access procedures:
Same as Notification Procedures:
    Requesters may write, call or visit the last IHS facility where 
medical care was provided. Requesters should also provide a reasonable 
description of the record being sought. Requesters may also request an 
accounting of disclosures that have been made of their record, if any.

Contesting record procedures:
    Requesters may write, call or visit the appropriate IHS Area/
Program Office Director or Service Unit Director/Chief Executive 
Officer at his/her address specified in Appendix 1, and specify the 
information being contested, the corrective action sought, and the 
reasons for requesting the correction, along with supporting 
information to show how the record is inaccurate, incomplete, untimely, 
or irrelevant.

Record source categories:
    Individual and/or family members, IHS health care personnel, 
contract health care providers, State and local health care provider 
organizations, Medicare and Medicaid funding agencies, and the SSA.

Systems exempted from certain provisions of the Act:
    None.

Appendix 1--System Managers and IHS Locations Under Their Jurisdiction 
Where Records are Maintained:

Director, Aberdeen Area Indian Health Service, Room 309, Federal 
Building, 115 Fourth Avenue, SE, Aberdeen, South Dakota 57401.
Director, Cheyenne River Service Unit, Eagle Butte Indian Hospital, 
P.O. Box 1012, Eagle Butte, South Dakota 57625.
Director, Crow Creek Service Unit, Ft. Thompson Indian Health 
Center, P.O. Box 200, Ft. Thompson, South Dakota 57339.
Director, Fort Berthold Service Unit, Fort Berthold Indian Health 
Center, P.O. Box 400, New Town, North Dakota 58763.
Director, Carl T. Curtis Health Center, P.O. Box 250, Macy, Nebraska 
68039.
Director, Fort Totten Service Unit, Fort Totten Indian Health 
Center, P.O. Box 200, Fort Totten, North Dakota 58335.
Director, Kyle Indian Health Center, P.O. Box 540, Kyle, South 
Dakota 57752.
Director, Lower Brule Indian Health Center, P.O. Box 191, Lower 
Brule, South Dakota 57548.
Director, McLaughlin Indian Health Center, P.O. Box 879, McLaughlin, 
South Dakota 57642.
Director, Omaha-Winnebago Service Unit, Winnebago Indian Hospital, 
Winnebago, Nebraska 68071.
Director, Pine Ridge Service Unit, Pine Ridge Indian Hospital, Pine 
Ridge, South Dakota 57770.
Director, Rapid City Service Unit, Rapid City Indian Hospital, 3200 
Canyon Lake Drive, Rapid City, South Dakota 57701.
Director, Rosebud Service Unit, Rosebud Indian Hospital, Rosebud, 
South Dakota 57570.
Director, Sisseton-Wahpeton Service Unit, Sisseton Indian Hospital, 
P.O. Box 189, Sisseton, South Dakota 57262.
Director, Standing Rock Service Unit, Fort Yates Indian Hospital, 
P.O. Box J, Fort Yates, North Dakota 58538.
Director, Trenton-Williston Indian Health Center, P.O. Box 210, 
Trenton, North Dakota 58853.
Director, Turtle Mountain Service Unit, Belcourt Indian Hospital, 
P.O. Box 160, Belcourt, North Dakota 58316.
Director, Wanblee Indian Health Center, 100 Clinic Drive, Wanblee, 
South Dakota 57577.
Director, Yankton-Wagner Service Unit, Wagner Indian Hospital, 110 
Washington Street, Wagner, South Dakota 57380.
Director, Youth Regional Treatment Center, P.O. Box 68, 
Mobridge, South Dakota 57601.
Director, Sac & Fox Health Center, 307 Meskwaki Road, Tama, Iowa 
52339.
Director, Santee Health Center, 425 Frazier Avenue, N ST Street 
2, Niobrara, Nebraska 68760.
Director, Alaska Area Native Indian Health Service, 4141 Ambassador 
Drive, Suite 300, Anchorage, Alaska 99508-5928.
Director, Albuquerque Area Indian Health Service, 5300 Homestead 
Road, NE, Albuquerque, New Mexico 87110.
Director, Acoma-Canoncito-Laguna Service Unit, Acoma-Canoncito-
Laguna Indian Hospital, P.O. Box 130, San Fidel, New Mexico 87049.
Director, T[oacute]Hajille Health Center, P.O. Box 3528, Canoncito, 
