Source: https://www.federalregister.gov/documents/2005/08/25/05-16890/privacy-act-of-1974-report-of-modified-or-altered-system
Timestamp: 2017-09-26 02:41:44
Document Index: 248878416

Matched Legal Cases: ['art 2', 'art 2', 'art 2', 'art 2', 'art 2', '§\u200910801', '§\u200951', '§\u20091386', '§\u2009164', 'art 5']

70 FR 49931
05-16890
Parents, Legal Guardians and Personal Representatives:
Same as Notification Procedures:
https://www.federalregister.gov/d/05-16890 https://www.federalregister.gov/d/05-16890
In accordance with the requirements of the Privacy Act of 1974, we are proposing to modify or alter an SOR, “Health, Medical and Billing Records (formerly known as the Health and Medical Records Systems),” System No. 09-17-0001. We propose to include contract health service records, as an additional category of individuals covered by the system, which consists of medical records to eligible American Indians and Alaska Native (AI/AN) people that supplements the health care resources available with the purchase of medical care and services that are not available within the IHS direct care system which may include, but not limited to, basic and specialty health care services from local and community health care providers, including hospital care, physician services, outpatient care, laboratory, dental, radiology, pharmacy, and transportation services. Under the Purpose of the system, we propose to include several new purposes that are in line with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provisions which were incorporated into the published IHS Notice of Privacy Practices (NPP) and to include debt collection activities. We are proposing to modify/alter/delete several published routine uses, as explained, to accommodate for program and statutory changes as indicated: Number 1 is modified/altered by separating the medical treatment, payment and health care operations into two separate routine uses 1 and 2 to include payment, billing, third-party reimbursement and debt collection activities; numbers 3, 4 and 11 are to include business associate agreement language to comply with HIPAA Privacy standards and renumbered as 5, 6 and 12 respectively; number 5 is to include a special requirement notice for sensitive protected health information (PHI) such as alcohol/drug abuse, HIV/AIDS, STD or mental health patient information and renumbered as 7; number 6 is to reflect changes in research disclosures to comply with HIPAA Privacy standards and renumbered as 8; number 7 is to include various cases of abuses, neglect, sexual assault and domestic violence and emphasis on meeting the requirements of 42 CFR part 2 and renumbered as 9; number 8 is to clarify the disclosures regarding suspected cases of child abuse and renumbered as 10; number 9 is modified to include legal proceedings related to administrative claims and the inclusive provision of the Department of Health and Human Services (DHHS)/Office of General Counsel (OGC) Start Printed Page 49932representation in litigation matters and renumbered as 11; number 10 is modified to include business associate agreement language to comply with HIPAA Privacy standards and is renumbered as 5; numbers 12 and 16 are modified and incorporated into one proposed routine use 13 with minor edits; number 14 is modified to reflect the permitted use/disclosure requirements of 45 CFR 164.502(g) and remains as 14; number 15 is modified with some minor edits to reflect current changes to enable efficient administration of health care operations and planning and delivery of patient medical care and renumbered as 18; and number 16 is being deleted and incorporated into the proposed routine use 13.
We propose to add 10 new routine uses to provide disclosures of records when all requirements are met: number 2, to provide disclosure for third-part reimbursement, fiscal intermediary functions and debt collection activities; number 3, to provide disclosures to state Medicaid agencies or other entities acting pursuant to a contract with Centers for Medicare & Medicaid Services (CMS) for fraud and abuse control efforts to the extent required by law or under an agreement between IHS and respective state Medicaid agency or other entities; number 16, to an individual having authority to act on behalf of an incompetent individual concerning health care decisions to the extent permitted under 45 CFR 164.502(g); number 17, information may be used or disclosed from an IHS facility directory unless the individual objects to the disclosure and may provide the religious affiliation only to members of the clergy; number 18, information may be disclosed to a relative, a close personal friend, or any other person identified by the individual that is directly relevant to that person's involvement with their care or payment for health care and may be used or disclosed to notify family member, personal representative, or other person responsible for the individual's care, of their location, general condition or death; number 20, to provide records to Federal and non-Federal protection and advocacy organizations for investigating incidents of abuse and neglect of individuals with development disabilities as defined in 42 U.S.C. 10801-10805(a)(4) and 42 CFR 51.41-46 to the extent authorized by law and the conditions of 45 CFR 1386.22(a)(2) are met; number 21, disclosure to a correctional institution or a law enforcement official, during the period of time the individual is either an inmate or is otherwise in lawful custody, for the provision of health care to the individual or for health and safety purposes; number 22, disclosure to the Social Security Administration (SSA) for validation of Social Security Number(s) (SSNs) purposes only; number 23, disclosure of relevant health care information may be made to funeral director or representatives of funeral homes to allow for necessary arrangements; number 24, disclosure to a public or private covered entity that is authorized by law or charter to assist in disaster relief efforts. Routine use previously numbered 13 is deleted as being no longer applicable to the system. Routine uses previously numbered 2, 3, 4, 5, 6, 7, 8, 9, 11, 12, and 15 have been renumbered as 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, and 19 respectively.
