**DEPARTMENT OF HEALTH AND HUMAN SERVICES**

**09-17-0001**

# IHS Medical, Health and Billing Records Systems 

##  Categories: 

1.  • [System name](#System_name)

    • [Security classification](#Security)

    • [System location](#System_location)

    • [Categories of individuals covered by the
    system](#Categories_of_individuals)

    • [Categories of records in the system](#Categories_of_records)

    • [Authority for maintenance of the system](#Authority)

    • [Purpose(s)](#Purpose)

    • [Routine uses](#Routine)

    0.  • [Policies and practices for storing, retrieving, accessing,
        retaining, and disposing of records in the
        system](#Policies_and_practices)

    • [System manager(s) and address](#System_manager)

    • [Notification procedure](#Notification)

    • [Record access procedures](#Record_access)

    • [Record source categories](#Record_source)

    • [Exempt Systems](#Exempt_Systems)

    0.  • [Appendix 1\--System Managers and IHS Locations Under Their
        Jurisdiction Where Records are Maintained](#Appendix_1).

    • [Appendix 2\--Federal Archives and Records Centers](#Appendix_2)

*(Federal Register(s):*

*August 25, 2005 (Vol. 70, Number 164) Page 49931-49940;*

*December 30, 2005 (Vol. 70, Number 250) Page 77405-77412); and*

*February 9, 2006 (Vol. 71, Number 27) Page 6781)*

**System name**[]{#System_name .anchor}**:** Medical, Health, and
Billing Records Systems,

HHS/IHS/OCPS.

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[**Security classification**](#_Categories:)[]{#Security .anchor}**:**
None.

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

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**Categories of individuals covered by the
system**[]{#Categories_of_individuals .anchor}: 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).

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**Categories of records in the system**[]{#Categories_of_records
.anchor}:

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

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.

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.

Logs of individuals provided health care by staff of specific hospital
or clinic departments such as surgery, emergency, obstetric delivery,
medical imaging, and laboratory.

Surgery and/or disease indices for individual facilities that list each
relevant individual by the surgery or disease.

Monitoring strips and tapes such as fetal monitoring strips and EEG and
EKG tapes.

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.

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**Authority for maintenance of the system**[]{#Authority .anchor}**:**

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).

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**Purposes**[]{#Purpose .anchor}: The purposes of this system are:

1\. To provide a description of an individual=s diagnosis, treatment and
outcome, and to plan for immediate and future care of the individual.

2\. To provide statistical data to IHS officials in order to evaluate
health care programs and to plan for future needs.

3\. To serve as a means of communication among members of the health
care team who contribute to the individual=s care; e.g., to integrate
information from field visits with records of treatment in IHS
facilities and with non-IHS health care providers.

4\. To serve as the official documentation of an individual=s health
care.

5\. To contribute to continuing education of IHS staff to improve the
delivery of health care services.

6\. For disease surveillance purposes. For example:

> \(a\) the Centers for Disease Control and Prevention may use these
> records to monitor various communicable diseases;
>
> \(b\) the National Institutes of Health may use these records to
> review the prevalence of particular diseases (e.g., malignant
> neoplasms, diabetes mellitus, arthritis, metabolism, and digestive
> diseases) for various ethnic groups of the United States; or
>
> \(c\) those public health authorities that are authorized by law may
> use these records to collect or receive such information for purposes
> of preventing or controlling disease, injury, or disability,
> including, but not limited to, the reporting of disease, injury, vital
> events such as birth or death and the conduct of public health
> surveillance, investigations, and interventions.

7\. To compile and provide aggregated program statistics. Upon request
of other components of DHHS, IHS will provide statistical information,
from which individual/personal identifiers have been removed, such as:

> \(a\) to the National Committee on Vital and Health Statistics for its
> dissemination of aggregated health statistics on various ethnic
> groups;
>
> \(b\) to the Assistant Secretary for Planning and Evaluation, Health
> Policy to keep a record of the number of sterilizations provided by
> federal funding;
>
> \(c\) to the Centers for Medicare & Medicaid Services (CMS) to
> document IHS health care covered by the Medicare and Medicaid programs
> for third-party reimbursement; or
>
> \(d\) to the Office of Clinical Standards and Quality, CMS to
> determine the prevalence of end-stage renal disease among the American
> Indian and Alaska Native (AI/AN) population and to coordinate
> individual care.

