**National Steering Committee for the **

**Reauthorization of the**

**Indian Health Care Improvement Act, P.L. 94-437**

**PREAMBLE**

**DRAFT 1 --- July 16, 1999**

**For Review and Comment Only**

+--------------------------------------------------------------------------+
| +----------------------------------------------------------------------+ |
| | **Indian Health Care Improvement Act (with DRAFT proposed            | |
| | amendments, if any)**                                                | |
| +----------------------------------------------------------------------+ |
|                                                                          |
| ***Comments and **Options***                                             |
+--------------------------------------------------------------------------+
|                                                                          |
+--------------------------------------------------------------------------+

***1.**** This is the first complete draft reviewed by the National
Steering Committee. It is the product of hundreds of hours of work by
tribal leaders, staff and consultants, representatives of urban Indian
organizations and the Indian Health Service. Every recommendation of the
regional meetings was reviewed and an attempt was made to understand the
concern and address it. Due to the shortage of time, this DRAFT is still
very rough. Cross-references have not been corrected in the body. A
cross-reference table will be provided at the National Meeting and will
be available on the IHS Web Site. This is the best tool for seeing how
sections may have moved around.*

***2.**** There were many recommendations for additions and amendments
to the definitions. None of these were addressed at this time. They will
be considered after the national tribal consultation meeting.*

  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --
  ***3.**** Your input is absolutely essential. We are many drafts away from a true "final" bill. Please comment. Information about how to submit written comments is found on the bottom of every page. The deadline for National Steering Committee review is August 16, 1999.*   
                                                                                                                                                                                                                                                                                    
  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --

**Public Law 94-437 \-- 94^th^ Congress, S. 522, September 30, 1976**

+-----------------------------------------------------------------+---+
| +-------------------------------------------------------+---+   |   |
| |   ----------------------------------                  |   |   |   |
| | ----------------------------------------------------- |   |   |   |
| | ----------------------------------------------------- |   |   |   |
| | -------------------------------------------------- -- |   |   |   |
| |   (as amended by: P.L. 96-537 (12/                    |   |   |   |
| | 17/80); P.L. 100-579 (10/31/88); P.L. 100-690 (11/18/ |   |   |   |
| | 88); P.L. 100-713 (11/23/88); P.L. 101-630 (11/28/90) |   |   |   |
| | ; P.L. 102-573 (10/29/92); P.L. 104-313 (10/19/96)    |   |   |   |
| |                                                       |   |   |   |
| |                                                       |   |   |   |
| |                                                       |   |   |   |
| |                                                       |   |   |   |
| |   ----------------------------------                  |   |   |   |
| | ----------------------------------------------------- |   |   |   |
| | ----------------------------------------------------- |   |   |   |
| | -------------------------------------------------- -- |   |   |   |
| |                                                       |   |   |   |
| | To implement the Federal responsibility for the care  |   |   |   |
| | and education of the Indian people by improving the   |   |   |   |
| | services and facilities of Federal Indian health      |   |   |   |
| | programs and encouraging maximum participation of     |   |   |   |
| | Indians in such programs, and for other purposes.     |   |   |   |
| +-------------------------------------------------------+---+   |   |
| |                                                       |   |   |   |
| +-------------------------------------------------------+---+   |   |
|                                                                 |   |
| Be it enacted by the Senate and House of Representatives of the |   |
| United States of American in Congress assembled, That this Act  |   |
| may be cited as the "Indian Health Care Improvement Act."       |   |
+-----------------------------------------------------------------+---+
|                                                                 |   |
+-----------------------------------------------------------------+---+

**FINDINGS**

**SEC. 2.** The Congress finds the following:

\(a\) Federal [delivery of]{.underline} health services [and funding of
tribal and urban Indian health programs]{.underline} to maintain and
improve the health of the Indians are consonant with and required by the
Federal government's historical and unique legal relationship[, as
reflected in the Constitution, treaties, Federal statutes and the course
of dealings of the United States with Indian tribes]{.underline}
~~with,~~ and [the United States']{.underline} resulting
[trust]{.underline} responsibility to the American Indian people.

