[Title 42 CFR C]
[Code of Federal Regulations (annual edition) - October 1, 2008 Edition]
[Title 42 - PUBLIC HEALTH]
[Chapter I - PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN]
[Subchapter C - MEDICAL CARE AND EXAMINATIONS]
[From the U.S. Government Printing Office]


42PUBLIC HEALTH12008-10-012008-10-01falseMEDICAL CARE AND EXAMINATIONSCSUBCHAPTER CPUBLIC HEALTHPUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN
               SUBCHAPTER C_MEDICAL CARE AND EXAMINATIONS



PART 31_MEDICAL CARE FOR CERTAIN PERSONNEL OF THE COAST GUARD, NATIONAL OCEAN 

SURVEY, PUBLIC HEALTH SERVICE, AND FORMER LIGHTHOUSE SERVICE--Table of 

Contents




                               Definitions

Sec.
31.1 Meaning of terms.

 Provisions Applicable to Coast Guard, National Ocean Survey and Public 
                             Health Service

31.2 Persons entitled to treatment.
31.3 Use of Service facilities.
31.4 Use of other than Service facilities.
31.5 Application for treatment; active duty personnel.
31.6 Personnel absent without leave.
31.7 Continuance of medical relief after loss of status.
31.8 Retired personnel; extent of treatment.
31.9 Dependent members of families; treatment.
31.10 Dependent members of families; use of Service facilities.

     Provisions Applicable to Personnel of Former Lighthouse Service

31.11 Persons entitled to treatment.
31.12 Use of Service facilities.
31.13 Use of other than Service facilities.
31.14 Application for treatment; active duty personnel.
31.15 Continuance of medical relief after loss of status.
31.16 Retired personnel; extent of treatment.

    Source: 21 FR 9821, Dec. 12, 1956, unless otherwise noted.

                               Definitions



Sec. 31.1  Meaning of terms.

    As used in this part, the term:
    (a) Act means the Public Health Service Act, approved July 1, 1944, 
58 Stat. 682, as amended.
    (b) Service means the Public Health Service.
    (c) Surgeon General means the Surgeon General of the Public Health 
Service.
    (d) Medical relief station means a first-, second-, third-, or 
fourth-class station of the Service.
    (e) First-class stations means a hospital operated by the Service.
    (f) Second-class station means a medical relief facility, other than 
a hospital of the Service, under the charge of a commissioned officer.
    (g) Third-class station means a medical relief facility, other than 
a hospital of the Service, under the charge of a medical officer or 
employee of the Service other than a commissioned officer.
    (h) Fourth-class station means a medical relief facility designated 
by the Surgeon General, other than a first-, second-, or third-class 
station.
    (i) Designated physician means a physician holding an appointment to 
act regularly for the Service for a class or classes of specified 
beneficiaries at a place where there is no medical relief station.
    (j) Designated dentist means a dentist holding an appointment to 
perform dental service for the Service for a class or classes of 
specified beneficiaries.
    (k) Active duty means active duty status as distinguished from being 
on inactive status or retired and includes periods of authorized leave 
or liberty.
    (l) Dependent members of families in the case of male personnel 
means the lawful wife, the unmarried children (including stepchildren or 
adopted children) under 21 years of age, and the father or mother if in 
fact dependent upon such son for his or her chief support; and in the 
case of female personnel, the unmarried children (including stepchildren 
or adopted children) under 21 years of age if their father is dead or 
they are in fact dependent on such mother for their chief support, the 
father or mother if in fact dependent upon such daughter for his or her 
chief support, and the husband if in fact dependent upon such wife for 
his chief support: Provided, however, That in the case of members of the 
Women's Reserve of the Coast Guard the husbands of such members shall 
not be considered dependents.

(Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216)

[[Page 101]]

 Provisions Applicable to Coast Guard, National Ocean Survey and Public 
                             Health Service



Sec. 31.2  Persons entitled to treatment.

    To the extent and under the circumstances prescribed in Sec. Sec. 
31.2 to 31.10, the following persons shall be entitled to medical, 
surgical, and dental treatment and hospitalization by the Service:
    (a) Coast Guard. (1) Commissioned officers, chief warrant officers, 
warrant officers, cadets, and enlisted personnel of the Regular Coast 
Guard, including those on shore duty and those on detached duty, whether 
on active duty or retired;
    (2) Regular members of the Coast Guard Reserve when on active duty 
or when retired for disability;
    (3) Temporary members of the Coast Guard Reserve when on active duty 
or in case of physical injury incurred or sickness or disease contracted 
while performing active Coast Guard duty;
    (4) Members of the Women's Reserve of the Coast Guard when on active 
duty or when retired for disability;
    (5) Members of the Coast Guard Auxiliary in case of physical injury 
incurred or sickness or disease contracted while performing active Coast 
Guard duty.
    (b) National Ocean Survey. Commissioned officers, ships' officers, 
and members of the crews of vessels of the National Ocean Survey, 
including those on shore duty and those on detached duty whether on 
active duty or retired.
    (c) Public Health Service. (1) Commissioned officers of the Regular 
Corps of the Service, whether on active duty or retired;
    (2) Commissioned officers of the Reserve Corps of the Service when 
on active duty or when retired for disability.

(Sec. 326, 58 Stat. 697, as amended 42 U.S.C. 253)



Sec. 31.3  Use of Service facilities.

    Except as otherwise provided in Sec. Sec. 31.3 to 31.10, the 
persons specified in Sec. 31.2 shall be entitled to medical, surgical, 
and dental treatment and hospitalization only at medical relief stations 
and by designated physicians and designated dentists, and the cost of 
services procured elsewhere shall not be borne by the Service.

(Sec. 326, 58 Stat. 697, as amended 42 U.S.C. 253)



Sec. 31.4  Use of other than Service facilities.

    (a) When a person specified in Sec. 31.2 who is on active duty 
requires immediate medical, surgical, or dental treatment or 
hospitalization and the urgency of the situation does not permit 
treatment at a medical relief station or by a designated physician or 
designated dentist, an officer of the same service as the patient may 
arrange for treatment or hospitalization at the expense of the Service.
    (b) When the circumstances are such that an officer of the same 
service as the patient is not available to make the necessary 
arrangements, the treatment or hospitalization may be obtained by or on 
behalf of the patient at the expense of the Service.
    (c) In every case of treatment or hospitalization as defined in 
paragraph (b) of this section, the responsible superior officer of the 
patient shall be notified as promptly as possible and a full report 
shall be submitted by such officer to the Surgeon General through 
appropriate official channels. As soon as practicable, unless the 
interests of the patient or the Government require otherwise, treatment 
or hospitalization shall be continued at a medical relief station or by 
a designated physician or designated dentist or at another appropriate 
Federal medical facility.
    (d) When the necessary medical relief cannot be obtained from a 
medical relief station or a designated physician or designated dentist, 
preference shall be given to other Federal medical facilities when 
reasonably available and when conditions permit.
    (e) Vouchers on proper forms covering expenses for treatment or 
hospitalization under the circumstances specified in paragraphs (a) and 
(b) of this section shall be forwarded to the Surgeon General through 
appropriate official channels. Each such voucher shall be accompanied by 
or contain a statement of the facts necessitating the treatment or 
hospitalization. Unreasonable charges for emergency

[[Page 102]]

treatment or hospitalization will not be allowed.
    (f) Expenses for consultants or special services, or for dental 
treatment other than emergency measures to relieve pain, shall not be 
allowed except when authorized in advance by the headquarters of the 
Service or, in extraordinary cases, when subsequently approved by such 
headquarters upon receipt of report and satisfactory explanation as to 
the necessity and urgency therefor.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.5  Application for treatment; active duty personnel.