8\. To process and collect third-party claims and facilitate fiscal
intermediary functions and to process debt collection activities.

9\. To improve the IHS national patient care database by means of
obtaining and verifying an individual=s SSN with the Social Security
Administration (SSA).

10\. To provide information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of
organs to facilitate organ, eye, or tissue donation and transplant.

11\. To provide information to individuals about treatment alternatives
or other types of health-related benefits and services.

12\. To provide information to the Food and Drug Administration (FDA) in
connection with an FDA-regulated product or activity.

13\. To provide information to correctional institutions as necessary
for health and safety purposes.

14\. To provide information to governmental authorities (e.g., social
services or protective services agencies) on victims of abuse, neglect,
sexual assault or domestic violence.

15\. To provide information to the National Archives and Records
Administration in records management inspections conducted under the
authority of 44 U.S.C \' 2901, *et seq.*

16\. To provide relevant health care information to funeral directors or
representatives of funeral homes to allow necessary arrangements prior
to and in anticipation of an individual=s impending death.

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**Routine uses of records maintained in the system, including categories
of users and the purposes of such uses**[]{#Routine .anchor}:

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

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

1\. Records may be disclosed to Federal and non-Federal (public or
private) health care providers that provide health care services to IHS
individuals for purposes of planning for or providing such services, or
reporting results of medical examination and treatment.

2\. Records may be disclosed to Federal, state, local or other
authorized organizations that provide third-party reimbursement or
fiscal intermediary functions for the purposes of billing or collecting
third-party reimbursements. Relevant records may be disclosed to debt
collection agencies under a business associate agreement arrangement
directly or through a third party.

3\. Records may be disclosed to state agencies or other entities acting
pursuant to a contract with CMS, for fraud and abuse control efforts, to
the extent required by law or under an agreement between IHS and
respective state Medicaid agency or other entities.

4\. Records may be disclosed to school health care programs that serve
AI/AN for the purpose of student health maintenance.

5\. Records may be disclosed to the Bureau of Indian Affairs (BIA) or
its contractors under an agreement between IHS and the BIA relating to
disabled AI/AN children for the purposes of carrying out its functions
under the Individuals with Disabilities Education Act (IDEAS), 20 U.S.C.
1400, *et seq*.

6\. Records may be disclosed to organizations deemed qualified by the
Secretary of DHHS and under a business associate agreement to carry out
quality assessment/improvement, medical audits, utilization review or to
provide accreditation or certification of health care facilities or
programs.

7\. Records may be disclosed under a business associate agreement to
individuals or authorized organizations

sponsored by IHS, such as the National Indian Women=s Resource Center,
to conduct analytical and evaluation

studies.

8\. Disclosure may be made to a congressional office from the record of
an individual in response to an inquiry from the congressional office
made at the request of that individual. An authorization, Form IHS 810,
is required for the disclosure of sensitive protected health information
(PHI) (e.g., alcohol/drug abuse patient information, human
immunodeficiency virus (HIV)/AIDS, STD, or mental health) that is
maintained in the medical record.

9\. Records may be disclosed for research purposes to the extent
permitted by:

> \(a\) determining that the use(s) or disclosure(s) are met under 45
> CFR \' 164.512(i), or
>
> \(b\) determining that the use(s) or disclosure(s) are met under 45
> CFR \' 164.514(a) through (c) for de-identified PHI, and 5 U.S.C. 552a
> (b)(5), or
>
> \(c\) determining that the requirements of 45 CFR \' 164.514 (e) for
> limited data sets, and 5 U.S.C. 552a (b)(5) are met.
>
> 10\. Information from records, such as information concerning the
> commission of crimes, suspected cases of abuse (including child, elder
> and sexual abuse), neglect, sexual assault or domestic violence,
> births, deaths, alcohol or drug abuse, immunizations, cancer, or the
> occurrence of communicable diseases, may be disclosed to public health
> authorities or other appropriate government authorities, as authorized
> by Federal, state, Tribal or local law or regulation of the
> jurisdiction in which the facility is located.
>
> **Note:** In Federally conducted or assisted alcohol or drug abuse
> programs, under 42 CFR Part 2, disclosure of patient information for
> purposes of criminal investigations must be authorized by court order
> issued under 42 CFR Part 2.65, except that reports of suspected child
> abuse may be made to the appropriate state or local authorities under
> state law.

