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Privacy Act: [ 09-17-0003] Indian Health Service Medical Staff Credentials and Privileges Records, HHS/IHS/OHP....


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[2001 Privacy Act]
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                           Indian Health Service

   #..Table of Contents

       09-17-0001  Health and Medical Records Systems, HHS/IHS/OHP.
       09-17-0002  Indian Health Service Scholarship and Loan Repayment 
   Programs, HHS/IHS/OHP.
       09-17-0003  Indian Health Service Staff Credentials and 
   Privileges Records, HHS/IHS/OHP.

   #..09-17-0001

   #....System name: Health and Medical Records Systems, HHS/IHS/OHP.

     Security classification:
       None.
     System location:
       Indian Health Service (IHS) hospitals, health centers, school 
   health centers, health stations, field clinics, Service Units, IHS 
   Area Offices (Appendix 1), and Regional Federal Records Centers 
   (Appendix 2). Automated records, including Patient Care Component 
   (PCC) records, are stored at the Data Processing Service Center, IHS, 
   located in Albuquerque, New Mexico (Appendix 1). Records may also be 
   located at hospitals and offices of health care providers who are 
   under contract to IHS, including Tribal contractors. A current list 
   of contractor site, including Tribal contractors, is available by 
   writing to the appropriate System Manager (Area or Service Unit 
   Director) at the address shown in Appendix 1.
     Categories of individuals covered by the system:
       Individuals, including both IHS beneficiaries and 
   nonbeneficiaries, who are examined/treated on an inpatient and/or 
   outpatient basis by IHS staff and/or contract (including tribal 
   contract) health care providers.
     Categories of records in the system:
       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, tribe; case 
   records for special programs such as: Dental, social service, mental 
   health, nursing; and laboratory test results. 2. Follow-up registers 
   of individuals with specific health conditions or a particular health 
   status such as: Tumors, communicable diseases, hospital commitment, 
   suspected and confirmed physical child abuse and neglect, 
   immunizations, self-destructive behavior, or handicap. 3. Logs of 
   individuals provided health care by staffs of specific hospital 
   components such as: Surgery, emergency, obstetric delivery, x-ray and 
   laboratory. 4. Operation and/or disease indices for particular 
   hospitals which list each relevant patient by the operation or 
   disease. 5. Monitoring strips and tapes such as fetal monitoring 
   strips and EEG and EKG tapes. 6. Third-party reimbursement records 
   containing name, address, date of birth, date of admission and 
   Medicare or Medicaid claim numbers, SSN, health plan name, insurance 
   number, employment status, and other relevant claim information 
   necessary to process and validate third-party reimbursement claims.
     Authority for maintenance of the system:
       Section 321 of the Public Health Service Act, as amended, (42 
   U.S.C. 248), ``Hospitals, Medical Examinations and Medical Care.'' 
   Section 327A of the Public Health Service Act, as amended, (42 U.S.C. 
   254a-1), ``Hospital-Affiliated Primary Care Centers.'' Indian Self 
   Determination and Education Assistance Act (25 U.S.C. 450). Snyder 
   Act (25 U.S.C. 13). Indian Health Care Improvement Act (25 U.S.C. 
   1601 et. seq). Construction of Community Hospitals Act (25 U.S.C. 
   2005-2005f). Indian Health Service Transfer Act (42 U.S.C. 2001-
   2004).
   Purpose(s):
       The purposes of this system are:
       1. To provide a description of a patient's illness, the treatment 
   administered and results achieved, and to plan for future care of the 
   patient.
       2. To provide IHS program officials with statistical data upon 
   which the health care program is evaluated and modified to meet 
   future needs.
       3. To serve as a means of communication among members of the 
   health care team who contribute to the patient's care by integrating 
   information from field visits with that from IHS facilities which 
   have provided treatment.
       4. To serve as the official documentation of health care 
   rendered.
       5. To contribute to continuing education of IHS staff to improve 
   their competency to deliver health care services.
       6. For disease surveillance purposes. For example:
       (a) The Centers for Disease Control may use these records for 
   their monitoring of various communicable diseases among persons 
   residing within the United States; and,
       (b) The National Institutes of Health may use these records for 
   their review of the prevalence of particular diseases (i.e., 
   malignant neoplasms, diabetes mellitus, arthritis, metabolism and 
   digestive diseases) for various ethnic groups of the Nation.
       7. To compile and provide aggregated program statistics. Upon 
   request of other components of the Department, IHS will provide 
   statistical information, from which individual identifiers have been 
   removed, such as:
       (a) To the National Center for Health Statistics, for its 
   dissemination of aggregated health statistics for various ethnic 
   groups;
       (b) To the Assistant Secretary for Population Affairs to keep a 
   record of the number of sterilizations provided through the use of 
   Federal funds;
       (c) To the Health Care Financing Administration for the 
   documentation of IHS health care covered by the Medicare and Medicaid 
   programs for third-party reimbursement; and
       (d) To the Bureau of Support Services, Health Care Financing 
   Administration, to determine the prevalence of end-stage renal 
   disease among the American Indian and Alaska Native population and to 
   coordinate the care of American Indian and Alaska Native patients 
   with this condition.
       8. To process and collect third-party claims.
       9. To improve the IHS national patient care database through 
   obtaining and verifying patients' SSNs with the Social Security 
   Administration.
     Routine uses of records maintained in the system, including 
   categories of users and the purposes of such uses:
       Note: Special requirements for alcohol and drug abuse patients: 
   If an individual receives treatment, or 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 which may be made without patient consent are: 
   (1) To meet medical emergencies (42 CFR Part D, sec. 2.51), (2) for 
   research, audit, evaluation and examination (42 CFR Part D, secs. 
   2.52 and 2.53), (3) pursuant to a court order (42 CFR 2.61-2.67), and 
   (4) pursuant to a qualified service organization agreement, as 
   defined in 42 CFR 2.11. In all other situations, written consent of 
   the patient is usually required prior to disclosure of alcohol or 
   drug abuse information under the routine uses listed below. 
   Individuals acting in loco parentis to minors, as well as parents, 
   legal guardians, and custodians may act on behalf of the subject 
   individual for purposes of giving consent for disclosures to others 
   when it is determined that the subject individual is a minor who is 
   unable to or cannot exercise with appropriate understanding, the 
   right of consent by himself or herself.