New Mexico 87026.
Director, New Sunrise Treatment Center, P.O. Box 219, San Fidel, New 
Mexico 87049.
Director, Albuquerque Service Unit, Albuquerque Indian Hospital, 801 
Vassar Drive, NE, Albuquerque, New Mexico 87049.
Director, Albuquerque Indian Dental Clinic, P.O. Box 67830, 
Albuquerque, New Mexico 87193.
Director, Alamo Navajo Health Center, P.O. Box 907, Magdalena, New 
Mexico 87825.
Director, Jemez PHS Health Center, P.O. Box 279, Jemez, New Mexico 
87024
Director, Santa Ana PHS Health Center, P.O. Box 37, Bernalillo, New 
Mexico 87004.
Director, Sandia PHS Health Center, P.O. Box 6008, Bernalillo, New 
Mexico 87004.
Director, Zia PHS Health Center, 155 Capital Square, Zia, New Mexico 
87053.
Director, Santa Fe Service Unit, Santa Fe Indian Hospital, 1700 
Cerrillos Road, Santa Fe, New Mexico 87501.
Director, Santa Clara Health Center, RR5, Box 446, Espanola, New 
Mexico 87532.
Director, San Felipe Health Center, P.O. Box 4344, San Felipe, New 
Mexico 87001.
Director, Cochiti Health Center, P.O. Box 105, 255 Cochiti Street, 
Cochiti, New Mexico 87072.
Director, Santo Domingo Health Center, P.O. Box 340, Santo Domingo, 
New Mexico 87052.
Director, Southern Colorado-Ute Service Unit, P.O. Box 778, Ignacio, 
Colorado 81137.
Director, Ignacio Indian Health Center, P.O. Box 889, Ignacio, 
Colorado 81137.
Director, Towaoc Ute Health Center, Towaoc, Colorado 81334.
Director, Jicarilla Indian Health Center, P.O. Box 187, Dulce, New 
Mexico 87528.
Director, Mescalero Service Unit, Mescalero Indian Hospital, P.O. 
Box 210, Mescalero, New Mexico 88340.
Director, Taos/Picuris Indian Health Center, P.O. Box 1956, 1090 
Goat Springs Road, Taos, New Mexico 87571.
Director, Zuni Service Unit, Zuni Indian Hospital, Zuni, New Mexico 
87327.
Director, Pine Hill Health Center, P.O. Box 310, Pine Hill, New 
Mexico 87357.
Director, Bemidji Area Indian Health Service, 522 Minnesota Avenue, 
N.W., Bemidji, Minnesota 56601.
Director, Red Lake Service Unit, PHS Indian Hospital, Highway 1, Red 
Lake, Minnesota 56671.
Director, Leech Lake Service Unit, PHS Indian Hospital, 425 7th 
Street, NW., Cass Lake, Minnesota 56633.
Director, White Earth Service Unit, PHS Indian Hospital, P.O. Box 
358, White Earth, Minnesota 56591.
Director, Billings Area Indian Health Service, P.O. Box 36600, 2900 
4th Avenue North, Billings, Montana 59101.
Director, Blackfeet Service Unit, Browning Indian Hospital, P.O. Box 
760, Browning, Montana 59417.
Director, Heart Butte PHS Indian Health Clinic, Heart Butte, Montana 
59448.
Director, Crow Service Unit, Crow Indian Hospital, Crow Agency, 
Montana 59022.
Director, Lodge Grass PHS Indian Health Center, Lodge Grass, Montana 
59090.
Director, Pryor PHS Indian Health Clinic, P.O. Box 9, Pryor, Montana 
59066.
Director, Fort Peck Service Unit, Poplar Indian Hospital, Poplar, 
Montana 59255.
Director, Fort Belknap Service Unit, Harlem Indian Hospital, Harlem, 
Montana 59526.
Director, Hays PHS Indian Health Clinic, Hays, Montana 59526.
Director, Northern Cheyenne Service Unit, Lame Deer Indian Health 
Center, Lame Deer, Montana 59043.
Director, Wind River Service Unit, Fort Washakie Indian Health 
Center, Fort Washakie, Wyoming 82514.
Director, Arapahoe Indian Health Center, Arapahoe, Wyoming 82510.
Director, Chief Redstone Indian Health Center, Wolf Point, Montana 
59201.
Director, California Area Indian Health Service, John E. Moss 
Federal Building, 650 Capitol Mall, Suite 7-100, Sacramento, 
California 95814.
Director, Nashville Area Indian Health Service, 711 Stewarts Ferry 
Pike, Nashville, Tennessee 37214-2634.
Director, Catawba PHS Indian Nation of South Carolina, P.O. Box 188, 
Catawba, South Carolina 29704.
Director, Unity Regional Youth Treatment Center, P.O. Box C-201, 
Cherokee, North Carolina 28719.

