[Federal Register Volume 75, Number 7 (Tuesday, January 12, 2010)]
[Notices]
[Pages 1625-1632]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-285]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Privacy Act of 1974; Report of Amended or Altered System; 
Medical, Health and Billing Records System

AGENCY: Indian Health Service (IHS), HHS.

ACTION: Amendment of One Altered Privacy Act System of Records (PASOR), 
09-17-0001.

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SUMMARY: Pursuant to the provisions of the Privacy Act of 1974, as 
amended, 5 U.S.C. 552a(e)(4), the IHS has amended and is publishing the 
proposed alteration of a system of records, System No. 09-17-0001, 
``Medical, Health and Billing Records.'' The amended and altered system 
of records is to reflect revisions in the Purpose and Routine Uses 
sections, the Notification Procedures section and updates to Appendix 1 
of the PASOR.
    In the Purpose section of the PASOR, IHS is altering number seven 
to allow the disclosure of controlled substance prescription data and/
or protected health information (PHI) and personally identifiable 
information (PII) to its business associate contractor(s) for stated 
healthcare operations prior to transferring to various State Health 
Monitoring Programs and Registries; and to disclose data transmission 
of PHI to various health data exchange, regional health information and 
e-prescribing networks.
    In the Routine Uses section, routine use number thirteen is altered 
to include language that will allow the disclosure to various stated 
healthcare operations and health data exchange, regional health 
information and e-prescribing networks.
    In the Notification Procedure section under Record Access and 
Contesting Record procedures, IHS is referencing its various IHS forms 
with its stated purposes to be utilized by the requester(s).

DATES: Effective Dates: IHS filed an altered 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, Office of Management and Budget (OMB) on January 12, 2010. To 
ensure that all parties have adequate time in which to comment, the 
altered PASOR will become effective 40 days from the publication of the 
notice, or from the date the SOR was submitted to OMB and the Congress, 
whichever is later, unless IHS receives comments on all portions of 
this notice.

ADDRESSES: The public should address comments to: Mr. William Tibbitts, 
IHS Privacy Act Officer, Division of Regulatory Affairs, Office of 
Management Services, 801 Thompson Avenue, TMP, Suite 450, Rockville, MD 
20852-1627; call non-toll free (301) 443-1116; send via facsimile to 
(301) 443-9879, or send your e-mail requests, comments, and return 
address to: <a href="/cdn-cgi/l/email-protection#93c4fafffffaf2febdc7faf1f1fae7e7e0d3fafbe0bdf4fce5"><span class="__cf_email__" data-cfemail="cf98a6a3a3a6aea2e19ba6adada6bbbbbc8fa6a7bce1a8a0b9">[email protected]</span></a>.

FOR FURTHER INFORMATION CONTACT: Ms. Patricia Gowan, IHS Lead Health 
Information Management (HIM) Consultant and Area HIM Consultants, 
Office of Health Programs, Phoenix Area Office, Two Renaissance Square, 
Suite 606, 40 North Central Avenue, Phoenix, AZ 85004-4450, Telephone 
(602) 364-5172 or via the Internet at <a href="/cdn-cgi/l/email-protection#e0b081949289838981cea78f97818ea0898893ce878f96"><span class="__cf_email__" data-cfemail="02526376706b616b632c456d75636c426b6a712c656d74">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: As required by the Privacy Act of 1974, as 
amended, 5 U.S.C. 552a(e)(4), this document sets forth the amendment of 
the proposed alteration of a system of records maintained by the IHS. 
IHS is altering System No. 09-17-0001, ``Health, Medical and Billing 
Records,'' for the stated reasons. First, a change to the Purpose 
section number seven will further enable IHS to disclose controlled 
substance prescription data to a business associate contractor(s) for 
stated healthcare operations prior to transferring to various State 
Health Monitoring Programs and Registries; as well as to enable IHS to 
disclose data transmission of PHI to various health data exchange and/
or regional health information contractors. Second, a change to the 
Routine Uses section number thirteen will enable IHS to allow the 
disclosure of information from the record for the various stated 
healthcare operations and Health Data Exchange; Regional Health 
Information; and e-prescribing networks.

    Dated: December 29, 2009.
Yvette Roubideaux,
Director, Indian Health Service.

Department of Health and Human Services

Indian Health Service

System Number: 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 health and computerized records, including but not limited 
to clinical information and Patient Care Component (PCC) records, are 
stored in the Resource and Patient Management System (RPMS) at the 
National Programs/Office of Information Technology (NP/OIT), IHS, 
located in Albuquerque, New Mexico. 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 Privacy Act System of Records (PASOR)

[[Page 1626]]

Notice, 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 the 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.
    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 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

[[Page 1627]]

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 IHS-810 form, 
Authorization for Use or Disclosure of Protected Health Information, 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 CFR 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 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 (including a Health Information Exchange, Regional 
Health Information Organization, or E-prescribing Gateway) for the 
purpose of computerized data entry, medical

[[Page 1628]]

transcription, duplication services, maintenance of records, data 
formatting services or for any other agency function or activity 
involving the use or disclosure 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/AIDS 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/AIDS 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 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.
    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

[[Page 1629]]

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) (FRC). 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 medical, health and 
billing 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 medical, health and billing services from 
three to seven years and then are transferred to the appropriate 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 and National Archives and Records 
Administration (NARA). 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.