\(b\) A major [national]{.underline} goal of the United States is to
provide the quantity and quality of health [services which will permit
the health]{.underline} status of Indians [regardless of where they
live]{.underline} to be raised to [a]{.underline} ~~the highest
possible~~ level [that is no less than that of the general
population]{.underline} and to [provide for]{.underline} ~~encourage~~
the maximum participation of Indians[, Indian tribes and Indian and
tribal organizations]{.underline} in the planning[,
delivery]{.underline} and management of those services.

\(c\) Federal health services to Indians have resulted in a reduction in
the prevalence and incidence of ~~preventable~~ illnesses among, and
unnecessary and premature deaths of, Indians.

\(d\) Despite such services, the unmet health needs of the American
Indian people [remain]{.underline} ~~are~~ severe and the health status
of Indians is far below that of the general population of the United
States.

[(e) Indian tribes have through the cession of over 400 million acres of
land to the United States in exchange for promises, often reflected in
treaties, of health care secured a ]{.underline}*[de
facto]{.underline}*[ contract based on moral, legal and historic
obligations for health care from the United States.]{.underline}

  -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  [(f) From the time of European occupation and colonization through the twentieth century policies and practices of the United States caused and/or contributed to the severe health conditions of Indians.]{.underline}
  -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

*The Act should reflect the increased role of tribal providers in
meeting the objectives of the Act.*

  --
  --

**DECLARATION OF [NATIONAL POLICY]{.underline} ~~HEALTH OBJECTIVES~~**

**SEC. 3 **(a). The Congress hereby declares that it is the policy of
this Nation, in fulfillment of its special [trust]{.underline}
responsibilities and legal obligations to the American Indian people, to
assure the highest possible health status for Indians ~~and urban
Indians~~ and to provide all resources necessary to affect that policy.

\(b\) It is the intent of the Congress that the Nation [raise the health
standards of]{.underline} ~~ meet the following health status objectives
with respect to~~ Indians ~~and urban Indians~~ by the year
[2010]{.underline} ~~2000~~ [to not less than that of the general
population.]{.underline}

~~(1)Reduce coronary heart disease deaths to a level of no more than 100
per 100,000.~~

~~(2) Reduce the prevalence of overweight individuals to no more than 30
percent. ~~

~~(3) Reduce the prevalence of anemia to less than 10 percent among
children aged 1 through 5.~~

~~(4)Reduce the level of cancer deaths to a rate of no more than 130 per
100,000.~~

~~(5)Reduce the level of lung cancer deaths to a rate of no more than 42
per 100,000. ~~

~~(6)Reduce the level of chronic obstructive pulmonary disease related
deaths to a rate of no more than 25 per 100,000 ~~

~~(7)Reduce deaths among men caused by alcohol-related motor vehicle
crashes to no more than 44.8 per 100,000. ~~

~~(8)Reduce cirrhosis deaths to no more than 13 per 100,000. ~~

~~ (9)Reduce drug-related deaths to no more than 3 per 100,000. ~~

~~(10)Reduce pregnancies among girls aged 17 and younger to no more than
50 per 1,000 adolescents. ~~

~~(11)Reduce suicide among men to no more than 12.8 per 100,000. ~~

~~(12)Reduce by 15 percent the incidence of injurious suicide attempts
among adolescents aged 14 through 17. ~~

~~(13)Reduce to less than 10 percent the prevalence of mental disorders
among children and adolescents. ~~

~~(14)Reduce the incidence of child abuse or neglect to less than 25.2
per 1,000 children under age 18. ~~

~~(15)Reduce physical abuse directed at women by male partners to no
more than 27 per 1,000 couples. ~~

~~(16)Increase years of healthy life to at least 65 years. ~~

~~(17)Reduce deaths caused by unintentional injuries to no more than
66.1 per 100,000. ~~

~~(18)Reduce deaths caused by motor vehicle crashes to no more than 39.2
per 100,000. ~~