    (a) An applicant for medical relief who is on active duty shall 
furnish a certificate identifying him. Such certificate, in the case of 
Coast Guard personnel, shall be signed by an officer of the Coast Guard, 
and in the case of National Ocean Survey personnel, shall be signed by 
an officer of the National Ocean Survey. Commissioned officers of any of 
the services mentioned in Sec. 31.2 and officers in charge of units may 
sign their own certificates. In an emergency, the officer in charge of a 
medical relief station, or a designated physician or designated dentist, 
may accept other evidence of status satisfactory to him.
    (b) A temporary member of the Coast Guard Reserve except when on 
active duty or a member of the Coast Guard Auxiliary shall, when 
applying for medical relief, furnish a statement signed by a responsible 
superior officer setting forth the facts and circumstances giving rise 
to the need for medical relief. In emergencies, such statement shall be 
furnished promptly after the member has received the immediately 
required care and treatment. Such statement shall be presumptive 
evidence of the facts stated, but if investigation indicates that the 
injury, sickness, or disease was not incurred or contracted in the 
manner stated, further treatment may be denied.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.6  Personnel absent without leave.

    No member of any of the services enumerated in Sec. 31.2 shall be 
entitled when absent without leave to medical relief except at a medical 
relief station or by a designated physician or designated dentist.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.7  Continuance of medical relief after loss of status.

    If a member is separated from any of the services enumerated in 
Sec. 31.2, except persons specified in Sec. 31.2(a) (3) and (5) who 
shall be entitled to treatment after separation under the conditions set 
forth in such paragraphs, while undergoing treatment by the Service, his 
treatment shall be discontinued immediately unless the physician in 
charge determines that the condition of the patient does not permit 
interruption of treatment, in which case the treatment shall be 
discontinued as soon as practicable and the condition of the patient 
permits. At that time he shall be discharged from treatment and shall 
not thereafter be afforded medical relief by the Service by reason of 
his previous service.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.8  Retired personnel; extent of treatment.

    (a) A retired member of the Coast Guard, National Ocean Survey, or 
Public Health Service specified in Sec. 31.2 shall be entitled to 
medical, surgical, and dental treatment and hospitalization at medical 
relief stations of the first-, second-, and third-class, upon 
presentation of satisfactory evidence of his status.
    (b) Elective medical or surgical treatment requiring hospitalization 
shall be furnished only at hospitals operated by the Service.
    (c) Dental treatment shall be furnished to the extent of available 
facilities only at medical relief stations where full-time dental 
officers are on duty; at other medical relief stations the dental 
treatment shall be limited

[[Page 103]]

to emergency measures necessary to relieve pain.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.9  Dependent members of families; treatment.

    To the extent and under the circumstances prescribed in this part, 
the Service shall provide medical advice and outpatient treatment at 
first-, second-, and third-class medical relief stations and 
hospitalization at first-class stations to the dependent members of 
families of the following persons:
    (a) Coast Guard. Commissioned officers, chief warrant officers, 
warrant officers, cadets, and enlisted personnel of the Regular Coast 
Guard, including those on shore duty and those on detached duty, whether 
on active duty or retired; and regular members of the United States 
Coast Guard Reserve and members of the Women's Reserve of the Coast 
Guard, when on active duty or when retired for disability.
    (b) National Ocean Survey. Commissioned officers, ships' officers, 
and members of the crews of vessels of the United States National Ocean 
Survey, including those on shore duty and those on detached duty, 
whether on active duty or retired.
    (c) Public Health Service. Commissioned officers of the Regular 
Corps of the Service, whether on active duty or retired, and 
commissioned officers of the Reserve Corps of the Service when on active 
duty or when retired for disability.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.10  Dependent members of families; use of Service facilities.

    (a) A dependent member of the family of any person specified in 
Sec. 31.9 shall, upon presentation of satisfactory evidence of such 
status, be entitled to medical advice and out-patient treatment at 
first-, second-, and third-class medical relief stations and 
hospitalization at first-class stations if suitable accommodations are 
available therein and if the condition of the dependent is such as to 
require hospitalization, both as determined by the medical officer in 
charge.
    (b) Hospitalization at first-class stations shall be at a per diem 
cost to the officer, enlisted person, member of a crew or other person 
concerned. Such cost shall be at such uniform rate as may be prescribed 
from time to time by the President for the hospitalization of dependents 
of naval and Marine Corps personnel at any naval hospital.
    (c) Hospitalization at first-class stations and out-patient 
treatment at first-, second-, and third-class stations may include such 
services and supplies as, in the judgment of the medical officer in 
charge, are necessary for reasonable and adequate treatment.
    (d) Dental treatment shall be furnished to the extent of available 
facilities only at medical relief stations where full-time officers are 
on duty.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)

     Provisions Applicable to Personnel of Former Lighthouse Service



Sec. 31.11  Persons entitled to treatment.

    To the extent and under the circumstances prescribed in this part, 
the following persons shall be entitled to medical, surgical, and dental 
treatment and hospitalization by the Service: Lightkeepers, assistant 
lightkeepers, and officers and crews of vessels of the former Lighthouse 
Service, including any such persons who subsequent to June 30, 1939, 
have involuntarily been assigned to other civilian duty in the Coast 
Guard, who were entitled to medical relief at hospitals and other 
stations of the Service prior to July 1, 1944, and who are now or 
hereafter on active duty or who have been or may hereafter be retired 
under the provisions of section 6 of the act of June 20, 1918, as 
amended (33 U.S.C. 763).

(Sec. 610(b), 58 Stat. 714, as amended; 33 U.S.C. 763c)



Sec. 31.12  Use of Service facilities.

    Except as otherwise provided herein, the persons specified in Sec. 
31.11 shall be entitled to medical, surgical, and dental treatment and 
hospitalization only at medical relief stations and by designated 
physicians and designated dentists, and the cost of services procured

[[Page 104]]

elsewhere shall not be borne by the Service.

(Sec. 610(b), 58 Stat. 714, as amended; 33 U.S.C. 763c)



Sec. 31.13  Use of other than Service facilities.