The security classification previously reported as “None” will remain. We have modified the language in the routine uses to provide clarification to IHS' intention to disclose individual-specific information contained in this system. The routine uses will then be prioritized and reordered according to their usage. We will also take the opportunity to update any sections of the system notice to provide clarity on the changing environment to include for digital records and the initiative of transitioning from a paper-based record to a computerized-based or electronic medical record.
Effective Dates: The Report of Intent to Amend a System of Records Notice and an advance copy of the system notice have been sent to the Chair of the House Committee on Government Reform and Oversight, the Chair of the Senate Committee on Governmental Affairs, and the Administrator, Office of Information and Regulatory Affairs, Office of Management and Budget (OMB). To ensure that all parties have adequate time in which to comment, the modified system of records, including routine uses, will become effective 40 days from the publication of the notice, or from the date it was submitted to OMB and the Congress, whichever is later, unless IHS receives comments that require alterations to this notice.
The public should address comments to: Mr. William Tibbitts, IHS Privacy Act Officer, Division of Regulatory, Records Access and Policy Liaison, 801 Thompson Avenue, TMP 450, Rockville, MD 20852-1627; call non-toll free (301) 443-1116; send via facsimile to (301) 443-2316, or send your e-mail requests, comments, and return address to: wtibbitt@hqe.ihs.gov.
Ms. Patricia Gowan, IHS Lead Health Information Management (HIM) Consultant, Office of Clinical and Preventative Services, Reyes Building, 801 Thompson Avenue, Suite 314, Rockville, MD 20852-1627, Telephone (301) 443-2522.
A. Major Alteration of 09-17-0001, “Indian Health Service Health and Medical Records Systems, HHS/IHS/OHP”: IHS provides care and treatment to patients at IHS health care facilities and under contract. Whenever possible, IHS seeks reimbursement through third-party payers such as Medicare, Medicaid, and private insurers. IHS is proposing to alter the existing system of records as follows:
1. IHS is changing the title of the system from “Health and Medical Records System, HHS/IHS/OHP,” to “Medical, Health, and Billing Records System, HHS/IHS/OCPS,” to clarify that IHS also uses the records in the system to process, document, and monitor third-party payment billing and reimbursement claims, in addition to debt collection activities.
2. IHS is proposing to include contract health service records as an additional category of individuals covered by the system.
3. IHS is proposing to include several new purposes that are in line with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provisions. These seven (7) new purposes are as follow: (1) To provide information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs to facilitate organ, eye, or tissue donation and transplant. (2) To provide information to individuals about treatment alternatives or other types of health-related benefits and services. (3) To provide information to the Food and Drug Administration (FDA) in connection with an FDA-regulated product or activity. (4) To provide information to correctional institutions as necessary for health and safety purposes. (5) To provide information to governmental authorities (e.g., social service or protective services agencies) on victims of abuse, neglect, sexual assault or domestic violence. (6) To provide information to the National Archives and Records Administration in records management inspections conducted under the authority of 44 U.S.C. 2901 et seq. (7) To provide relevant health care information to funeral directors or representatives of funeral homes to allow necessary arrangements prior to and in Start Printed Page 49933anticipation of an individual's impending death.