[[Page 49939]]

Director, Navajo Area Indian Health Service, P.O. Box 9020, Highway 
264, Window Rock, Arizona 86515-9020.
Director, Chinle Service Unit, Chinle Comprehensive Health Care 
Facility, PO Drawer PH, Chinle, Arizona 86503.
Director, Tsaile Health Center, P.O. Box 467, Navajo Routes 64 and 
12, Tsaile, Arizona 86556.
Director, Rock Point Field Clinic, c/o Tsaile Health Center, P.O. 
Box 647, Tsaile, Arizona 86557.
Director, Pinon Health Station, Pinon, Arizona 86510.
Director, Crownpoint Service Unit, Crownpoint Comprehensive Health 
Care Facility, P.O. Box 358, Crownpoint, New Mexico 87313.
Director, Pueblo Pintado Health Station, c/o Crownpoint 
Comprehensive Health Care Facility, P.O. Box 358, Crownpoint, New 
Mexico 87313.
Director, Fort Defiance Service Unit, Fort Defiance Indian Hospital, 
P.O. Box 649, Intersection of Navajo Routes N12 & N7, Fort Defiance, 
Arizona 86515.
Director, Nahata Dziil Health Center, P.O. Box 125, Sanders, Arizona 
86512.
Director, Gallup Service Unit, Gallup Indian Medical Center, P.O. 
Box 1337, Nizhoni Boulevard, Gallup, New Mexico 87305.
Director, Tohatchi Indian Health Center, P.O. Box 142, Tohatchi, New 
Mexico 87325.
Director, Ft. Wingate Health Station, c/o Gallup Indian Medical 
Center, P.O. Box 1337, Gallup, New Mexico 87305.
Director, Kayenta Service Unit, Kayenta Indian Health Center, P.O. 
Box 368, Kayenta, Arizona 86033.
Director, Inscription House Health Center, P.O. Box 7397, Shonto, 
Arizona 86054.
Director, Dennehotso Clinic, c/o Kayenta Health Center, P.O. Box 
368, Kayenta, Arizona 86033.
Director, Shiprock Service Unit, Northern Navajo Medical Center, 
P.O. Box 160, U.S. Hwy 491 North, Shiprock, New Mexico 87420.
Director, Dzilth-Na-O-Dith-Hle Indian Health Center, 6 Road 7586, 
Bloomfield, New Mexico 87413.
Director, Teecnospos Health Center, P.O. Box 103, N5114 BIA School 
Road, Teecnospos, Arizona 86514.
Director, Sanostee Health Station, c/o Northern Navajo Medical 
Center, P.O. Box 160, Shiprock, New Mexico 87420.
Director, Toadlena Health Station, c/o Northern Navajo Medical 
Center, P.O. Box 160, Shiprock, New Mexico 87420.
Director, Teen Life Center, c/o Northern Navajo Medical Center, P.O. 
Box 160, Shiprock, New Mexico 87420.
Director, Oklahoma City Area Indian Health Service, Five Corporation 
Plaza, 3625 NW 56th Street, Oklahoma City, Oklahoma 73112.
Director, Claremore Service Unit, Claremore Comprehensive Indian 
Health Facility, West Will Rogers Boulevard and Moore, Claremore, 
Oklahoma 74017.
Director, Clinton Service Unit, Clinton Indian Hospital, Route 1, 
Box 3060, Clinton, Oklahoma 73601-9303.
Director, El Reno PHS Indian Health Clinic, 1631A E. Highway 66, El 
Reno, Oklahoma 73036.
Director, Watonga Indian Health Center, Route 1, Box 34-A, Watonga, 
Oklahoma 73772.
Director, Haskell Service Unit, PHS Indian Health Center, 2415 
Massachusetts Avenue, Lawrence, Kansas 66044.
Director, Lawton Service Unit, Lawton Indian Hospital, 1515 Lawrie 
Tatum Road, Lawton, Oklahoma 73501.
Director, Anadarko Indian Health Center, P.O. Box 828, Anadarko, 
Oklahoma 73005.
Director, Carnegie Indian Health Center, P.O. Box 1120, Carnegie, 
Oklahoma 73150.
Director, Holton Service Unit, PHS Indian Health Center, 100 West 
6th Street, Holton, Kansas 66436.
Director, Pawnee Service Unit, Pawnee Indian Service Center, RR2, 
Box 1, Pawnee, Oklahoma 74058-9247.
Director, Pawhuska Indian Health Center, 715 Grandview, Pawhuska, 
Oklahoma 74056.
Director, Tahlequah Service Unit, W. W. Hastings Indian Hospital, 
100 S. Bliss, Tahlequah, Oklahoma 74464.
Director, Wewoka Indian Health Center, P.O. Box 1475, Wewoka, 
