Privacy Act of 1974; Report of Modified or Altered System Medical, Health and Billing Records System, 50038-50045 [E8-19481]
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50038
Federal Register / Vol. 73, No. 165 / Monday, August 25, 2008 / Notices
programs will determine the number of
their staff members that will participate
in the interview. The evaluation will
include an assessment of whether HP/
DP grantees achieve measurable health
outcomes, synthesize the evaluation
findings, and include a written report
with recommendations to enhance
program effectiveness. The information
gathered will be used to prepare a final
report for OMB. Affected Public:
Individuals. Type of Respondents:
Tribal/Urban organizations program
staff.
The table below provides: Types of
data collection instruments, Estimated
number of respondents, Number of
responses per respondent, Average
burden hour per response, and Total
annual burden hour(s).
ESTIMATED BURDEN HOURS
Estimated
number of
respondents
Data collection instrument
Responses
per
respondent
Average
burden hour
per response
Total annual
burden hours
HP/DP Grantees Telephone and Face-to-Face Interview Survey ..................
231
1
1
231
Total ..........................................................................................................
231
........................
........................
231
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There are no Capital Costs, Operating
Costs, and/or Maintenance Costs to
report.
Request for Comments: Your written
comments and/or suggestions are
invited on one or more of the following
points: (a) Whether the information
collection activity is necessary to carry
out an agency function; (b) whether the
agency processes the information
collected in a useful and timely fashion;
(c) the accuracy of the public burden
estimate (the estimated amount of time
needed for individual respondents to
provide the requested information); (d)
whether the methodology and
assumptions used to determine the
estimates are logical; (e) ways to
enhance the quality, utility, and clarity
of the information being collected; and
(f) ways to minimize the public burden
through the use of automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology.
Send Comments and Requests for
Further Information: Send your written
comments, requests for more
information on the proposed collection,
or requests to obtain a copy of the data
collection instrument(s) and
instructions to: Ms. Janet Ingersoll,
Acting IHS Reports Clearance Officer,
801 Thompson Avenue, TMP 450,
Rockville, MD 20852–1627; call non-toll
free (301) 443–6177; send via facsimile
to (301) 443–2316; or send your e-mail
requests, comments, and return address
to: janet.ingersoll@ihs.gov.
Comment Due Date: Your comments
regarding this information collection are
best assured of having full effect if
received within 60 days of the date of
this publication.
Dated: August 18, 2008.
Robert G. McSwain,
Director, Indian Health Service.
[FR Doc. E8–19480 Filed 8–22–08; 8:45 am]
BILLING CODE 4165–16–M
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Indian Health Service
Privacy Act of 1974; Report of Modified
or Altered System Medical, Health and
Billing Records System
AGENCY:
Indian Health Service (IHS),
HHS.
Notice of Proposed Modification
or Alteration to a System of Records
(SOR).
ACTION:
SUMMARY: In accordance with the
requirements of the Privacy Act of 1974,
IHS is proposing to modify or alter an
SOR, ‘‘Medical, Health and Billing
Records,’’ System No. 09–17–0001. IHS
is proposing to amend routine use
number 10 to be more consistent with
the Health Insurance Portability and
Accountability Act (HIPAA) Privacy
Rule language, 45 CFR 164.512(b) by
changing the language to state ‘‘which
are authorized by applicable Federal,
State, Tribal or local law * * *,’’ which
would give IHS the discretion of
allowing additional disclosures. For
example, this change will give IHS the
discretion to disclose controlled
substance prescription data to a
centralized database administered by an
authorized State public health entity,
such as state prescription drug
monitoring programs (PMP). IHS is also
proposing to add routine use number 25
to meet the newly established
requirement by the Office of
Management and Budget (OMB)
Memoranda (M) 07–16, Safeguarding
Against and Responding to the Breach
of Personally Identifiable Information
and to Comply with HHS Incident
Reporting and Handling Requirements.
Effective Dates: IHS filed an altered/
modified system report with the Chair
of the House Committee on Oversight
and Government Reform, the Chair of
the Senate Committee on Homeland
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Security and Governmental Affairs, and
the Administrator, Office of Information
and Regulatory Affairs, OMB on August
25, 2008. To ensure that all parties have
adequate time in which to comment, the
modified SOR 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 invites comments on
all portions of this notice.