    (a) When a person specified in Sec. 31.11 who is on active duty 
requires immediate medical, surgical, or dental treatment or 
hospitalization and the urgency of the situation does not permit 
treatment at a medical relief station or by a designated physician or 
designated dentist, an officer or other appropriate supervisory official 
of the Coast Guard may arrange for treatment or hospitalization.
    (b) In every such case of treatment or hospitalization, a full 
report thereof shall be submitted to the Surgeon General through Coast 
Guard headquarters. As soon as practicable, unless the interests of the 
patient or the Government require otherwise, treatment or 
hospitalization shall be continued at a medical relief station or by a 
designated physician or designated dentist or at another appropriate 
Federal medical facility.
    (c) When the necessary medical relief cannot be obtained from a 
medical relief station or a designated physician or designated dentist, 
preference shall be given to other Federal medical facilities when 
reasonably available and when conditions permit.
    (d) Vouchers on proper forms covering expenses for treatment or 
hospitalization under the circumstances specified in paragraph (a) of 
this section shall be forwarded to the Surgeon General through Coast 
Guard headquarters. Each such voucher shall be accompanied by or contain 
a statement of the facts necessitating the treatment or hospitalization. 
Unreasonable charges for emergency treatment or hospitalization will not 
be allowed.
    (e) Expenses for consultants or special services, or for dental 
treatment other than emergency measures to relieve pain, shall not be 
allowed except when authorized in advance by the headquarters of the 
Service or, in extraordinary cases, when subsequently approved by such 
headquarters upon receipt of report and satisfactory explanation as to 
the necessity and urgency therefor.

(Sec. 610(b), 58 Stat. 714 as amended; 33 U.S.C. 763c)



Sec. 31.14  Application for treatment; active duty personnel.

    An applicant for medical relief who is on active duty shall furnish 
a certificate identifying him. Such certificate shall be signed by an 
officer or other appropriate supervisory official of the Coast Guard. In 
an emergency, the officer in charge of a medical relief station, or a 
designated physician or designated dentist, may accept other evidence of 
status satisfactory to him.

(Sec. 610(b), 58 Stat. 714 as amended; 33 U.S.C. 763c)



Sec. 31.15  Continuance of medical relief after loss of status.

    If a person is separated while undergoing treatment by the Service, 
his treatment shall be discontinued immediately unless the physician or 
dentist in charge determines that the condition of the patient does not 
permit interruption of treatment, in which case the treatment shall be 
discontinued as soon as practicable and the condition of the patient 
permits. At that time he shall be discharged from treatment and shall 
not thereafter be afforded medical relief by the Service by reason of 
his previous service.

(Sec. 610(b), 58 Stat. 714, as amended; 33 U.S.C. 763c)



Sec. 31.16  Retired personnel; extent of treatment.

    (a) Any retired person specified in Sec. 31.11 shall be entitled to 
medical, surgical, and dental treatment and hospitalization at medical 
relief stations of the first, second, and third class, upon presentation 
of satisfactory evidence of his status.
    (b) Elective medical or surgical treatment requiring hospitalization 
shall be furnished only at hospitals operated by the Service.
    (c) Dental treatment shall be furnished to the extent of available 
facilities only at medical relief stations where full-time dental 
officers are on duty; at other medical relief stations the dental 
treatment shall be limited

[[Page 105]]

to emergency measures necessary to relieve pain.

(Sec. 610(b), 58 Stat. 714, as amended; 33 U.S.C. 763c)



PART 32_MEDICAL CARE FOR PERSONS WITH HANSEN'S DISEASE AND OTHER PERSONS IN 

EMERGENCIES--Table of Contents




                               Definitions

Sec.
32.1 Meaning of terms.

                              Beneficiaries

32.6 Persons eligible.

                      Persons With Hansen's Disease

32.86 Admissions to Service facilities.
32.87 Confirmation of diagnosis.
32.88 Examinations and treatment.
32.89 Discharge.
32.90 Notification to health authorities regarding discharged patients.
32.91 Purchase of services for Hansen's disease patients.

           Nonbeneficiaries: Temporary Treatment in Emergency

32.111 Conditions and extent of treatment; charges.

    Authority: Secs. 320, 321 and 322(b), Public Health Service Act (42 
U.S.C. 247e, 248 and 249(b)).

    Source: 40 FR 25816, June 19, 1975, unless otherwise noted.

                               Definitions



Sec. 32.1  Meaning of terms.

    All terms not defined herein shall have the same meaning as given 
them in the Act.
    (a) Act means the Public Health Service Act, approved July 1, 1944, 
58 Stat. 682, as amended;
    (b) Service means the Public Health Service;
    (c) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved may have been delegated.
    (d) Authorizing official means Service officers or employees duly 
designated by the Director, Bureau of Health Care Delivery and 
Assistance, to authorize and provide care and treatment to beneficiaries 
at Service expense.

[40 FR 25816, June 19, 1975, as amended at 48 FR 10318, Mar. 11, 1983]

                              Beneficiaries



Sec. 32.6  Persons eligible.

    (a) Under this part the following persons are entitled to care and 
treatment by the Service as hereinafter prescribed:
    (1) Persons afflicted with Hansen's disease; and
    (2) Non-beneficiaries for temporary treatment and care in cases of 
emergency.
    (b) Separate regulations govern: (1) The medical care of certain 
personnel, and their dependents, of the Coast Guard, National Oceanic 
and Atmospheric Administration, and Public Health Service (see part 31 
of this chapter);
    (2) Physical and mental examination of aliens (see part 34 of this 
chapter); and
    (3) Medical care for Native Americans (see part 36 of this chapter).

[48 FR 10318, Mar. 11, 1983]

                      Persons With Hansen's Disease



Sec. 32.86  Admissions to Service facilities.

    Any person with Hansen's disease who presents himself for care or 
treatment or who is referred to the Service by the proper health 
authority of any State, Territory, or the District of Columbia shall be 
received into the Service hospital at Carville, Louisiana, or into any 
other hospital of the Service which has been designated by the Secretary 
as being suitable for the accommodation of persons with Hansen's 
disease.



Sec. 32.87  Confirmation of diagnosis.

    At the earliest practicable date, after the arrival of a patient at 
the Service hospital at Carville, Louisiana, or at another hospital of 
the Service the medical staff shall confirm or disprove the diagnosis of 
Hansen's disease. If the diagnosis of Hansen's disease is confirmed, the 
patient shall be provided appropriate inpatient or outpatient

[[Page 106]]

treatment. If the diagnosis is not confirmed, the patient shall be 
discharged.

[40 FR 25816, June 19, 1975; 40 FR 36774, Aug. 22, 1975]



Sec. 32.88  Examinations and treatment.

    Patients will be provided necessary clinical examinations which may 
be required for the diagnosis of primary or secondary conditions, and 
such treatment as may be prescribed.