       1. Records may be disclosed to State, local or other authorized 
   organizations which provide health services to American Indians and 
   Alaska Natives, or provide third-party reimbursement or fiscal 
   intermediary functions, for the purpose of planning for or providing 
   such services, billing or collecting third-party reimbursements and 
   reporting results of medical examination and treatment.
       2. Records may be disclosed to Federal and non-Federal school 
   systems which serve American Indians and Alaska Natives for the 
   purpose of student health maintenance.
       3. Records may be disclosed to organizations deemed qualified by 
   the Secretary to carry out quality assessment, medical audits, 
   utilization review or to provide accreditation or certification of 
   health care facilities or programs.
       4. Records may be disclosed to authorized organizations, such as 
   the United States Office of Technology Assessment, or individuals for 
   conduct of analytical and evaluation studies sponsored by the IHS.
       5. Records may be disclosed to a congressional office in response 
   to an inquiry from that office made at the request of the subject 
   individual.
       6. A record may be disclosed for a research purpose, when the 
   Department:
       (a) Has determined that the use or disclosure does not violate 
   legal or policy limitations under which the record was provided, 
   collected, or obtained;
       (b) Has determined that the research purpose (1) cannot be 
   reasonably accomplished unless the record is provided in individually 
   identifiable form, and (2) warrants the risk to the privacy of the 
   individual that additional exposure of the record might bring;
       (c) Has required the recipient to--(1) establish reasonable 
   administrative, technical, and physical safeguards to prevent 
   unauthorized use or disclosure of the record, and (2) remove or 
   destroy the information that identifies the individual at the 
   earliest time at which removal or destruction can be accomplished 
   consistent with the purpose of the research project, unless the 
   recipient has presented adequate justification of a research or 
   health nature for retaining such information, and (3) make no further 
   use or disclosure of the record except--(A) in emergency 
   circumstances affecting the health or safety of any individual, (B) 
   for use in another research project, under these same conditions, and 
   with written authorization of the Department, (C) for disclosure to a 
   properly identified person for the purpose of an audit related to the 
   research project, if information that would enable research subjects 
   to be identified is removed or destroyed at the earliest opportunity 
   consistent with the purpose of the audit, or (D) when required by 
   law;
       (d) Has secured a written statement attesting to the recipient's 
   understanding of, and willingness to abide by these provisions.
       7. The IHS health care providers may disclose information from 
   these records regarding the commission of crimes or the occurrence of 
   communicable diseases, tumors, suspected child abuse, births, deaths, 
   alcohol or drug abuse, etc., as required by Federal law or regulation 
   or State or local law or regulation of the jurisdiction in which the 
   facility is located. Disclosure may be made to organizations as 
   specified by the law or regulation, such as births and deaths to 
   State or local health departments, and crimes to law enforcement 
   agencies. In federally conducted or assisted alcohol or drug abuse 
   programs, the disclosure of the contents of records which pertain to 
   patient identity, diagnosis, prognosis or treatment of alcohol or 
   drug abuse is restricted under 42 CFR part 2; e.g., disclosure of 
   patient information on alcohol and drug abuse for purposes of 
   criminal investigation generally 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.
       8. The IHS health care providers may disclose information from 
   these records regarding suspected cases of child abuse to: (1) 
   Agencies of any Indian tribe, any State or the Federal Government 
   that need to know the information in the performance of their duties, 
   and (2) members of community child protection teams of the purpose of 
   establishing a diagnosis, formulating a treatment plan, monitoring 
   the plan, investigation reports of suspected child abuse, 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(s) (local, State and/or tribal, law enforcement agencies and 
   IHS). In federally conducted or assisted alcohol or drug abuse 
   programs, the disclosure to the contents of records which pertain to 
   patient identity, diagnosis, prognosis, or treatment of alcohol or 
   drug abuse is restricted under 42 CFR part 2; e.g., disclosure of 