The public should address
comments to: Mr. William Tibbitts, IHS
Privacy Act/HIPAA Privacy Officer,
Office of Management Services, Division
of Regulatory Affairs, Records Access
and Policy Liaison, 801 Thompson
Avenue, TMP, Suite 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:
William.Tibbitts@ihs.gov.
ADDRESSES:
Ms.
Patricia Gowan, IHS Lead Health
Information Management (HIM)
Consultant and Area HIM Consultant,
Phoenix Area Office, Two Renaissance
Square, 40 North Central Avenue,
Phoenix, AZ 85004–4450, Telephone
(602) 364–5172.
FOR FURTHER INFORMATION CONTACT:
IHS
initiated a national workgroup
consisting of IHS Chief Medical Officers
(CMOs) and the IHS National Pharmacy
Council (NPC) to assist the IHS in
systematically addressing the issue of
prescription drug abuse. Currently,
approximately 35 States have controlled
substances prescription reporting
systems that allow providers to monitor
their patient’s prescriptions and access
to controlled substances.
SUPPLEMENTARY INFORMATION:
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Dated: August 18, 2008.
Robert G. McSwain,
Director, Indian Health Service.
09–17–0001
SYSTEM NAME:
Medical, Health, and Billing Records
Systems, Health and Human Services/
Indian Health Service/Office of Clinical
and Preventive Services, (HHS/IHS/
OCPS).
SECURITY CLASSIFICATION:
None.
SYSTEM LOCATION:
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.
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
Electroencephalogram (EEG) and
Electrocardiogram (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:
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:
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Note: Records relating to claims by and
against the HHS are maintained in the
Administrative Claims System, 09–90–0062,
HHS/Office of the Secretary/Office of the
General Counsel (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,
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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 collect and provide information
to IHS officials and epidemiology
centers established and funded under 25
U.S.C. 1621m 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.
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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 and
epidemiology centers established and
funded under 25 U.S.C. 1621m 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 HHS, 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.
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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:
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This system of records contains
individually identifiable health
information. The HHS Privacy Act
Regulations (45 CFR Part 5b) and the
Privacy Rule (45 CFR Parts 160 and 164)
issued pursuant to the 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 2.52–2.53), (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.
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1. Records may be disclosed to
Federal and non-Federal (public or
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 (IDEA),
20 U.S.C. 1400, et seq.
6. Records may be disclosed to
organizations deemed qualified by the
secretary of HHS 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
PHI (e.g., alcohol/drug abuse patient
information, Human Immunodeficiency
Virus/Acquired Immune Deficiency
Syndrome (HIV/AIDS), Sexually
Transmitted Diseases (STDs), or mental
health) that is maintained in the
medical record.
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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
CFP. 164.514(e) for limited data sets,
and 5 U.S.C. 552a.(b)(5) are met.
10. Information from records,
including but not limited to information
concerning the commission of crimes,
suspected cases of abuse (including
child, elder and sexual abuse), the
reporting of neglect, sexual assault or
domestic violence, births, deaths,
alcohol or drug abuse, immunization,
cancer, or the occurrence of
communicable diseases, may be
disclosed to public health authorities,
epidemiology centers established and
funded under 25 U.S.C. 1621m, and
other appropriate government
authorities which are authorized by
applicable Federal, State, Tribal or local
law or regulations to receive such
information.
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 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 BIA, 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
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compatible with the purpose for which
the records were collected. Such
disclosure may be made to the HHS/
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) HHS or any component thereof; or
(ii) Any HHS employee in his or her
official capacity; or
(iii) Any HHS employee in his or her
individual capacity where the DOJ (or
HHS, where it is authorized to do so)
has agreed to represent the employee; or
(iv) The United States or any agency
thereof (other than HHS) where HHS/
OGC has determined that the litigation
and/or proceedings related to an
administrative claim is likely to affect
HHS 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 a
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
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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),
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 needlesharing 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 needlesharing partner(s) or that the provision
of such information cannot reasonably
be verified;
(d) The notification of the partner(s) is
made, whenever possible, by the subject
individual’s physician or by a
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professional counselor and shall follow
standard counseling practices; and
(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.
10801–10805(a) (4) and 42 CFR 51.41–
46, to the extent that such disclosure is
authorized by law and the conditions of
45 CFR 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
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individual’s whereabouts and his or her
health status or death.