~~(19)Among children aged 6 months through 5 years, reduce the
prevalence of blood lead levels exceeding 15 ug/dl and reduce to zero
the prevalence of blood lead levels exceeding 25 ug/dl. ~~

~~(20)Reduce dental caries (cavities) so that the proportion of children
with one or more caries (in permanent or primary teeth) is no more than
45 percent among children aged 6 through 8 and no more than 60 percent
among adolescents aged 15. ~~

~~(21)Reduce untreated dental caries so that the proportion of children
with untreated caries (in permanent or primary~~**~~[
]{.underline}~~**~~teeth) is no more than 20 percent among children aged
6 through 8 and no more than 40 percent among adolescents aged 15. ~~

~~(22) Reduce to no more than 20 percent the proportion of individuals
aged 65 and older who have lost all of their natural teeth. ~~

~~(23) Increase to at least 45 percent the proportion of individuals
aged 35 to 44 who have never lost a permanent tooth due to dental caries
or periodontal disease. ~~

~~(24) Reduce destructive periodontal disease to a prevalence of no more
than 15 percent among individuals aged 35 to 44. ~~

~~(25)Increase to at least 50 percent the proportion of children who
have received protective sealants on the occlusal (chewing) surfaces of
permanent molar teeth.~~

~~(26)Reduce the prevalence of gingivitis among individuals aged 35 to
44 to no more than 50 percent. ~~

~~(27)Reduce the infant mortality rate to no more than 8.5 per 1,000
live births. ~~

~~(28)Reduce the fetal death rate (20 or more weeks of gestation) to no
more than 4 per 1,000 live births plus fetal deaths. ~~

~~(29)Reduce the maternal mortality rate to no more than 3.3 per 100,000
live births. ~~

~~ (30)Reduce the incidence of fetal alcohol syndrome to no more than 2
per 1,000 live births. ~~

~~(31)Reduce stroke deaths to no more than 20 per 100,000.~~

~~(32)Reverse the increase in end-stage renal disease (requiring
maintenance dialysis or transplantation) to attain an incidence of no
more than 13 per 100,000. ~~

~~(33)Reduce breast cancer deaths to no more than 20.6 per 100,000
women. ~~

~~ (34)Reduce deaths from cancer of the uterine cervix to no more than
1.3 per 100,000 women. ~~

~~(35)Reduce colorectal cancer deaths to no more than 13.2 per 100,000.
~~

~~(36)Reduce to no more than 11 percent the proportion of individuals
who experience a limitation in major activity due to chronic conditions.
~~

~~(37)Reduce significant hearing impairment to a prevalence of no more
than 82 per 1,000. ~~

~~(38)Reduce significant visual impairment to a prevalence of no more
than 30 per 1,000. ~~

~~(39)Reduce diabetes-related deaths to no more than 48 per 100,000. ~~

~~(40)Reduce diabetes to an incidence of no more than 2.5 per 1,000 and
a prevalence of no more than 62 per 1,000. ~~

~~(41)Reduce the most severe complications of diabetes as follows:~~

~~(A) End-stage renal disease, 1.9 per 1,000.~~

~~(B) Blindness, 1.4 per 1,000.~~

~~(C) Lower extremity amputation, 4.9 per 1,000 ~~

~~(D) Perinatal mortality, 2 percent.~~

~~(E) Major congenital malformations, 4 percent.~~

~~(42)Confine annual incidence of diagnosed AIDS cases to no more than
1,000 cases ~~

~~(43)Confine the prevalence of HIV infection to no more than 100 per
100,000. ~~

~~(44)Reduce gonorrhea to an incidence of no more than 225 cases per
100,000. ~~

~~(45)Reduce chlamydia trachomatis infections, as measured by a decrease
in the incidence of nongonococcal urethritis to no more than 170 cases
per 100,000. ~~

~~ (46)Reduce primary and secondary syphilis to an incidence of no more
than 10 cases per 100,000. ~~