Sec. 32.89  Discharge.

    Patients with Hansen's disease will be discharged when, in the 
opinion of the medical staff of the hospital, optimum hospital benefits 
have been received.



Sec. 32.90  Notification to health authorities regarding discharged patients.

    Upon the discharge of a patient the medical officer in charge shall 
give notification of such discharge to the appropriate health officer of 
the State, Territory, or other jurisdiction in which the discharged 
patient is to reside. The notification shall also set forth the clinical 
findings and other essential facts necessary to be known by the health 
officer relative to such discharged patient.



Sec. 32.91  Purchase of services for Hansen's disease patients.

    Hansen's disease patients being treated on either an inpatient or 
outpatient basis at a hospital or clinic facility of the Service, other 
than the National Center for Hansen's Disease (Carville, Louisiana), 
may, at the sole discretion of the Secretary and subject to available 
appropriations, be provided care for the treatment of Hansen's disease 
at the expense of the Service upon closure or transfer of such hospital 
or clinic pursuant to section 987 of the Omnibus Budget Reconciliation 
Act of 1981 (Pub. L. 97-35). Payment will only be made for care arranged 
for by an authorizing official of the Service as defined in Sec. 
32.1(f) of this part.

[46 FR 51918, Oct. 23, 1981]

           Nonbeneficiaries: Temporary Treatment in Emergency



Sec. 32.111  Conditions and extent of treatment; charges.

    (a) Persons not entitled to treatment by the Service may be provided 
temporary care and treatment at medical care facilities of the Service 
in case of emergency as an act of humanity.
    (b) Persons referred to in paragraph (a) of this section who, as 
determined by the officer in charge of the Service facility, are able to 
defray the cost of their care and treatment shall be charged for such 
care and treatment at the following rates (which shall be deemed to 
constitute the entire charge in each instance): In the case of 
hospitalization, at the current interdepartmental reciprocal per diem 
rate; and, in the case of outpatient treatment, at rates established by 
the Secretary.



PART 34_MEDICAL EXAMINATION OF ALIENS--Table of Contents




Sec.
34.1 Applicability.
34.2 Definitions.
34.3 Scope of examinations.
34.4 Medical notifications.
34.5 Postponement of medical examination.
34.6 Applicability of Foreign Quarantine Regulations.
34.7 Medical and other care; death.
34.8 Reexamination; convening of review boards; expert witnesses; 
          reports.

    Authority: 42 U.S.C. 216, 249, 252; 8 U.S.C. 1182, 1224, 1226; sec. 
601 of Pub. L. 101-649.



Sec. 34.1  Applicability.

    The provisions of this part shall apply to the medical examination 
of:
    (a) Aliens applying for a visa at an embassy or consulate of the 
United States;
    (b) Aliens arriving in the United States;
    (c) Aliens required by the INS to have a medical examination in 
connection with determination of their admissibility into the United 
States; and
    (d) Aliens applying for adjustment status.

[56 FR 25001, May 31, 1991]

[[Page 107]]



Sec. 34.2  Definitions.

    As used in this part, terms shall have the following meanings:
    (a) CDC. Centers for Disease Control, Public Health Service, U.S. 
Department of Health and Human Services.
    (b) Communicable disease of public health significance. Any of the 
following diseases:
    (1) Chancroid.
    (2) Gonorrhea.
    (3) Granuloma inguinale.
    (4) Human immunodeficiency virus (HIV) infection.
    (5) Leprosy, infectious.
    (6) Lymphogranuloma venereum.
    (7) Syphilis, infectious stage.
    (8) Tuberculosis, active.
    (c) Civil surgeon. A physician, with not less than 4 years' 
professional experience, selected by the District Director of INS to 
conduct medical examinations of aliens in the United States who are 
applying for adjustment of status to permanent residence or who are 
required by the INS to have a medical examination.
    (d) Class A medical notification. Medical notification of:
    (1) A communicable disease of public health significance;
    (2)(i) A physical or mental disorder and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others;
    (ii) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior; or
    (3) Drug abuse or addiction.
    (e) Class B medical notification. Medical notification of a physical 
or mental abnormality, disease, or disability serious in degree or 
permanent in nature amounting to a substantial departure from normal 
well-being.
    (f) Director. The Director of the Centers for Disease Control.
    (g) Drug abuse. The non-medical use of a substance listed in section 
202 of the Controlled Substances Act, as amended (21 U.S.C. 802) which 
has not necessarily resulted in physical or psychological dependence.
    (h) Drug addiction. The non-medical use of a substance listed in 
section 202 of the Controlled Substances Act, as amended (21 U.S.C. 802) 
which has resulted in physical or psychological dependence.
    (i) INS. Immigration and Naturalization Service, U.S. Department of 
Justice.
    (j) Medical examiner. A panel physician, civil surgeon, or other 
physician designated by the Director to perform medical examinations of 
aliens.
    (k) Medical hold document. A document issued to the INS by a 
quarantine inspector of the Public Health Service at a port of entry 
which defers the inspection for admission until the cause of the medical 
hold is resolved.
    (l) Medical notification. A document issued to a consular authority 
or the INS by a medical examiner, certifying the presence or absence of:
    (1) A communicable disease of public health significance;
    (2)(i) A physical or mental disorder and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others;
    (ii) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior;
    (3) Drug abuse or addiction; or
    (4) Any other physical abnormality, disease, or disability serious 
in degree or permanent in nature amounting to a substantial departure 
from normal well-being.
    (m) Medical officer. A physician of the Public Health Service 
Commissioned Corps assigned by the Director to conduct physical and 
mental examinations of aliens.
    (n) Mental disorder. A currently accepted psychiatric diagnosis, as 
defined by the Diagnostic and Statistical Manual of Mental Disorders 
published by the American Psychiatric Association, or by other 
authoritative sources.
    (o) Panel physician. A physician selected by a United States embassy 
or consulate to conduct medical examinations of aliens applying for 
visas.

[[Page 108]]

    (p) Physical disorder. A currently accepted medical diagnosis, as 
defined by the Manual of the International Classification of Diseases, 
Injuries, and Causes of Death published by the World Health 
Organization, or by other authoritative sources.

[21 FR 9829, Dec. 12, 1956, as amended at 52 FR 32543, Aug. 28, 1987; 56 
FR 25001, May 31, 1991]



Sec. 34.3  Scope of examinations.

    (a) General. In performing examinations, medical examiners shall 
consider those matters that relate to:
    (1) A communicable disease of public health significance;
    (2)(i) A physical or mental disorder and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others;
    (ii) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior;
    (3) Drug abuse or addiction; and
    (4) Any other physical abnormality, disease, or disability serious 
in degree or permanent in nature amounting to a substantial departure 
from normal well-being.