25. To appropriate Federal agencies
and Department contractors that have a
need to know the information for the
purpose of assisting the Department’s
efforts to respond to a suspected or
confirmed breach of the security or
confidentiality of information
maintained in this system of records,
and the information disclosed is
relevant and necessary for that
assistance.
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.
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SAFEGUARDS:
Safeguards apply to records stored onsite 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 PHI is reviewed
periodically and controlled for
VerDate Aug<31>2005
15:18 Aug 22, 2008
Jkt 214001
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 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 and
Security Rule requirements and
specified AIS security provisions are
specifically included in contracts and
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Sfmt 4703
agreements and the system manager or
his/her designee oversee compliance
with these contract requirements.
4. Implementing Guidelines: HHS
Chapter 45–10 and supplementary
Chapter PHS.hf: 45–10 of the General
Administration Manual; HHS,
‘‘Automated Information Systems
Security Program Handbook,’’ as
amended; HHS 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 164.302 through 164.318; and EGovernment 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 (FRC). 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 FRC. (See Appendix 2
for FRC 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
FRC.
SYSTEM MANAGER(S) AND ADDRESS:
Policy Coordinating Official: Director,
OCPS, IHS, 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.
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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
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15:18 Aug 22, 2008
Jkt 214001
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
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.
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Fmt 4703
Sfmt 4703
50043
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, To’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.
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Director, Santa Fe Service Unit, Santa Fe
Indian Hospital, 1700 Cerrillos Road, Santa
Fe, New Mexico 87501.
Director, Santa Clara Health Center, RR5,
P.O. 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,
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15:18 Aug 22, 2008
Jkt 214001
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.
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, P.O.
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, do 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 and 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, do
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, do 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, do
Northern Navajo Medical Center, P.O. Box
160, Shiprock, New Mexico 87420.
Director, Toadlena Health Station, do
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
Street, Oklahoma City, Oklahoma 73112.
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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, P.O. 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 S5. 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, Supal, 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, Fort McDermitt Clinic, P.O. Box
315, McDermitt, Nevada 89421.
Director, Phoenix Service Unit, Phoenix
Indian Medical Center, 4212 North 16th
Street, Phoenix, Arizona 85016.
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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
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, 23123 Cajalco Road,
Perris, California 93570–7298.
Washington, Oregon, Idaho and Alaska, and
U.S. Courts Records for the mentioned
States, Federal Archives and Records
Center, 6125 Sand Point Way NE, Seattle,
Washington 98115–7999.
[FR Doc. E8–19481 Filed 8–22–08; 8:45 am]
Appendix 2—Federal Archives and
Records Centers
ebenthall on PRODPC60 with NOTICES
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, Weilpinit Service Unit, David C.
Wynecoop Memorial Clinic, P.O. Box 357,
Weilpinit, 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, P.O. 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.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
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
National Institutes of Health
VerDate Aug<31>2005
15:18 Aug 22, 2008
Jkt 214001
BILLING CODE 4165–16–M
Submission for OMB Review;
Comment Request; National Institutes
of Health Construction Grants
SUMMARY: Under the provisions of
Section 3507(a)(1)(D) of the Paperwork
PO 00000
Frm 00064
Fmt 4703
Sfmt 4703
50045
Reduction Act of 1995, the National
Institutes of Health (NIH) has submitted
to the Office of Management and Budget
(OMB) a request to review and approve
the information collection listed below.
This proposed information collection
was previously published in the Federal
Register on June 16, 2008, pages 34026–
34027, and allowed 60 days for public
comment. No public comments were
received. The purpose of this notice is
to allow an additional 30 days for public
comment. The NIH may not conduct or
sponsor, and the respondent is not
required to respond to, information that
has been extended, revised or
implemented on or after October 1,
2008, unless it displays a currently valid
OMB control number.
Proposed Collection: Title: National
Institutes of Health Construction
Grants—42 CFR Part 52b (Final Rule).