~~(47)Reduce the incidence of pelvic inflammatory disease, as measured
by a reduction in hospitalization for pelvic inflammatory disease to no
more than 250 per 100,000 women aged 15 through 44. ~~

~~(48)Reduce viral hepatitis B infection to no more than 40 per 100,000
cases. ~~

~~(49)Reduce indigenous cases of vaccine-preventable diseases as
follows: ~~

~~(A) Diphtheria among individuals aged 25 and younger, 0.~~

~~(B) Tetanus among individuals aged 25 and younger, 0.~~

~~(C) Polio (wild-type virus), 0. ~~

~~(D) Measles, 0. ~~

~~(E) Rubella, 0. ~~

~~(F) Congenital Rubella Syndrome, 0. ~~

~~(G) Mumps, 500. ~~

~~(H) Pertussis, 1,000. ~~

~~ (50) Reduce epidemic-related pneumonia and influenza deaths among
individuals aged 65 and older to no more than 7.3 per 100,000. ~~

~~(51)Reduce the number of new carriers of viral hepatitis B among
Alaska Natives to no more than 1 case. ~~

~~(52)Reduce tuberculosis to an incidence of no more than 5 cases per
100,000. ~~

~~(53)Reduce bacterial meningitis to no more than 8 cases per 100,000.
~~

~~(54)Reduce infectious diarrhea by at least 25 percent among children.
~~

~~(55)Reduce acute middle ear infections among children aged 4 and
younger, as measured by days of restricted activity or school
absenteeism, to no more than 105 days per 100 children. ~~

~~ (56)Reduce cigarette smoking to a prevalence of no more than 20
percent. ~~

~~(57)Reduce smokeless tobacco use by youth to a prevalence of no more
than 10 percent. ~~

~~(58)Increase to at least 65 percent the proportion of parents and
caregivers who use feeding practices that prevent baby bottle tooth
decay. ~~

~~(59)Increase to at least 75 percent the proportion of mothers who
breast feed their babies in the early postpartum period, and to at least
50 percent the proportion who continue breast feeding until their babies
are 5 to 6 months old. ~~

~~(60)Increase to at least 90 percent the proportion of pregnant women
who receive prenatal care in the first trimester of pregnancy. ~~

~~(61)Increase to at least 70 percent the proportion of individuals who
have received, as a minimum within the appropriate interval, all of the
screening and immunization services and at least one of the counseling
services appropriate for their age and gender as recommended by the
United States Preventive Services Task Force. ~~

  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  \(c\) [Tribes and tribal organizations may set health care priorities and establish objectives fro their own programs that may vary from national objectives.]{.underline}
  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------

*The health status objectives for Indians should be the same as for the
Nation as a whole. *

+----------------------------------------------------------------------+
| +----------------------------------------------------------------+   |
| |   -----------------------------------------                    |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| |   *Area and tribal planning processes are                      |   |
| |  identified in (a)(2), but under (3) the right of tribes and t |   |
| | ribal organizations to develop unique objectives is retained.* |   |
| |   -----------------------------------------                    |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| |                                                                |   |
| | [(d)]{.underline} ~~(c)~~ It is the [policy]{.underline}       |   |
| | ~~intent~~ of the Congress that the Nation increase the        |   |
| | proportion of all degrees in the health professions and allied |   |
| | and associated health profession fields awarded to Indians [so |   |
| | that each geographic service area availability of health       |   |
| | professionals is raised]{.underline} to [at least the level of |   |
| | that of the general population]{.underline} ~~0.6 percent~~.   |   |
| +----------------------------------------------------------------+   |
|                                                                      |
| *The level has to be higher than that of the proportion of Indians   |
| to the general population or the level will never match that of the  |
| general population.*                                                 |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

~~(d) The Secretary shall submit to the President, for inclusion in each
report required to be transmitted to the Congress under section 801, a
report on the progress made in each area of the Service toward meeting
each of the objectives described in subsection (b). ~~