Oklahoma 74884.
Director, Phoenix Area Indian Health Service, Two Renaissance 
Square, 40 North Central Avenue, Phoenix, Arizona 85004.
Director, Colorado River Service Unit, Chemehuevi Indian Health 
Clinic, P.O. Box 1858, Havasu Landing, California 92363.
Director, Colorado River Service Unit, Havasupai Indian Health 
Station, P.O. Box 129, Supai, Arizona 86435.
Director, Colorado River Service Unit, Parker Indian Health Center, 
12033 Agency Road, Parker, Arizona 85344.
Director, Colorado River Service Unit, Peach Springs Indian Health 
Center, P.O. Box 190, Peach Springs, Arizona 86434.
Director, Colorado River Service Unit, Sherman Indian High School, 
9010 Magnolia Avenue, Riverside, California 92503.
Director, Elko Service Unit, Newe Medical Clinic, 400 ``A'' Newe 
View, Ely, Nevada 89301.
Director, Elko Service Unit, Southern Bands Health Center, 515 
Shoshone Circle, Elko, Nevada 89801.
Director, Fort Yuma Service Unit, Fort Yuma Indian Hospital, P.O. 
Box 1368, Fort Yuma, Arizona 85366.
Director, Keams Canyon Service Unit, Hopi Health Care Center, P.O. 
Box 4000, Polacca, Arizona 86042.
Director, Schurz Service Unit, Schurz Service Unit Administration, 
Drawer A, Schurz, Nevada 89427.
Director, Phoenix Service Unit, Phoenix Indian Medical Center, 4212 
North 16th Street, Phoenix, Arizona 85016.
Director, Phoenix Service Unit, Salt River Health Center, 10005 East 
Osborn Road, Scottsdale, Arizona 85256.
Director, San Carlos Service Unit, Bylas Indian Health Center, P.O. 
Box 208, Bylas, Arizona 85550.
Director, San Carlos Service Unit, San Carlos Indian Hospital, P.O. 
Box 208, San Carlos, Arizona 85550.
Director, Unitah and Ouray Service Unit, Fort Duchesne Indian Health 
Center, P.O. Box 160, Ft. Duchesne, Utah 84026.
Director, Whiteriver Service Unit, Cibecue Health Center, P.O. Box 
37, Cibecue, Arizona 85941.
Director, Whiteriver Service Unit, Whiteriver Indian Hospital, P.O. 
Box 860, Whiteriver, Arizona 85941.
Director, Desert Vision Youth Wellness Center/RTC, P.O. Box 458, 
Sacaton, AZ 85247.
Director, Portland Area Indian Health Service, Room 476, Federal 
Building, 1220 Southwest Third Avenue, Portland, Oregon 97204-2829.
Director, Colville Service Unit, Colville Indian Health Center, P.O. 
Box 71-Agency Campus, Nespelem, Washington 99155.
Director, Fort Hall Service Unit, Not-Tsoo Gah-Nee Health Center, 
P.O. Box 717, Fort Hall, Idaho 83203.
Director, Neah Bay Service Unit, Sophie Trettevick Indian Health 
Center, P.O. Box 410, Neah Bay, Washington 98357.
Director, Warm Springs Service Unit, Warm Springs Indian Health 
Center, P.O. Box 1209, Warm Springs, Oregon 97761.
Director, Wellpinit Service Unit, David C. Wynecoop Memorial Clinic, 
P.O. Box 357, Wellpinit, Washington 99040.
Director, Western Oregon Service Unit, Chemawa Indian Health Center, 
3750 Chemawa Road, NE, Salem, Oregon 97305-1198.
Director, Yakama Service Unit, Yakama Indian Health Center, 401 
Buster Road, Toppenish, Washington 98948.
Director, Tucson Area Indian Health Service, 7900 South ``J'' Stock 
Road, Tucson, Arizona 85746-9352.
Director, Pascua Yaqui Service Unit, Division of Public Health, 7900 
South ``J'' Stock Road, Tucson, Arizona 85746.
Director, San Xavier Indian Health Center, 7900 South ``J'' Stock 
Road, Tucson, Arizona 85746.
Director, Sells Service Unit, Santa Rosa Indian Health Center, HCO1, 
Box 8700, Sells, Arizona 85634.
Director, Sells Service Unit, Sells Indian Hospital, P.O. Box 548, 
Sells, Arizona 85634.
Director, Sells Service Unit, West Side Health Station, P.O. Box 
548, Sells, Arizona 85634.