11\. Information may be disclosed from these records regarding suspected
cases of child abuse to:

> \(a\) Federal, state or Tribal agencies that need to know the
> information in the performance of their duties, and
>
> \(b\) members of community child protection teams for the purposes of
> investigating reports of suspected child abuse, establishing a
> diagnosis, formulating or monitoring a treatment plan, and making
> recommendations to the appropriate court. Community child protection
> teams are comprised of representatives of Tribes, the 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 compatible with the purpose for which the
> records were collected. Such disclosure may be made to the DHHS/Office
> of General Counsel (OGC) and/or Department of Justice (DOJ), pursuant
> to an agreement between IHS and OGC, when any of the following is a
> party to litigation and/or proceedings related to an administrative
> claim or has an interest in the litigation and/or proceedings related
> to an administrative claim:

(?) DHHS or any component thereof; or

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(i) Any DHHS employee in his or her official capacity; or

(ii) Any DHHS employee in his or her individual capacity where the DOJ
     (or DHHS, where it is authorized to do so) has agreed to represent
     the employee; or

(iii) The United States or any agency thereof (other than DHHS) where
      DHHS/OGC has determined that the litigation and/or proceedings
      related to an administrative claim is likely to affect DHHS or any
      of its components.

> \(b\) In the litigation and/or proceedings related to an
> administrative claim described in subsection (a) above, information
> from these records may be disclosed to a court or other tribunal, or
> to another party before such tribunal in response to an order of a
> court or administrative tribunal, provided that the covered entity
> discloses only the information expressly authorized by such order.

13\. Records may be disclosed under a business associate agreement to an
IHS contractor for the purpose of computerized data entry, medical
transcription, duplication services, or maintenance of records contained
in this system.

14\. Records may be disclosed under a personal services contract or
other agreement to student volunteers, individuals working for IHS, and
other individuals performing functions for IHS who do not technically
have the status of agency employees, if they need the records in the
performance of their agency functions.

15\. Records regarding specific medical services provided to 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;
> and
>
> \(d\) the notification of the partner(s) is made, whenever possible,
> by the subject individual=s physician or by a professional counselor
> and shall follow standard counseling practices.
>
> \(e\) IHS has advised the partner(s) to whom information is disclosed
> that they shall not re-disclose or use such information for a purpose
> other than that for which the disclosure was made.

20\. Records may be disclosed to Federal and non-Federal protection and
advocacy organizations that serve AI/AN for the purpose of investigating
incidents of abuse and neglect of individuals with developmental
disabilities (including mental disabilities), as defined in 42 U.S.C.
\'\' 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 individual=s whereabouts and his or her
health status or death.

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**Policies and practices for storing, retrieving, accessing, retaining,
and disposing of records in the system**[]{#Policies_and_practices
.anchor}**:**

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**Storage:** File folders, ledgers, card files, microfiche, microfilm,
computer tapes, disk packs, digital photo discs, and automated,
computer-based or electronic files.

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

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**Safeguards:** Safeguards apply to records stored on-site and off-site.