[(e) It is the policy of Congress to require active consultation with
Indian people to implement this Act and nation policy of Indian
Self-Determination.]{.underline}

+----------------------------------------------------------------------+
|   -----------------------------------------------------------        |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   [(f) It is the policy of Congress that funds for health c          |
| are programs and facilities operated by tribes and tribal organizati |
| ons are provided on the same basis as such funds are provided to pro |
| grams and facilities operated directly by the Service. ]{.underline} |
|   -----------------------------------------------------------        |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *The responsibility for reports about objectives should not be       |
| shifted to IHS or the tribes. It should rest with the same Federal   |
| agency responsible for reporting on the status for the Nation.*      |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**DEFINITIONS**

**Sec. 4.** For purposes of this Act\--

+-----------------------------------------------------------------+---+
| +-------------------------------------------------------+---+   |   |
| | +-------------------------------------------------+   |   |   |   |
| | |   -------                                       |   |   |   |   |
| | | ----------------------------------------------- |   |   |   |   |
| | | ----------------------------------------------- |   |   |   |   |
| | |   \(a\)                                         |   |   |   |   |
| | |  \"Secretary\", unless otherwise designated, me |   |   |   |   |
| | | ans the Secretary of Health and Human Services. |   |   |   |   |
| | |   -------                                       |   |   |   |   |
| | | ----------------------------------------------- |   |   |   |   |
| | | ----------------------------------------------- |   |   |   |   |
| | |                                                 |   |   |   |   |
| | | ***This section will be amended **after all the |   |   |   |   |
| | | other sections are **complete.***               |   |   |   |   |
| | +-------------------------------------------------+   |   |   |   |
| | |                                                 |   |   |   |   |
| | +-------------------------------------------------+   |   |   |   |
| |                                                       |   |   |   |
| | \(b\) \"Service\" means the Indian Health Service.    |   |   |   |
| +-------------------------------------------------------+---+   |   |
| |                                                       |   |   |   |
| +-------------------------------------------------------+---+   |   |
|                                                                 |   |
| \(c\) \"Indians\" or \"Indian\", unless otherwise designated,   |   |
| means any person who is a member of an Indian tribe, as defined |   |
| in subsection (d) hereof, except that, for the purpose of       |   |
| section 102 and 103, such terms shall mean any individual who   |   |
| (1), irrespective of whether he or she lives on or near a       |   |
| reservation, is a member of a tribe, band, or other organized   |   |
| group of Indians, including those tribes, bands, or groups      |   |
| terminated since 1940 and those recognized now or in the future |   |
| by the State in which they reside, or who is a descendant, in   |   |
| the first or second degree, of any such member, or (2) is an    |   |
| Eskimo or Aleut or other Alaska Native, or (3) is considered by |   |
| the Secretary of the Interior to be an Indian for any purpose,  |   |
| or (4) is determined to be an Indian under regulations          |   |
| promulgated by the Secretary.                                   |   |
+-----------------------------------------------------------------+---+
|                                                                 |   |
+-----------------------------------------------------------------+---+

\(d\) \"Indian tribe\" means any Indian tribe, band, nation, or other
organized group or community, including any Alaska Native village or
group or regional or village corporation as defined in or established
pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688),
which is recognized as eligible for the special programs and services
provided by the United States to Indians because of their status as
Indians.

\(e\) \"Tribal organization\" means the elected governing body of any
Indian tribe or any legally established organization of Indians which is
controlled by one or more such bodies or by a board of directors elected
or selected by one or more such bodies (or elected by the Indian
population to be served by such organization) and which includes the
maximum participation of Indians in all phases of its activities.