4. IHS is proposing to modify/alter/delete several published routine uses and to include ten (10) new routine uses when all requirements have been met. IHS is modifying/altering routine use #1 by separating the medical treatment, payment, and health care operations to routine uses #1 and #2 respectively; routine uses #2 is renumbered as #4; routine uses #3 and #4 are modified to include business associate agreement language to comply with HIPAA Privacy standards and renumbered as #6 and #7 respectively; routine use #5 is altered to include a special requirement notice for sensitive protected health information (PHI) as such alcohol/drug abuse, HIV/AIDS, STD or mental health patient information and renumbered as #8; routine use #6 is modified/altered to reflect changes in research disclosures to comply with HIPAA Privacy standards and renumbered as #9; routine use #7 is modified/altered to include various cases of abuses, neglect, sexual assault and domestic violence with an emphasis on 42 CFR part 2 and renumbered as #10; routine use #8 is modified to clarify the disclosure under (a) and (b) with no statutory language change on child abuse and the deletion of statutory citation of 42 CFR Part 2 and renumbered as #11; routine use #9 is modified to include legal proceedings related to administrative claims and the inclusive provision of the DHHS/Office of General Counsel (OGC) representation in litigation matters and renumbered as #12; routine use #10 was modified/altered to reflect statutory requirement and renumbered as #5; routine use #11 is modified to include business associate agreement language to comply with the HIPAA Privacy standards and altered to eliminate the safeguard requirements of the Privacy Act and was renumbered as #13; routine uses #12 and #16 were modified and incorporated into one proposed routine use disclosure with minor edits and to efficiently administer health care operations and to assist in the planning and delivery of patient's medical care and renumbered as #14; routine use #13 was deleted as no longer applicable to the purpose and function of IHS; routine use #14 is modified to reflect the permitted use/disclosure requirement of 45 CFR 164.502(g) citation and renumbered as #15; routine use #15 is modified with some minor edits to reflect current changes and remains as #15; and routine use #16 is being deleted and incorporated into the new routine use #13.
IHS is proposing to add ten (10) new routine uses as follows: routine use #2 is to provide disclosure for third-party reimbursement, fiscal intermediary functions, and debt collection activities; routine use #3 is to provide state agencies or other entities acting pursuant to a contract with CMS for fraud and abuse control efforts to the extent required by law or under an agreement between IHS and respective state Medicaid agency or other entities; routine use #16 is to provide an individual having authority to act on behalf of an incompetent individual concerning health care decisions to the extent permitted under 45 CFR 164.502(g); routine use #17 is that certain protected health information may be used or disclosed from an IHS facility directory unless the individual objects to the disclosure and IHS may provide the religious affiliation only to members of the clergy to the extent permitted under 45 CFR 164.510; routine use #18 is that relevant protected health information may be disclosed to a relative, a close personal friend, or any other person identified by the individual with their care or payment for health care. Information may be used or disclosed to notify family members, personal representative, or other person responsible for the individual's care, of their location, general condition or death; routine use #20 to Federal and non-Federal protection and advocacy organization for purpose of investigating incidents of abuse and neglect of individuals with development disabilities as defined in 42 U.S.C. 10801-10805(a)(4) and 42 CFR 51.41-46 to the extent authorized by law and the conditions of 45 CFR 1386.22(a)(2) are met; routine use #21 is for disclosure to a correctional institution or a law enforcement official, during the period of time the individual is either an inmate or is otherwise in lawful custody, for the provision of health care to the individual or for health and safety purposes; routine use #22 is for disclosure to the Social Security Administration for validation of SSN(s) purposes only; routine use #23 is that disclosure of relevant health care information may be made to funeral director or representatives of funeral homes to allow for necessary arrangements; and routine use #24 is for disclosure to a public or private covered entity that is authorized by law or charter to assist in disaster relief efforts.
In addition to updating and making editorial corrections to improve the clarity of the system notice, this alteration requires the updating of the system manager listing, and revisions of the Categories of Records, Purposes, Authority, Safeguard, Retention and Disposal, Notification and Access Procedures sections.
Medical, Health, and Billing Records Systems, HHS/IHS/OCPS.
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.
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.
2. Follow-up registers of individuals with a specific health condition or a particular health status such as cancer, diabetes, communicable diseases, Start Printed Page 49934suspected and confirmed abuse and neglect, immunizations, suicidal behavior, or disabilities.
(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
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;
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.
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.
1. Records may be disclosed to Federal and non-Federal (public or Start Printed Page 49935private) 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.
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:
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.
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:
(b) Members of community child protection teams for the purposes of investigating reports of suspected child abuse, establishing a diagnosis, formulating or monitoring a treatment plan, and making recommendations to the appropriate court. Community child protection teams are comprised of representatives of Tribes, the Bureau of Indian Affairs, child protection service agencies, the judicial system, law enforcement agencies and IHS.