The scope of the examination shall include any laboratory or additional 
studies that are deemed necessary, either as a result of the physical 
examination or pertinent information elicited from the alien's medical 
history, for the examining physician to reach a conclusion about the 
presence or absence of a physical or mental abnormality, disease, or 
disability.
    (b) Persons subject to requirement for chest X-ray examination and 
serologic testing. (1) Except as provided in paragraph (b)(1)(v) of this 
section, a chest X-ray examination, serologic testing for syphilis and 
serologic testing for HIV of persons 15 years of age and older shall be 
required as part of the examination of:
    (i) Applicants for immigrant visas;
    (ii) Students, exchange visitors, and other applicants for a 
nonimmigrant visa who are required by a consular authority to have a 
medical examination;
    (iii) Aliens outside the United States who apply for refugee status;
    (iv) Applicants in the United States who apply for adjustment of 
status under the immigration statute and regulations;
    (v) Exceptions. Neither a chest X-ray examination nor serologic 
testing for syphilis and HIV shall be required if the alien is under the 
age of 15. Provided, a tuberculin skin test shall be required if there 
is evidence of contact with a person known to have tuberculosis or other 
reason to suspect tuberculosis, and a chest X-ray examination shall be 
required in the event of a positive tuberculin reaction, and serologic 
testing where there is reason to suspect infection with syphilis or HIV. 
Additional exceptions to the requirement for a chest X-ray examination 
may be authorized for good cause upon application approved by the 
Director.
    (2) Tuberculin skin test examination. (i) All aliens 2 years of age 
or older in the United States who apply for adjustment of status to 
permanent residents, under the immigration laws and regulations, or 
other aliens in the United States who are required by the INS to have a 
medical examination in connection with a determination of their 
admissibility, shall be required to have a tuberculin skin test. 
Exceptions to this requirement may be authorized for good cause upon 
application approved by the Director. In the event of a positive 
tuberculin reaction, a chest X-ray examination shall be required. If the 
chest radiograph is consistent with tuberculosis, the alien shall be 
referred to the local health authority for evaluation. Evidence of this 
evaluation shall be provided to the civil surgeon before a medical 
notification may be issued.
    (ii) Aliens less than 2 years old shall be required to have a 
tuberculin skin test if there is evidence of contact with a person known 
to have tuberculosis or other reason to suspect tuberculosis. In the 
event of a positive tuberculin reaction, a chest X-ray examination shall 
be required. If the chest radiograph is consistent with tuberculosis, 
the alien shall be referred to the local health authority for 
evaluation. Evidence of this evaluation shall be provided to the

[[Page 109]]

civil surgeon before a medical notification may be issued.
    (3) Sputum smear examination. All aliens subject to the chest X-ray 
examination requirement and for whom the radiograph shows an abnormality 
consistent with pulmonary tuberculosis shall be required to have a 
sputum smear examination for acid-fast bacilli.
    (4) How and where performed. All chest X-ray films used in medical 
examinations performed under the regulations in this part shall be large 
enough to encompass the entire chest (approximately 14 by 17 inches; 
35.6x43.2 cm.). Serologic testing for HIV shall be a sensitive and 
specific test, confirmed when positive by a test such as the Western 
blot test or an equally reliable test. For aliens examined abroad, the 
serologic testing for HIV must be completed abroad, except that the 
Attorney General after consultation with the Secretary of State and the 
Secretary of Health and Human Services may in emergency circumstances 
permit serologic testing of refugees for HIV to be completed in the 
United States.
    (5) Chest X-ray, laboratory, and treatment reports. The chest X-ray 
reading and serologic test results for syphilis and HIV shall be 
included in the medical notification. When the medical examiner's 
conclusions are based on a study of more than one chest X-ray film, the 
medical notification shall include at least a summary statement of 
findings of the earlier films, followed by a complete reading of the 
last film, and dates and details of any laboratory tests and treatment 
for tuberculosis.
    (c) Procedure for transmitting records. For aliens issued immigrant 
visas, the medical notification and chest X-ray film, if any, shall be 
placed in a separate envelope which shall be sealed and attached to the 
alien's visa in such a manner as to be readily detached at the U.S. port 
of entry. When more than one chest X-ray film is used as a basis for the 
examiner's conclusions, all films shall be included.
    (d) Failure to present records. When a determination of 
admissibility is to be made at the U.S. port of entry, a medical hold 
document shall be issued pending completion of any necessary examination 
procedures. A medical hold document may be issued for aliens who:
    (1) Are not in possession of a valid medical notification, if 
required;
    (2) Have a medical notification which is incomplete;
    (3) Have a medical notification which is not written in English;
    (4) Are suspected to have an excludable medical condition.
    (e) The Attorney General, after consultation with the Secretary of 
State and the Secretary of Health and Human Services, may in emergency 
circumstances permit the medical examination of refugees to be completed 
in the United States.
    (f) All medical examinations shall be carried out in accordance with 
such technical instructions for physicians conducting the medical 
examination of aliens as may be issued by the Director. Copies of such 
technical instructions are available upon request to the Director, 
Division of Quarantine, Mailstop E03, CDC, Atlanta GA 30333.

[56 FR 25002, May 31, 1991]



Sec. 34.4  Medical notifications.

    (a) Medical examiners shall issue medical notifications of their 
findings of the presence or absence of Class A or Class B medical 
conditions. The presence of such condition must have been clearly 
established.
    (b) Class A medical notifications. (1) The medical examiner shall 
report his/her findings to the consular officer or the INS by Class A 
medical notification which lists the specific condition for which the 
alien may be excluded, if an alien is found to have:
    (i) A communicable disease of public health significance;
    (ii)(A) A physical or mental disorder, and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others; or
    (B) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior;
    (iii) Drug abuse or addition.

[[Page 110]]


Provided, however, That a Class A medical notification of a physical or 
mental disorder, and behavior associated with that disorder that may 
pose, or has posed, a threat to the property, safety, or welfare of the 
alien or others, shall in no case be issued with respect to an alien 
having only mental shortcomings due to ignorance, or suffering only from 
a condition attributable to remediable physical causes or of a temporary 
nature, caused by a toxin, medically prescribed drug, or disease.
    (2) The medical notification shall state the nature and extent of 
the abnormality; the degree to which the alien is incapable of normal 
physical activity; and the extent to which the condition is remediable. 
The medical examiner shall indicate the likelihood, that because of the 
condition, the applicant will require extensive medical care or 
institutionalization.
    (c) Class B medical notifications. (1) If an alien is found to have 
a physical or mental abnormality, disease, or disability serious in 
degree or permanent in nature amounting to a substantial departure from 
normal well-being, the medical examiner shall report his/her findings to 
the consular or INS officer by Class B medical notification which lists 
the specific conditions found by the medical examiner. Provided, 
however, that a Class B medical notification shall in no case be issued 
with respect to an alien having only mental shortcomings due to 
ignorance, or suffering only from a condition attributable to remediable 
physical causes or of a temporary nature, caused by a toxin, medically 
prescribed drug, or disease.
    (2) The medical notification shall state the nature and extent of 
the abnormality, the degree to which the alien is incapable of normal 
physical activity, and the extent to which the condition is remediable. 
The medical examiner shall indicate the likelihood, that because of the 
condition, the applicant will require extensive medical care or 
institutionalization.
    (d) Other medical notifications. If as a result of the medical 
examination, the medical examiner does not find a Class A or Class B 
condition in an alien, the medical examiner shall so indicate on the 
medical notification form and shall report his findings to the consular 
or INS officer.