   patient information on alcohol or drug abuse for purposes of criminal 
   investigation generally must be authorized by court order issued 
   under 42 CFR 2.65 except that reports of suspected child abuse by be 
   made to the appropriate State or local authorities under State law.
       9. The Department may disclose information from this system of 
   records to the Department of Justice, to a court or other tribunal, 
   or to another party before such tribunal, when:
       (a) HHS, or any component thereof; or
       (b) Any HHS employee in his or her official capacity; or
       (c) Any HHS employee in his or her individual capacity where the 
   Department of Justice (or HHS, where it is authorized to do so) has 
   agreed to represent the employee; or
       (d) The United States or any agency thereof where HHS determines 
   that the litigation is likely to affect HHS or any of its components, 
   is a party to litigation or has an interest in such litigation, and 
   HHS determines that the use of such records by the Department of 
   Justice, the tribunal, or the other party is relevant and necessary 
   to the litigation and would help in the effective representation of 
   the governmental party, provided, however, that in each case, HHS 
   determines that such disclosure is compatible with the purpose for 
   which the records were collected.
       10. Records may be disclosed to the Bureau of Indian Affairs and 
   its contractors for the identification of American Indian and Alaska 
   Native handicapped children to permit that Bureau to carry out the 
   Education for All Handicapped Children Act of 1975 (20 U.S.C. 1401 et 
   seq.).
       11. Records may be disclosed to an IHS contractor, including 
   tribal contractors, for the purpose of computerized data entry or 
   maintenance of records contained in this system. The contractor shall 
   be required to maintain Privacy Act safeguards with respect to the 
   receipt and processing of such records.
       12. Records may be disclosed to a health care provider 
   undercontract to IHS (including tribal contractors) to permit the 
   contractor to obtain health and medical information about the subject 
   individual in order to provide appropriate health services to that 
   individual. The contractor shall be required to maintain Privacy Act 
   safeguards with respect to the receipt and processing of such 
   records.
       13. Records may be disclosed to the State of Alaska, Department 
   of Health and Social Services (DHSS) (which supplies part or all of 
   this information to IHS), in response to its request for patient 
   summaries, portions of immunization registers, disease indices and 
   other computer-generated medical summaries. This information assists 
   DHSS in its provision of health care to the subject individual. 
   Disclosure to the State of Alaska's DHSS is limited to information 
   concerning its patients.
       14. Disclosures regarding specific medical services may be made 
   from the records of a minor patient to the minor's parent or legal 
   guardian who previously consented to those specific medical services.
       15. (a) PHS may inform the sexual and/or needle-sharing 
   partner(s) of a subject individual who is infected with the human 
   immunodeficiency virus (HIV) of their exposure to HIV, under the 
   following circumstances:
       (1) The information has been obtained in the course of clinical 
   activities at PHS facilities carried out by PHS personnel or 
   contractors;
       (2) The PHS employee or contractor has made reasonable efforts to 
   counsel and encourage the subject individual to provide the 
   information to the individual's sexual or needle-sharing partner(s);
       (3) The PHS employee or contractor determines that the subject 
   individual is unlikely to provide the information to the sexual or 
   needle-sharing partner(s) or that the provision of such information 
   cannot reasonably be verified; and
       (4) 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.
       (b) PHS may disclose information to State or local public health 
   departments, to assist in the notification of the subject 
   individual's sexual and/or needle-sharing partner(s), or in the 
   verification that the subject individual has, notified such sexual or 
   needle-sharing partner(s).
       Records may be disclosed to student volunteers, individuals 
   working under a personal services contract, and other individuals 
   performing functions for PHS who do not technically have the status 
   of agency employees, if they need the records in the performance of 
   their agency functions.
     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 and automated files.
     Retrievability:

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