+-----------------------------------------------------------------+---+
| +-------------------------------------------------------+---+   |   |
| | +---------------------------------------------+---+   |   |   |   |
| | | +-----------------------------------+---+   |   |   |   |   |   |
| | | |   -- --                           |   |   |   |   |   |   |   |
| | | |                                   |   |   |   |   |   |   |   |
| | | |                                   |   |   |   |   |   |   |   |
| | | |   -- --                           |   |   |   |   |   |   |   |
| | | |                                   |   |   |   |   |   |   |   |
| | | | \(f\) \"Urban Indian\" means any  |   |   |   |   |   |   |   |
| | | | individual who resides in an      |   |   |   |   |   |   |   |
| | | | urban center, as defined in       |   |   |   |   |   |   |   |
| | | | subsection (g) hereof, and who    |   |   |   |   |   |   |   |
| | | | meets one or more the four        |   |   |   |   |   |   |   |
| | | | criteria in subsection (c)(1)     |   |   |   |   |   |   |   |
| | | | through (4) of this section.      |   |   |   |   |   |   |   |
| | | +-----------------------------------+---+   |   |   |   |   |   |
| | | |                                   |   |   |   |   |   |   |   |
| | | +-----------------------------------+---+   |   |   |   |   |   |
| | |                                             |   |   |   |   |   |
| | | \(g\) \"Urban center\" means any community  |   |   |   |   |   |
| | | which has a sufficient urban Indian         |   |   |   |   |   |
| | | population with unmet health needs to       |   |   |   |   |   |
| | | warrant assistance under title V, as        |   |   |   |   |   |
| | | determined by the Secretary.                |   |   |   |   |   |
| | +---------------------------------------------+---+   |   |   |   |
| | |                                             |   |   |   |   |   |
| | +---------------------------------------------+---+   |   |   |   |
| |                                                       |   |   |   |
| | \(h\) \"Urban Indian organization\" means a nonprofit |   |   |   |
| | corporate body situated in an urban center, governed  |   |   |   |
| | by an urban Indian controlled board of directors, and |   |   |   |
| | providing for the maximum participation of all        |   |   |   |
| | interested Indian groups and individuals, which body  |   |   |   |
| | is capable of legally cooperating with other public   |   |   |   |
| | and private entities for the purpose of performing    |   |   |   |
| | the activities described in section 503(a).           |   |   |   |
| +-------------------------------------------------------+---+   |   |
| |                                                       |   |   |   |
| +-------------------------------------------------------+---+   |   |
|                                                                 |   |
| \(i\) \"Area office\" mean an administrative entity including a |   |
| program office, within the Indian Health Service through which  |   |
| services and funds are provided to the service units within a   |   |
| defined geographic area.                                        |   |
+-----------------------------------------------------------------+---+
|                                                                 |   |
+-----------------------------------------------------------------+---+

\(j\) \"Service unit\" means\--

\(1\) an administrative entity within the Indian Health Service, or

\(2\) a tribe or tribal organization operating health care programs or
facilities with funds from the Service under the Indian
Self-Determination Act,

  ----------------------------------------------------------------------------------------------------------------------------------- --
  through which services are provided, directly or by contract, to the eligible Indian population within a defined geographic area.   
                                                                                                                                      
  ----------------------------------------------------------------------------------------------------------------------------------- --

\(k\) "Health promotion"\--

\(1\) cessation of tobacco smoking,

\(2\) reduction in the misuse of alcohol and drugs,

\(3\) improvement of nutrition,

\(4\) improvement in physical fitness,

\(5\) family planning,

\(6\) control of stress, and

  ----------------------------------------------------------------------------------- --
  \(7\) pregnancy and infant care (including prevention of fetal alcohol syndrome).   
                                                                                      
  ----------------------------------------------------------------------------------- --