Type of Information Collection Request:
Extension of No. 0925–0424, expiration
date 8/31/2008. Need and Use of the
Information Collection: This request is
for OMB review and approval of an
extension for the information collection
and recordkeeping requirements
contained in the regulation codified at
42 CFR Part 52b. The purpose of the
regulation is to govern the awarding and
administration of grants awarded by
NIH and its components for
construction of new buildings and the
alteration, renovation, remodeling,
improvement, expansion, and repair of
existing buildings, including the
provision of equipment necessary to
make the buildings (or applicable part of
the buildings) suitable for the purpose
for which it was constructed. In terms
of reporting requirements: Section
52b.9(b) of the regulation requires the
transferor of a facility which is sold or
transferred, or owner of a facility, the
use of which has changed, to provide
written notice of the sale, transfer or
change within 30 days. Section 52b.10(f)
requires a grantee to submit an
approved copy of the construction
schedule prior to the start of
construction. Section 52b.10(g) requires
a grantee to provide daily construction
logs and monthly status reports upon
request at the job site. Section 52b.11(b)
requires applicants for a project
involving the acquisition of existing
facilities to provide the estimated cost of
the project, cost of the acquisition of
existing facilities, and cost of
remodeling, renovating, or altering
facilities to serve the purposes for which
they are acquired.In terms of
recordkeeping requirements: Section
52b.10(g) requires grantees to maintain
daily construction logs and monthly
status reports at the job site. Frequency
E:\FR\FM\25AUN1.SGM
25AUN1
Agencies
[Federal Register Volume 73, Number 165 (Monday, August 25, 2008)]
[Notices]
[Pages 50038-50045]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-19481]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Privacy Act of 1974; Report of Modified or Altered System
Medical, Health and Billing Records 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, IHS is proposing to modify or alter an SOR, ``Medical, Health and
Billing Records,'' System No. 09-17-0001. IHS is proposing to amend
routine use number 10 to be more consistent with the Health Insurance
Portability and Accountability Act (HIPAA) Privacy Rule language, 45
CFR 164.512(b) by changing the language to state ``which are authorized
by applicable Federal, State, Tribal or local law * * *,'' which would
give IHS the discretion of allowing additional disclosures. For
example, this change will give IHS the discretion to disclose
controlled substance prescription data to a centralized database
administered by an authorized State public health entity, such as state
prescription drug monitoring programs (PMP). IHS is also proposing to
add routine use number 25 to meet the newly established requirement by
the Office of Management and Budget (OMB) Memoranda (M) 07-16,
Safeguarding Against and Responding to the Breach of Personally
Identifiable Information and to Comply with HHS Incident Reporting and
Handling Requirements.
Effective Dates: IHS filed an altered/modified system report with
the Chair of the House Committee on Oversight and Government Reform,
the Chair of the Senate Committee on Homeland Security and Governmental
Affairs, and the Administrator, Office of Information and Regulatory
Affairs, OMB on August 25, 2008. To ensure that all parties have
adequate time in which to comment, the modified SOR 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 invites comments on all portions of this notice.
ADDRESSES: The public should address comments to: Mr. William Tibbitts,
IHS Privacy Act/HIPAA Privacy Officer, Office of Management Services,
Division of Regulatory Affairs, Records Access and Policy Liaison, 801
Thompson Avenue, TMP, Suite 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:
William.Tibbitts@ihs.gov.
FOR FURTHER INFORMATION CONTACT: Ms. Patricia Gowan, IHS Lead Health
Information Management (HIM) Consultant and Area HIM Consultant,
Phoenix Area Office, Two Renaissance Square, 40 North Central Avenue,
Phoenix, AZ 85004-4450, Telephone (602) 364-5172.
SUPPLEMENTARY INFORMATION: IHS initiated a national workgroup
consisting of IHS Chief Medical Officers (CMOs) and the IHS National
Pharmacy Council (NPC) to assist the IHS in systematically addressing
the issue of prescription drug abuse. Currently, approximately 35
States have controlled substances prescription reporting systems that
allow providers to monitor their patient's prescriptions and access to
controlled substances.
[[Page 50039]]
Dated: August 18, 2008.
Robert G. McSwain,
Director, Indian Health Service.
09-17-0001
SYSTEM NAME:
Medical, Health, and Billing Records Systems, Health and Human
Services/Indian Health Service/Office of Clinical and Preventive
Services, (HHS/IHS/OCPS).
SECURITY CLASSIFICATION:
None.