> **1. Authorized Users:** Access is limited to authorized IHS
> personnel, volunteers, IHS contractors, subcontractors, and other
> business associates in the performance of their duties. Examples of
> authorized personnel include: Medical records personnel, business
> office personnel, contract health staff, health care providers,
> authorized researchers, medical audit personnel, health care team
> members, and legal and administrative personnel on a need to know
> basis.
>
> **2. Physical Safeguards:** Records are kept in locked metal filing
> cabinets or in a secured room or in other monitored areas accessible
> to authorized users at all times when not actually in use during
> working hours and at all times during non-working hours. Magnetic
> tapes, disks, other computer equipment (e.g., pc workstations) and
> other forms of personal data are stored in areas where fire and life
> safety codes are strictly enforced. Telecommunication equipment (e.g.,
> computer terminal, servers, modems and disks) of the Resource and
> Patient Management System (RPMS) are maintained in locked rooms during
> non-working hours. Network (Internet or Intranet) access of authorized
> individual(s) to various automated and/or electronic programs or
> computers (e.g., desktop, laptop, handheld or other computer types)
> containing protected personal identifiers or personal health
> information (PHI) is reviewed periodically and controlled for
> authorizations, accessibility levels, expirations or denials,
> including passwords, encryptions or other devices to gain access.
> Combinations and/or electronic passcards on door locks are changed
> periodically and whenever an IHS employee resigns, retires or is
> reassigned.
>
> **3. Procedural Safeguards:** Within each facility a list of personnel
> or categories of personnel having a demonstrable need for the records
> in the performance of their duties has been developed and is
> maintained. Procedures have been developed and implemented to review
> one-time requests for disclosure to personnel who may not be on the
> authorized user list. Proper charge-out procedures are followed for
> the removal of all records from the area in which they are maintained.
> Records may not be removed from the facility except in certain
> circumstances, such as compliance with a valid court order or shipment
> to the Federal Records Center(s). Persons who have a need to know are
> entrusted with records from this system of records and are instructed
> to safeguard the confidentiality of these records. These individuals
> are to make no further disclosure of the records except as authorized
> by the system manager and permitted by the Privacy Act and the HIPAA
> Privacy Rule as adopted, and to destroy all copies or to return such
> records when the need to know has expired. Procedural instructions
> include the statutory penalties for noncompliance.
>
> The following automated information systems (AIS) security procedural
> safeguards are in place for automated health and medical records
> maintained in the RPMS. A profile of automated systems security is
> maintained. Security clearance procedures for screening individuals,
> both Government and contractor personnel, prior to their participation
> in the design, operation, use or maintenance of IHS AIS are
> implemented. The use of current passwords and log-on codes are
> required to protect sensitive automated data from unauthorized access.
> Such passwords and codes are changed periodically. An automated or
> electronic audit trail is maintained and reviewed periodically. Only
> authorized IHS Division of Information Resources staff may modify
> automated files in batch mode. Personnel at remote terminal sites may
> only retrieve automated or electronic data. Such retrievals are
> password protected. Privacy Act requirements, HIPAA Privacy Rule and
> Security requirements and specified AIS security provisions are
> specifically included in contracts and agreements and the system
> manager or his/her designee oversee compliance with these contract
> requirements.
>
> **4. Implementing Guidelines:** DHHS Chapter 45-10 and supplementary
> Chapter PHS.hf: 45-10 of the General Administration Manual; DHHS,
> AAutomated Information Systems Security Program Handbook,@ as amended;
> DHHS IRM Policy HHS-IRM-2000-0005, AIRM Policy for IT Security for
> Remote Access@; OMB Circular A-130 AManagement 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 (Public Law 107-347, 44 U.S.C. Ch 36).

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

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

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**Notification procedure**[]{#Notification .anchor}

**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.

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**Record access procedures**[]{#Record_access .anchor}

**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**[]{#Record_source .anchor}**:** 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.

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**Systems exempted from certain provisions of the
Act**[]{#Exempt_Systems .anchor}**:** None**.**

[**\<**Top of Page\>](#_Categories:)

**Appendix 1 - System Managers and IHS Locations Under Their**

**Jurisdiction Where Records are Maintained**[]{#Appendix_1
.anchor}**:**

**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.

Director, Santa Fe Service Unit, Santa Fe Indian Hospital, 1700
Cerrillos Road, Santa Fe, New Mexico 87501.

Director, Santa Clara Health Center, RR5, Box 446, Espanola, New Mexico
87532.

Director, San Felipe Health Center, P.O. Box 4344, San Felipe, New
Mexico 87001.

Director, Cochiti Health Center, P.O. Box 105, 255 Cochiti Street,
Cochiti, New Mexico 87072.

Director, Santo Domingo Health Center, P.O. Box 340, Santo Domingo, New
Mexico 87052.

Director, Southern Colorado-Ute Service Unit, P.O. Box 778, Ignacio,
Colorado 81137.

Director, Ignacio Indian Health Center, P.O. Box 889, Ignacio, Colorado
81137.

Director, Towaoc Ute Health Center, Towaoc, Colorado 81334.

Director, Jicarilla Indian Health Center, P.O. Box 187, Dulce, New
Mexico 87528.

Director, Mescalero Service Unit, Mescalero Indian Hospital, P.O. Box
210, Mescalero, New Mexico 88340.

Director, Taos/Picuris Indian Health Center, P.O. Box 1956, 1090 Goat
Springs Road, Taos, New Mexico 87571.

Director, Zuni Service Unit, Zuni Indian Hospital, Zuni, New Mexico
87327.

Director, Pine Hill Health Center, P.O. Box 310, Pine Hill, New Mexico
87357.