NOTIFICATION PROCEDURES:
    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

[[Page 1630]]

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 be required to fill out an IHS-810 form, 
Authorization for Use or Disclosure of Protected Health Information, 
for this purpose. Requesters may be required to fill out the following 
forms for the purposes stated:
    a. IHS-912-1 form, Request for Restriction(s). (The requester may 
restrict the use of their PHI with some exceptions);
    b. IHS-912-2 form, Request for Revocation of Restriction(s). (The 
requester or the IHS may revoke a previous restriction(s));
    c. IHS-913 form, Request for An Accounting of Disclosures. (The 
requester and/or personal representative may request an accounting 
where IHS has disclosed during the calendar year without their 
consent); or,
    d. IHS-963 form, Request for Confidential Communication By 
Alternative Means or Alternate Location. (The requester and/or personal 
representative may request their PHI be communicated by an alternative 
means such as regular mail, telephone, or facsimile; or communicated to 
an alternate location).
    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. The requestor shall use the IHS-
917 form, Request for Correction/Amendment of Protected Health 
Information, for this purpose.
    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 
<greek-i>2, Niobrara, Nebraska 68760.
Director, Alaska Area Native Indian Health Service, 4141 Ambassador 
Drive, Suite 300, Anchorage, Alaska 99508-5928.
Director, Albuquerque Area 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 87106.
    Director, Albuquerque Indian Dental Clinic, P.O. Box 67830, 
Albuquerque, New Mexico 87193.
    Director, Santa Fe Service Unit, Santa Fe Indian Hospital, 1700 
Cerrillos Road, Santa Fe, New Mexico 87505.
    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.

[[Page 1631]]

    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, Ute Mountain 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, P.O. Box 467, 
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, 
NW., 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 59107.
    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 Dear 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, Hwy 191 & Hospital Road, 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, c/o Tsaile Health Center, 
P.O. Box 647, Tsaile, Arizona 86557.
    Director, Pinon Health Center, Navajo Route 4, P.O. Box 10, 
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, 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, Four Corners Regional Health Center, U.S. Hwy 160, 
Navajo Route 35-Red Mesa, HRC 6100, Box 30, Teec Nos Pos, Arizona 
86514.
    Director, Sanostee Health Station, c/o Northern Navajo Medical 
Center, P.O. Box 160, Shiprock, New Mexico 87420.
    Director, Toadlena Health Station, c/o Northern Navajo Medical 
Center, P.O. Box 160, Shiprock, New Mexico 87420.
    Director, Teen Life Center, c/o Northern Navajo Medical Center, 
P.O. Box 160, Shiprock, New Mexico 87420.
Director, Oklahoma City Area Indian Health Service, Five Corporation 
Plaza, 3625 NW 56th Street, Oklahoma City, Oklahoma 73112.
    Director, Claremore Service Unit, Claremore Comprehensive Indian 
Health Facility, West Will Rogers Boulevard and Moore, Claremore, 
Oklahoma 74017.
    Director, Clinton Service Unit, Clinton Indian Hospital, Route 
1, 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 S. Bliss, Tahlequah, Oklahoma 74464.
    Director, Wewoka Indian Health Center, P.O. Box 1475, Wewoka, 
Oklahoma 74884.
Director, Phoenix Area Indian Health Service, Two Renaissance 
Square, 40 North Central Avenue, Phoenix, Arizona 85004.
    Director, Colorado River Service Unit, Chemehuevi Indian Health 
Clinic, P.O. Box 1858, Havasu Landing, California 92363.
    Director, Colorado River Service Unit, Havasupai Indian Health 
Station, P.O. Box 129, Supai, Arizona 86435.
    Director, Colorado River Service Unit, Parker Indian Health 
Center, 12033 Agency Road, Parker, Arizona 85344.
    Director, Colorado River Service Unit, Peach Springs Indian 
Health Center, P.O. Box 190, Peach Springs, Arizona 86434.
    Director, Colorado River Service Unit, Sherman Indian High 
School, 9010 Magnolia Avenue, Riverside, California 92503.
    Director, Elko Service Unit, Newe Medical Clinic, 400 ``A'' Newe 
View, Ely, Nevada 89301.
    Director, Elko Service Unit, Southern Bands Health Center, 515 
Shoshone Circle, Elko, Nevada 89801.
    Director, Fort Yuma Service Unit, Fort Yuma Indian Hospital, 
P.O. Box 1368, Fort Yuma, Arizona 85366.
    Director, Keams Canyon Service Unit, Hopi Health Care Center, 
P.O. Box 4000, Polacca, Arizona 86042.
    Director, Schurz Service Unit, Schurz Service Unit 
Administration, Drawer A, Schurz, Nevada 89427.
    Director, 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 1632]]

    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, P.O. Box 458, 
Sacaton, Arizona 85247.
    Director, Nevada Skies Youth Wellness Center, 104 Big Bend Ranch 
Road, P.O. Box 280, Wadsworth, Nevada 89442.
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, Warm Springs Service Unit, Warm Springs Indian Health 
Center, P.O. Box 1209, Warm Springs, Oregon 97761.
    Director, Wellpinit Service Unit, David C. Wynecoop Memorial 
Clinic, P.O. Box 357, Wellpinit, Washington 99040.
    Director, Western Oregon Service Unit, Chemawa Indian Health 
Center, 3750 Chemawa Road, NE, Salem, Oregon 97305-1198.
    Director, Yakama Service Unit, Yakama Indian Health Center, 401 
Buster Road, Toppenish, Washington 98948.
Director, Tucson Area Indian Health Service, 7900 South ``J'' Stock 
Road, Tucson, Arizona 85746-9352.
    Chief Medical Officer, Pascua Yaqui Service Unit, Division of 
Public Health, 7900 South ``J'' Stock Road, Tucson, Arizona 85746.
    Facility 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, San Simon Health Center, HC01 Box 
8150, 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. 2010-285 Filed 1-11-10; 8:45 am]
BILLING CODE 4165-16-P


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