SYSTEM LOCATION:
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 HHS are
maintained in the Administrative Claims System, 09-90-0062, HHS/
Office of the Secretary/Office of the General Counsel (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, 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
Electroencephalogram (EEG) and Electrocardiogram (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 collect and provide information to IHS officials and
epidemiology centers established and funded under 25 U.S.C. 1621m 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 and
epidemiology centers established and funded under 25 U.S.C. 1621m 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 HHS, 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.
[[Page 50040]]
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 HHS Privacy Act Regulations (45 CFR Part 5b) and the
Privacy Rule (45 CFR Parts 160 and 164) issued pursuant to the 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 2.52-2.53), (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
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 (IDEA),
20 U.S.C. 1400, et seq.
6. Records may be disclosed to organizations deemed qualified by
the secretary of HHS 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 PHI (e.g.,
alcohol/drug abuse patient information, Human Immunodeficiency Virus/
Acquired Immune Deficiency Syndrome (HIV/AIDS), Sexually Transmitted
Diseases (STDs), 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 CFP. 164.514(e) for
limited data sets, and 5 U.S.C. 552a.(b)(5) are met.
10. Information from records, including but not limited to
information concerning the commission of crimes, suspected cases of
abuse (including child, elder and sexual abuse), the reporting of
neglect, sexual assault or domestic violence, births, deaths, alcohol
or drug abuse, immunization, cancer, or the occurrence of communicable
diseases, may be disclosed to public health authorities, epidemiology
centers established and funded under 25 U.S.C. 1621m, and other
appropriate government authorities which are authorized by applicable
Federal, State, Tribal or local law or regulations to receive such
information.
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 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 BIA, 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
[[Page 50041]]
compatible with the purpose for which the records were collected. Such
disclosure may be made to the HHS/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) HHS or any component thereof; or
(ii) Any HHS employee in his or her official capacity; or
(iii) Any HHS employee in his or her individual capacity where the
DOJ (or HHS, where it is authorized to do so) has agreed to represent
the employee; or
(iv) The United States or any agency thereof (other than HHS) where
HHS/OGC has determined that the litigation and/or proceedings related
to an administrative claim is likely to affect HHS 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 a
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), 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;
(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; and
(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. 10801-10805(a) (4) and 42 CFR 51.41-46, to the extent that
such disclosure is authorized by law and the conditions of 45 CFR
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
[[Page 50042]]
individual's whereabouts and his or her health status or death.
25. To appropriate Federal agencies and Department contractors that
have a need to know the information for the purpose of assisting the
Department's efforts to respond to a suspected or confirmed breach of
the security or confidentiality of information maintained in this
system of records, and the information disclosed is relevant and
necessary for that assistance.
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 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 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 and
Security Rule 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: HHS Chapter 45-10 and supplementary
Chapter PHS.hf: 45-10 of the General Administration Manual; HHS,
``Automated Information Systems Security Program Handbook,'' as
amended; HHS 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 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 (FRC). 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 FRC. (See Appendix 2 for
FRC 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 FRC.
SYSTEM MANAGER(S) AND ADDRESS:
Policy Coordinating Official: Director, OCPS, IHS, 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.
[[Page 50043]]
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
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, To'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.
[[Page 50044]]
Director, Santa Fe Service Unit, Santa Fe Indian Hospital, 1700
Cerrillos Road, Santa Fe, New Mexico 87501.
Director, Santa Clara Health Center, RR5, P.O. 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.
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, P.O. 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, do 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 and 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, do 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, do 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, do Northern Navajo Medical
Center, P.O. Box 160, Shiprock, New Mexico 87420.
Director, Toadlena Health Station, do 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 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,
P.O. 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 S5. 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, Supal, 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, Fort McDermitt Clinic, P.O. Box 315, McDermitt, Nevada
89421.
Director, Phoenix Service Unit, Phoenix Indian Medical Center, 4212
North 16th Street, Phoenix, Arizona 85016.
[[Page 50045]]
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, Weilpinit Service Unit, David C. Wynecoop Memorial Clinic,
P.O. Box 357, Weilpinit, 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,
P.O. 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 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, 23123 Cajalco Road, Perris, California 93570-7298.
Washington, Oregon, Idaho and Alaska, and U.S. Courts Records for
the mentioned States, Federal Archives and Records Center, 6125 Sand
Point Way NE, Seattle, Washington 98115-7999.
[FR Doc. E8-19481 Filed 8-22-08; 8:45 am]
BILLING CODE 4165-16-M