[56 FR 25003, May 31, 1991]



Sec. 34.5  Postponement of medical examination.

    Whenever, upon an examination, the medical examiner is unable to 
determine the physical or mental condition of an alien, completion of 
the medical examination shall be postponed for such observation and 
further examination of the alien as may be reasonably necessary to 
determine his/her physical or mental condition. The examination shall be 
postponed for aliens who have an acute infectious disease until the 
condition is resolved. The alien shall be referred for medical care as 
necessary.

[56 FR 25003, May 31, 1991]



Sec. 34.6  Applicability of Foreign Quarantine Regulations.

    Aliens arriving at a port of the United States shall be subject to 
the applicable provisions of 42 CFR part 71, Foreign Quarantine, with 
respect to examination and quarantine measures.

[56 FR 25003, May 31, 1991]



Sec. 34.7  Medical and other care; death.

    (a) An alien detained by or in the custody of the INS may be 
provided medical, surgical, psychiatric, or dental care by the Public 
Health Service through interagency agreements under which the INS shall 
reimburse the Public Health Service. Aliens found to be in need of 
emergency care in the course of medical examination shall be treated to 
the extent deemed practical by the attending physician and if considered 
to be in need of further care, may be referred to the INS along with the 
physician's recommendations concerning such further care.
    (b) In case of the death of an alien, the body shall be delivered to 
the consular or immigration authority concerned. If such death occurs in 
the United States, or in a territory or possession thereof, public 
burial shall be provided upon request of the INS and subject to its 
agreement to pay the

[[Page 111]]

burial expenses. Autopsies shall not be performed unless approved by the 
INS.

[56 FR 25003, May 31, 1991]



Sec. 34.8  Reexamination; convening of review boards; expert witnesses; 

reports.

    (a) The Director shall convene a board of medical officers to 
reexamine an alien:
    (1) Upon the request of the INS for a reexamination by such a board; 
or
    (2) Upon an appeal to the INS by an alien who, having received a 
medical examination in connection with the determination of admissiblity 
to the United States (including examination on arrival and adjustment of 
status as provided in the immigration laws and regulations) has been 
certified for a Class A condition.
    (b) For boards convened to reexamine aliens certified as:
    (1) Having a communicable disease of public health significance, the 
board shall consist of three medical officers, at least one of whom is 
experienced in the diagnosis and treatment of the communicable disease 
for which medical notification has been made, and the decision of the 
majority of the board shall prevail;
    (2)(i) Having a physical or mental disorder and behavior associated 
with the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others; or
    (ii) Having a history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior; or
    (iii) Being a drug abuser or addict;
    (3) In circumstances covered by paragraph (b)(2) of this section, 
the board shall consist of three medical officers, at least one of whom 
shall be a board certified psychiatrist, and the decision of the 
majority of the board shall prevail.
    (c) Reexamination shall include:
    (1) Review of all records submitted by the alien, other witnesses, 
or the board;
    (2) Use of any laboratory or additional studies which are deemed 
clinically necessary as a result of the physical examination or 
pertinent information elicited from the alien's medical history;
    (3) Consideration of statements regarding the alien's physical or 
mental condition made by a physician after his/her examination of the 
alien; and
    (4) An independent physical or psychiatric examination of the alien 
performed by the board, at the board's option.
    (d) An alien who is to be reexamined shall be notified of the time 
and place of his/her reexamination not less than 5 days prior thereto.
    (e) The alien, at his/her own cost and expense, may introduce as 
witnesses before the board such physicians or medical experts as the 
board may in its discretion permit; provided that the alien shall be 
permitted to introduce at least one expert medical witness. If any 
witnesses offered are not permitted by the board to testify, the record 
of the proceedings shall show the reason for the denial of permission.
    (f) Witnesses before the board shall be given a reasonable 
opportunity to examine the medical notification and other records 
involved in the reexamination and to present all relevant and material 
evidence orally or in writing until such time as the proceedings are 
declared by the board to be closed. During the course of the hearing the 
alien's attorney or representative shall be permitted to examine the 
alien and he/she, or the alien, shall be permitted to examine any 
witnesses offered in the alien's behalf and to cross-examine any 
witnesses called by the board. If the alien does not have an attorney or 
representative, the board shall assist the alien in the presentation of 
his/her case to the end that all of the material and relevant facts may 
be considered.
    (g) The findings and conclusions of the board shall be based on its 
medical examination of the alien, if any, and on the evidence presented 
and made a part of the record of its proceedings.
    (h) The board shall report its findings and conclusions to the INS, 
and shall also give prompt notice thereof to the alien if his/her 
reexamination has been based on his/her appeal. The board's report to 
the INS shall specifically affirm, modify, or reject the findings and

[[Page 112]]

conclusions of prior examining medical officers.
    (i) The board shall issue its medical notification in accordance 
with the applicable provisions of this part if it finds that an alien it 
has reexamined has a Class A or Class B condition.
    (j) If the board finds that an alien it has reexamined does not have 
a Class A or Class B condition, it shall issue its medical notification 
in accordance with the applicable provisions of this part.
    (k) After submission of its report, the board shall not be 
reconvened, nor shall a new board be convened, in connection with the 
same application for admission or for adjustment of status, except upon 
the express authorization of the Director.

[56 FR 25004, May 31, 1991]



PART 35_HOSPITAL AND STATION MANAGEMENT--Table of Contents




                            Subpart A_General

Sec.
35.1 Hospital and station rules.
35.2 Compliance with hospital rules.
35.3 Noncompliance; deprivation of privileges.
35.4 Noncompliance; discharge or transfer.
35.5 Entitlement to care after discharge or transfer by reason of 
          noncompliance.
35.6 Admissions; determination of eligibility for care.
35.7 Admissions; designation of person to be notified.
35.8 Safekeeping of money and effects; withdrawals.
35.9 Disposition of money and effects left by other than deceased 
          patients.
35.10 Destruction of effects dangerous to health.
35.11 Clinical records; confidential.
35.12 Solicitation of legal business prohibited.
35.13 Entry for negotiation of release or settlement.
35.14 Solicitation of legal business; negotiation of release or 
          settlement; assistance prohibited.
35.15 Consent to operative procedures.
35.16 Autopsies and other post-mortem operations.
35.17 Fees and charges for copying, certification, search of records and 
          related services.