**Director, Bemidji Area Indian Health Service**, 522 Minnesota Avenue,
N.W., Bemidji, Minnesota 56601.

Director, Red Lake Service Unit, PHS Indian Hospital, Highway 1, Red
Lake, Minnesota 56671.

Director, Leech Lake Service Unit, PHS Indian Hospital, 425 7^th^
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
4^th^ 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, PO Drawer PH, Chinle, Arizona 86503.

Director, Tsaile Health Center, P.O. Box 467, Navajo Routes 64 & 12,
Tsaile, Arizona 86556.

Director, Rock Point Field Clinic, c/o Tasaile Health Center, P.O. Box
647, Tsaile, Arizona 86557.

Director, Pinon Health Station, Pinon, Arizona 86510.

Director, Crownpoint Service Unit, Crownpoint Comprehensive Health Care
Facility, P.O. Box 358, Crownpoint, New Mexico 87313.

Director, Pueblo Pintado Health Station, c/o Crownpoint Comprehensive
Health Care Facility, P.O. Box 358, Crownpoint, New Mexico 87313.

Director, Fort Defiance Service Unit, Fort Defiance Indian Hospital,
P.O. Box 649, Intersection of Navajo Routes N12 & N7, Fort Defiance,
Arizona 86515.

Director, Nahata Dziil Health Center, P.O. Box 125, Sanders, Arizona
86512.

Director, Gallup Service Unit, Gallup Indian Medical Center, P.O. Box
1337, Nizhoni Boulevard, Gallup, New Mexico 87305.

Director, Tohatchi Indian Health Center, P.O. Box 142, Tohatchi, New
Mexico 87325.

Director, Ft. Wingate Health Station, c/o Gallup Indian Medical Center,
P.O. Box 1337, Gallup, New Mexico 87305.

Director, Kayenta Service Unit, Kayenta Indian Health Center, P.O. Box
368, Kayenta, Arizona 86033.

Director, Inscription House Health Center, P.O. Box 7397, Shonto,
Arizona 86054.

Director, Dennehotso Clinic, c/o Kayenta Health Center, P.O. Box 368,
Kayenta, Arizona 86033.

Director, Shiprock Service Unit, Northern Navajo Medical Center, P.O.
Box 160, U.S. Hwy 491 North, Shiprock, New Mexico 87420.

Director, Dzilth-Na-O-Dith-Hle Indian Health Center, 6 Road 7586,
Bloomfield, New Mexico 87413.

Director, Teecnospos Health Center, P.O. Box 103, N5114 BIA School Road,
Teecnospos, Arizona 86514.

Director, Sanostee Health Station, c/o Northern Navajo Medical Center,
P.O. Box 160, Shiprock, New Mexico 87420.

Director, Toadlena Health Station, c/o Northern Navajo Medical Center,
P.O. Box 160, Shiprock, New Mexico 87420.

Director, Teen Life Center, c/o Northern Navajo Medical Center, P.O. Box
160, Shiprock, New Mexico 87420.

**Director, Oklahoma City Area Indian Health Service**, Five Corporation
Plaza, 3625 NW 56^th^ Street, Oklahoma City, Oklahoma 73112.

Director, Claremore Service Unit, Claremore Comprehensive Indian Health
Facility, West Will Rogers Boulevard and Moore, Claremore, Oklahoma
74017.

Director, Clinton Service Unit, Clinton Indian Hospital, Route 1, Box
3060, Clinton, Oklahoma 73601-9303.

Director, El Reno PHS Indian Health Clinic, 1631A E. Highway 66, El
Reno, Oklahoma 73036.

Director, Watonga Indian Health Center, Route 1, Box 34-A, Watonga,
Oklahoma 73772.

Director, Haskell Service Unit, PHS Indian Health Center, 2415
Massachusetts Avenue, Lawrence, Kansas 66044.

Director, Lawton Service Unit, Lawton Indian Hospital, 1515 Lawrie Tatum
Road, Lawton, Oklahoma 73501.

Director, Anadarko Indian Health Center, P.O. Box 828, Anadarko,
Oklahoma 73005.

Director, Carnegie Indian Health Center, P.O. Box 1120, Carnegie,
Oklahoma 73150.

Director, Holton Service Unit, PHS Indian Health Center, 100 West 6^th^
Street, Holton, Kansas 66436.