(*l*) "Disease prevention" includes--

\(1\) immunizations,

\(2\) control of high blood pressure,

\(3\) control of sexually transmittable diseases,

\(4\) prevention and control of diabetes,

\(5\) control of toxic agents,

\(6\) occupational safety and health,

\(7\) accident prevention,

\(8\) fluoridation of water, and

+-----------------------------------------------------------------+---+
| +-------------------------------------------------------+---+   |   |
| | +---------------------------------------------+---+   |   |   |   |
| | | +---------------------------------------+   |   |   |   |   |   |
| | | | +---------------------------------+   |   |   |   |   |   |   |
| | | | | +-----------------------+---+   |   |   |   |   |   |   |   |
| | | | | |   ------------------- |   |   |   |   |   |   |   |   |   |
| | | | | | ------------------ -- |   |   |   |   |   |   |   |   |   |
| | | | | |   \(9\) control of    |   |   |   |   |   |   |   |   |   |
| | | | | | infectious agents.    |   |   |   |   |   |   |   |   |   |
| | | | | |                       |   |   |   |   |   |   |   |   |   |
| | | | | |                       |   |   |   |   |   |   |   |   |   |
| | | | | |   ------------------- |   |   |   |   |   |   |   |   |   |
| | | | | | ------------------ -- |   |   |   |   |   |   |   |   |   |
| | | | | |                       |   |   |   |   |   |   |   |   |   |
| | | | | | \(m\) \"Service       |   |   |   |   |   |   |   |   |   |
| | | | | | area\" means the      |   |   |   |   |   |   |   |   |   |
| | | | | | geographical area     |   |   |   |   |   |   |   |   |   |
| | | | | | served by each area   |   |   |   |   |   |   |   |   |   |
| | | | | | office.               |   |   |   |   |   |   |   |   |   |
| | | | | +-----------------------+---+   |   |   |   |   |   |   |   |
| | | | | |                       |   |   |   |   |   |   |   |   |   |
| | | | | +-----------------------+---+   |   |   |   |   |   |   |   |
| | | | |                                 |   |   |   |   |   |   |   |
| | | | | \(n\) \"Health profession\"     |   |   |   |   |   |   |   |
| | | | | means allopathic medicine,      |   |   |   |   |   |   |   |
| | | | | family medicine, internal       |   |   |   |   |   |   |   |
| | | | | medicine, pediatrics, geriatric |   |   |   |   |   |   |   |
| | | | | medicine, obstetrics and        |   |   |   |   |   |   |   |
| | | | | gynecology, podiatric medicine, |   |   |   |   |   |   |   |
| | | | | nursing, public health nursing, |   |   |   |   |   |   |   |
| | | | | dentistry, psychiatry,          |   |   |   |   |   |   |   |
| | | | | osteopathy, optometry,          |   |   |   |   |   |   |   |
| | | | | pharmacy, psychology, public    |   |   |   |   |   |   |   |
| | | | | health, social work, marriage   |   |   |   |   |   |   |   |
| | | | | and family therapy,             |   |   |   |   |   |   |   |
| | | | | chiropractic medicine,          |   |   |   |   |   |   |   |
| | | | | environmental health and        |   |   |   |   |   |   |   |
| | | | | engineering, and allied health  |   |   |   |   |   |   |   |
| | | | | professions, or any other       |   |   |   |   |   |   |   |
| | | | | health profession.              |   |   |   |   |   |   |   |
| | | | +---------------------------------+   |   |   |   |   |   |   |
| | | |                                       |   |   |   |   |   |   |
| | | | *Consider adding "traditional"        |   |   |   |   |   |   |
| | | | services. *                           |   |   |   |   |   |   |
| | | +---------------------------------------+   |   |   |   |   |   |
| | | |                                       |   |   |   |   |   |   |
| | | +---------------------------------------+   |   |   |   |   |   |
| | |                                             |   |   |   |   |   |
| | | \(o\) \"Substance abuse\" includes inhalant |   |   |   |   |   |
| | | abuse.                                      |   |   |   |   |   |
| | +---------------------------------------------+---+   |   |   |   |
| | |                                             |   |   |   |   |   |
| | +---------------------------------------------+---+   |   |   |   |
| |                                                       |   |   |   |
| | \(p\) \"FAE\" means fetal alcohol effect.             |   |   |   |
| +-------------------------------------------------------+---+   |   |
| |                                                       |   |   |   |
| +-------------------------------------------------------+---+   |   |
|                                                                 |   |
| \(q\) \"FAS\" means fetal alcohol syndrome.                     |   |
+-----------------------------------------------------------------+---+