12. IHS may disclose information from these records in litigations and/or proceedings related to an administrative claim when:
(a) IHS has determined that the use of such records is relevant and necessary to the litigation and/or proceedings related to an administrative claim and would help in the effective representation of the affected party listed in subsections (i) through (iv) below, and that such disclosure is compatible with the purpose for which the records were collected. Such disclosure may be made to the DHHS/Office of General Counsel (OGC) and/or Department of Justice (DOJ), pursuant to an agreement between IHS and OGC, when any of the following is a party to litigation and/or proceedings related to an administrative claim or has an interest in the litigation and/or proceedings related to an administrative claim:
(iv) The United States or any agency thereof (other than DHHS) where DHHS/OGC has determined that the litigation and/or proceedings related to an administrative claim is likely to affect DHHS or any of its components.
13. Records may be disclosed under a business associate agreement to an IHS contractor for the purpose of computerized data entry, medical transcription, duplication services, or maintenance of records contained in this system.
14. Records may be disclosed under a personal services contract or other agreement to student volunteers, individuals working for IHS, and other individuals performing functions for IHS who do not technically have the status of agency employees, if they need the records in the performance of their agency functions.
15. Records regarding specific medical services provided to an unemancipated minor individual may be disclosed to the unemancipated minor's parent or legal guardian who previously consented to those specific medical services, to the extent permitted under 45 CFR 164.502(g).
16. Records may be disclosed to an individual having authority to act on behalf of an incompetent individual concerning health care decisions, to the extent permitted under 45 CFR 164.502(g).
17. Information may be used or disclosed from an IHS facility directory in response to an inquiry about a named individual from a member of the general public to establish the individual's presence (and location when needed for visitation purposes) or to report the individual's condition while hospitalized (e.g., satisfactory or stable), Start Printed Page 49936unless 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.
If the individual is present for, or otherwise available prior to, a use or disclosure, and is competent to make health care decisions;
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:
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.
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 Start Printed Page 49937is 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.
4. Implementing Guidelines: DHHS Chapter 45-10 and supplementary Chapter PHS.hf: 45-10 of the General Administration Manual; DHHS, “Automated Information Systems Security Program Handbook,” as amended; DHHS IRM Policy HHS-IRM-2000-0005, “IRM Policy for IT Security for Remote Access'; OMB Circular A-130 “Management of Federal Information Resources'; HIPAA Security Standards for the Protection of Electronic Protected Health Information, 45 CFR §§ 164.302 through 164.318; and E-Government Act of 2002 (Pub. L. 107-347, 44 U.S.C. Ch 36).
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.
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.
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.
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.
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.
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 Start Printed Page 49938required if there is any doubt regarding the relationship of the individual to the patient.
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.
Director, Aberdeen Area Indian Health Service, Room 309, Federal Building, 115 Fourth Avenue, SE, Aberdeen, South Dakota 57401.
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, TóHajille Health Center, P.O. Box 3528, Canoncito, New Mexico 87026.
Director, Albuquerque Service Unit, Albuquerque Indian Hospital, 801 Vassar Drive, NE, Albuquerque, New Mexico 87049.
Director, Jemez PHS Health Center, P.O. Box 279, Jemez, New Mexico 87024
Director, Bemidji Area Indian Health Service, 522 Minnesota Avenue, N.W., Bemidji, Minnesota 56601.
Director, Northern Cheyenne Service Unit, Lame Deer Indian Health Center, Lame Deer, Montana 59043.
Director, Unity Regional Youth Treatment Center, P.O. Box C-201, Cherokee, North Carolina 28719. Start Printed Page 49939
Director, Tsaile Health Center, P.O. Box 467, Navajo Routes 64 and 12, Tsaile, Arizona 86556.
Director, Oklahoma City Area Indian Health Service, Five Corporation Plaza, 3625 NW 56th Street, Oklahoma City, Oklahoma 73112.
Director, Unitah and Ouray Service Unit, Fort Duchesne Indian Health Center, P.O. Box 160, Ft. Duchesne, Utah 84026.
Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee, Federal Archives Start Printed Page 49940and Records Center, 1557 St. Joseph Avenue, East Point, Georgia 30344-2593.
Arizona, Southern California, and Clark County, Nevada, and U.S. Courts Records for the mentioned States, Federal Archives and Records Center, 24000 Avila Road, 1st Floor, East Entrance, Laguna Niguel, California 92677-3497.
[FR Doc. 05-16890 Filed 8-24-05; 8:45 am]