                     Subpart B_Transfer of Patients

35.21 Authorization of transfer.
35.22 Attendants.

         Subpart C_Disposition of Articles Produced by Patients

35.31 Retention by patients.
35.32 Board of appraisers.
35.33 Sale; prices; deposit of proceeds.
35.34 Resale.
35.35 Unsalable articles.

      Subpart D_Disposal of Money and Effects of Deceased Patients

35.41 Inventory.
35.42 Notice upon death.
35.43 Delivery only upon filing claim; forms; procedure.
35.44 Delivery to legal representative; to other claimants if value is 
          $1,000 or less.
35.45 Disposition of effects; exceptions.
35.46 Conflicting claims.
35.47 Disposition of Government checks.
35.48 Deposit of unclaimed money; sale of unclaimed effects and deposit 
          of proceeds.
35.49 Sale of unclaimed effects; procedures.
35.50 Disposition of unsold effects.
35.51 Manner of delivery; costs, receipts.
35.52 Delivery of possession only; title unaffected.

           Subpart E_Contributions for the Benefit of Patients

35.61 Applicability.
35.62 Acceptance of contributions.
35.63 Report of and accounting for contributions.
35.64 Donors.
35.65 Acceptable personal property.
35.66 Expenditure of cash contributions.

    Authority: Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216, sec. 
321, 53 Stat. 695, as amended; 42 U.S.C. 248, unless otherwise noted.

    Source: 21 FR 9830, Dec. 12, 1956, unless otherwise noted.



                            Subpart A_General



Sec. 35.1  Hospital and station rules.

    The officer in charge of a station or hospital of the Service is 
authorized to adopt such rules and issue such instructions, not 
inconsistent with the regulations in this part and other provisions of 
law, as he deems necessary for the efficient operation of the station or 
hospital and for the proper and humane care and treatment of all 
patients therein. All general rules governing the conduct and privileges 
of patients, and of members of the public

[[Page 113]]

while on the premises, shall be posted in prominent places.



Sec. 35.2  Compliance with hospital rules.

    All patients and visitors in stations and hospitals of the Service 
are expected to comply with the rules and instructions issued under the 
authority of the officer in charge.



Sec. 35.3  Noncompliance; deprivation of privileges.

    Any patient who wilfully fails or refuses to comply with rules or 
instructions of a hospital or station or with regulations of the 
Service, may, by the direction of the officer in charge, be deprived of 
recreational or other privileges accorded patients. Any visitor who 
wilfully fails or refuses to comply with any such rules, instructions, 
or regulations may, by direction of the officer in charge, be denied 
visiting privileges.



Sec. 35.4  Noncompliance; discharge or transfer.

    (a) If the officer in charge finds, upon investigation, that a 
patient other than a leprosy patient, by willful and persistent failure 
or refusal to comply with such rules, instructions, or regulations is 
seriously impeding the course of his own care and treatment, or that of 
other patients, he may (1) discharge the patient, or (2) if the patient 
is not a voluntary patient, arrange for his transfer to the custody of 
the authority responsible for his admission to the station or hospital. 
No patient shall be discharged or transferred on account of 
noncompliance if to do so would seriously endanger his life or health, 
nor shall any patient be discharged if his failure to comply is due, in 
the opinion of the officer in charge, to a mental disease or disorder.
    (b) If the discharge or transfer of a patient is likely to endanger 
the health of persons other than the patient or officers or employees of 
the station or hospital, the officer in charge shall give advance notice 
to appropriate State, county, or municipal authorities of the discharge 
or transfer.



Sec. 35.5  Entitlement to care after discharge or transfer by reason of 

noncompliance.

    No person otherwise entitled to care, treatment, or hospitalization 
at Service facilities, or in other facilities at the expense of the 
Service, shall be denied such care or treatment by reason of his prior 
discharge or transfer from any such facility under the provisions of 
Sec. 35.4.



Sec. 35.6  Admissions; determination of eligibility for care.

    Except as may otherwise be provided for specific classes of patients 
by the regulations of this chapter, the officer in charge of the station 
or hospital to which application is made is authorized to determine the 
eligibility of applicants, as beneficiaries of the Service, for care and 
for treatment. Such determinations shall be subject to review by the 
chief of the division of the Service responsible for administration of 
the station or hospital concerned upon referral made by the officer in 
charge in doubtful cases or upon appeal made by an applicant who has 
been denied care or treatment.



Sec. 35.7  Admissions; designation of person to be notified.

    Every in-patient, at the time of admission to the hospital or 
station or as soon thereafter as practicable, shall be requested to 
designate a person or persons to be notified in case of emergency.



Sec. 35.8  Safekeeping of money and effects; withdrawals.

    (a) A place for the safekeeping of money and effects of patients 
shall be provided at each station or hospital, and an itemized receipt 
therefor shall be furnished to the patient and to any other person who 
places money or effects therein for the benefit of the patient.
    (b) Money and effects may be withdrawn only by or on behalf of the 
patient, by his legally appointed representative authorized to receive 
or dispose of his property (including the money and effects in the 
custody of the station or hospital), or by a person who is authorized, 
under the law of the State in which the station or hospital

[[Page 114]]

is located, to receive or dispose of the patient's money and effects. In 
any case in which the officer in charge has had actual notice of the 
appointment of a legal representative, withdrawals may be made only by 
such representative or in accordance with his written directions. No 
delivery shall be made under this paragraph unless (1) the person 
receiving the money or effects shall sign an itemized receipt therefor, 
or (2) the delivery is witnessed by two persons. The provisions of this 
paragraph do not prohibit withdrawals made necessary by the provisions 
of this part for the disposition of money and effects left by patients 
on death or on departure from the station or hospital, or by the 
provisions of Sec. 35.10.



Sec. 35.9  Disposition of money and effects left by other than deceased 

patients.

    Money and effects left on the premises by a patient shall be 
forwarded promptly to him. If because his whereabouts are unknown his 
money and effects cannot be delivered to him within 120 days after his 
departure, his money shall be deposited into the Treasury and credited 
to the account entitled ``Money and Effects of Former Patients (PHS (T) 
name of patient),'' and his effects shall be held for him for six months 
and then sold in accordance with Sec. 35.49, and the proceeds deposited 
into the Treasury and credited to the above account.



Sec. 35.10  Destruction of effects dangerous to health.

    The officer in charge shall cause to be destroyed effects brought 
into or received in the station or hospital area by patients which, in 
the judgement of such officer, are dangerous as a source of disease to 
the health or life of patients or personnel of the station or hospital 
or visitors therein and cannot otherwise be safely disposed of or 
rendered harmless by disinfection or other means. The destruction of 
effects shall be witnessed by at least one officer or employee 
designated for that purpose by the officer in charge, and appropriate 
records of the destruction shall be maintained.