Appendix 2--Federal Archives and Records Centers

District of Columbia, Maryland Except U.S. Court Records for 
Maryland, Washington National Records Center, 4205 Suitland Road, 
Suitland, Maryland 20746-8001.
Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and 
Vermont, Federal Archives and Records Center, Frederick C. Murphy 
Federal Center, 380 Trapelo Road, Waltham, Massachusetts 02452-6399.
Northeast Region, Federal Archives and Records Center, 10 Conte 
Drive, Pittsfield, Massachusetts 01201-8230.
Mid-Atlantic Region and Pennsylvania, Federal Archives and Records 
Center, 14700 Townsend Road, Philadelphia, Pennsylvania 19154-1096.
Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, 
South Carolina, and Tennessee, Federal Archives

[[Page 49940]]

and Records Center, 1557 St. Joseph Avenue, East Point, Georgia 
30344-2593.
Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin and U.S. 
Court Records for the mentioned States, Federal Archives and Records 
Center, 7358 South Pulaski Road, Chicago, Illinois 60629-5898.
Michigan, Except U.S. Court Records, Federal Records Center, 3150 
Springboro Road, Dayton, Ohio 45439-1883.
Kansas, Iowa, Missouri and Nebraska, and U.S. Court Records for the 
mentioned States, Federal Archives and Records Center, 2312 East 
Bannister Road, Kansas City, Missouri 64131-3011.
New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands, and 
U.S. Court Records for the mentioned States and territories, 200 
Space Center Drive, Lee's Summit, Missouri 64064-1182.
Arkansas, Louisiana, Oklahoma and Texas, and U.S. Courts Records for 
the mentioned States, Federal Archives and Records Center, P.O. Box 
6216, Ft. Worth, Texas 76115-0216.
Colorado, Wyoming, Utah, Montana, New Mexico, North Dakota, and 
South Dakota, and U.S. Courts Records for the mentioned States, 
Federal Archives and Records Center, P.O. Box 25307, Denver, 
Colorado 80225-0307.
Northern California Except Southern California, Hawaii, and Nevada 
Except Clark County, the Pacific Trust Territories, and American 
Samoa, and U.S. Courts Records for the mentioned States and 
territories, Federal Archives and Records Center, 1000 Commodore 
Drive, San Bruno, California 94066-2350.
Arizona, Southern California, and Clark County, Nevada, and U.S. 
Courts Records for the mentioned States, Federal Archives and 
Records Center, 24000 Avila Road, 1st Floor, East Entrance, Laguna 
Niguel, California 92677-3497.
Washington