Director, Pawnee Service Unit, Pawnee Indian Service Center, RR2, Box 1,
Pawnee, Oklahoma 74058-9247.

Director, Pawhuska Indian Health Center, 715 Grandview, Pawhuska,
Oklahoma 74056.

Director, Tahlequah Service Unit, W. W. Hastings Indian Hospital, 100 S.
Bliss, Tahlequah, Oklahoma 74464.

Director, Wewoka Indian Health Center, P.O. Box 1475, Wewoka, Oklahoma
74884.

**Director, Phoenix Area Indian Health Service**, Two Renaissance
Square, 40 North Central Avenue, Phoenix, Arizona 85004.

Director, Colorado River Service Unit, Chemehuevi Indian Health Clinic,
P.O. Box 1858, Havasu Landing, California 92363.

Director, Colorado River Service Unit, Havasupai Indian Health Station,
P.O. Box 129, Supai, Arizona 86435.

Director, Colorado River Service Unit, Parker Indian Health Center,
12033 Agency Road, Parker, Arizona 85344.

Director, Colorado River Service Unit, Peach Springs Indian Health
Center, P.O. Box 190, Peach Springs, Arizona 86434.

Director, Colorado River Service Unit, Sherman Indian High School, 9010
Magnolia Avenue, Riverside, California 92503.

Director, Elko Service Unit, Newe Medical Clinic, 400 AA@ 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 16^th^ Street, Phoenix, Arizona 85016.

Director, Phoenix Service Unit, Salt River Health Center, 10005 East
Osborn Road, Scottsdale, Arizona 85256.

Director, San Carlos Service Unit, Bylas Indian Health Center, P.O. Box
208, Bylas, Arizona 85550.

Director, San Carlos Service Unit, San Carlos Indian Hospital, P.O. Box
208, San Carlos, Arizona 85550.

Director, Unitah and Ouray Service Unit, Fort Duchesne Indian Health
Center, P.O. Box 160, Ft. Duchesne, Utah 84026.

Director, Whiteriver Service Unit, Cibecue Health Center, P.O. Box 37,
Cibecue, Arizona 85941.

Director, Whiteriver Service Unit, Whiteriver Indian Hospital, P.O. Box
860, Whiteriver, Arizona 85941.

Director, Desert Vision Youth Wellness Center/RTC, P.O. Box 458,
Sacaton, AZ 85247.

**Director, Portland Area Indian Health Service**, Room 476, Federal
Building, 1220 Southwest 3^rd^ Avenue, Portland, Oregon 97204-2829.

Director, Colville Service Unit, Colville Indian Health Center, P.O. Box
71-Agency Campus, Nespelem, Washington 99155.

Director, Fort Hall Service Unit, Not-Tsoo Gah-Nee Health Center, P.O.
Box 717, Fort Hall, Idaho 83203.

Director, Neah Bay Service Unit, Sophie Trettevick Indian Health Center,
P.O. Box 410, Neah Bay, Washington 98357.

Director, Warm Springs Service Unit, Warm Springs Indian Health Center,
P.O. Box 1209, Warm Springs, Oregon 97761.

Director, Wellpinit Service Unit, David C. Wynecoop Memorial Clinic,
P.O. Box 357, Wellpinit, Washington 99040.

Director, Western Oregon Service Unit, Chemawa Indian Health Center,
3750 Chemawa Road, NE, Salem, Oregon 97305-1198.

Director, Yakama Service Unit, Yakama Indian Health Center, 401 Buster
Road, Toppenish, Washington 98948.

**Director, Tucson Area Indian Health Service**, 7900 South AJ@ Stock
Road, Tucson, Arizona 85746-9352.

Director, Pascua Yaqui Service Unit, Division of Public Health, 7900
South AJ@ Stock Road, Tucson, Arizona 85746.

Director, San Xavier Indian Health Center, 7900 South AJ@ Stock Road,
Tucson, Arizona 85746.

Director, Sells Service Unit, Santa Rosa Indian Health Center, HCO1, Box
8700, Sells, Arizona 85634.

Director, Sells Service Unit, Sells Indian Hospital, P.O. Box 548,
Sells, Arizona 85634.

Director, Sells Service Unit, West Side Health Station, P.O. Box 548,
Sells, Arizona 85634.

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**Appendix 2 - Federal Archives and Records Centers**[]{#Appendix_2
.anchor}

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.