Sec. 35.11  Clinical records; confidential.

    A complete clinical record shall be maintained for each patient 
admitted to a station or hospital of the Service. Such records shall be 
confidential and shall not be disclosed except as may be provided 
elsewhere in regulations of the Service.



Sec. 35.12  Solicitation of legal business prohibited.

    The solicitation, directly or indirectly, of legal business or of a 
retainer or agreement authorizing an attorney to render legal services, 
is prohibited in all stations and hospitals of the Service.



Sec. 35.13  Entry for negotiation of release or settlement.

    (a) No person shall be permitted to enter a station or hospital of 
the Service for the purpose of negotiating a settlement or obtaining a 
general or special release or statement from any patient with reference 
to any illness or personal injury for which the patient is receiving 
care or treatment, or for the purpose of conferring with him as an 
attorney or representative of an attorney with reference to such illness 
or injury, unless the patient has signified his willingness to have such 
person enter for such purpose and, in the judgment of the officer in 
charge, the physical or mental condition of the patient will not thereby 
be impaired.
    (b) Any person entering a station or hospital for a purpose 
enumerated in paragraph (a) of this section shall register in the manner 
prescribed by the officer in charge, and shall furnish for the records 
of the station or hospital the name of each patient by whom he has been 
received for such a purpose.



Sec. 35.14  Solicitation of legal business; negotiation of release or 

settlement; assistance prohibited.

    All employees of the Service and all persons attached in any 
capacity to a station or hospital, including patients, are forbidden to 
communicate, directly or indirectly, with any person for the purpose of 
aiding in the solicitation of legal business or in the negotiation of a 
settlement or the obtaining of a general or special release or statement 
from any patient with reference to any

[[Page 115]]

illness or personal injury for which the patient is receiving care or 
treatment therein. No patient is prohibited by this section from 
communicating on his own behalf with an attorney of his choice or with 
other persons.



Sec. 35.15  Consent to operative procedures.

    Except in emergencies when the patient is physically or mentally 
incapable of consenting and the delay required to obtain the consent of 
his natural or legal guardian would seriously endanger the patient's 
health, no operative procedure shall be undertaken unless the patient 
or, in the case of a minor or incompetent, his natural or legal guardian 
gives his consent, nor shall any major operative procedure or the 
administration of a general anaesthetic be undertaken unless such 
consent has been obtained in writing. The consent or refusal of consent 
shall be made a part of the clinical record.



Sec. 35.16  Autopsies and other post-mortem operations.

    Autopsies, or other post-mortem operations, including removal of 
tissue for transplanting, may be performed on the body of a deceased 
patient only by direction of the officer in charge and only if consented 
to in writing by a person authorized under the law of the State in which 
the station or hospital is located to permit an autopsy or such other 
post-mortem operation under the circumstances of the particular death 
involved. Restrictions or limitations imposed by the person consenting 
thereto on the extent of the autopsy or other post-mortem operation 
shall be observed. Documents embodying consent shall be made a part of 
the clinical record.

[25 FR 6331, July 6, 1960]



Sec. 35.17  Fees and charges for copying, certification, search of records and 

related services.

    A prescribed fee, in accordance with the schedule in paragraph (c) 
of this section, shall be collected for each of the listed services.
    (a) Application for services. Any person requesting (1) a copy of a 
clinical record, clinical abstract, or other document containing 
clinical information; or (2) a certification of a clinical record or 
document; or (3) a search of clinical records, shall make written 
application therefor to the Public Health Service facility having 
custody of the subject matter involved. Such application shall state 
specifically the particular record or document requested, and the 
purpose for which such copy or document is desired to be used. The 
application shall be accompanied by a deposit in an amount equal to the 
prescribed charge for the service rendered. Where it is not known if a 
clinical record or other document is in existence, the application shall 
be accompanied by a minimum deposit of $2.50.
    (b) Authorization for disclosure. The furnishing of copies of PHS 
records containing confidential clinical information must comply with 
the requirements of part I, title 42, Code of Federal Regulations, 
governing authorization for the disclosure of such information.
    (c) Schedule of fees.

(1) Photocopy reproduction of a clinical record or other
 document (through use of facility equipment):
  (a) Processing (searching, preparation of record and use of      $3.25
   equipment), first page.......................................
  (b) Each additional page......................................     .25
(2) Certification, per document.................................     .25
(3) Unsuccessful searching, per hour (minimum charge 1 hour)....    2.50
(4) Clinical abstracts, per request.............................    3.00
(5) Arranging commercial duplication of a clinical record, per       \1\
 request........................................................    0.50
(6) If the requested material is to be transmitted by registered
 mail, airmail, or special delivery mail, the postal fees
 therefor shall be added to the other fees provided above,
 unless the applicant has included proper postage or stamped
 return envelopes for this purpose.
 
\1\ The private concern which duplicates records for an applicant will
  make a separate charge therefor and will bill the applicant directly.

    (d) Waiver of fee. The prescribed fee may be waived, in the 
discretion of the medical officer in charge, under the following 
circumstances:
    (1) When the service or document is requested by another agency of 
the Federal Government for use in carrying out official Government 
business.
    (2) When a clinical record is requested for the purpose of providing 
continued medical care to a Service beneficiary by a non-Service 
physician, clinic, or hospital, in which case the record will be 
forwarded only to the physician, clinic, or hospital concerned.

[[Page 116]]

    (3) When the service or document is requested by an attorney in the 
prosecution of a Service beneficiary's personal injury claim against a 
third person, involving the concurrent assertion of a government medical 
care claim under 42 U.S.C. 2651-2653. In such case, the service or 
document requested will be furnished only upon compliance with all 
additional requirements for the release of records in third party 
recovery cases, including the proper execution of form PHS-4686, 
Agreement to Assign Claim Upon Request.
    (4) When the service or document is requested by, and furnished to, 
a Member of Congress for official use.
    (5) When the service or document is requested by, and furnished to, 
a court in lieu of the personal court appearance of an employee of the 
Public Health Service.
    (6) When the service or document is required to be furnished free in 
accordance with a Federal statute or an Executive order.
    (7) When the furnishing of the service or document requested without 
charge would be an appropriate courtesy to a foreign country or 
international organization.

(Sec. 501, 65 Stat. 290; 31 U.S.C. 483(a); sec. 215, 58 Stat. 690, as 
amended; 42 U.S.C. 216)

[32 FR 6842, May 4, 1967]



                     Subpart B_Transfer of Patients



Sec. 35.21  Authorization of transfer.

    Except as otherwise provided by law or regulation with respect to 
certain classes of patients, the officer in charge of a station or 
hospital of the Service may provide, without any cost to the patient, 
for the transfer of the patient either from such station or hospital to 
another station or hospital of the Service or to any non-Service station 
or hospital at which the patient may be received, or from any non-
Service hospital at which he is receiving care or treatment as a patient 
of the Service to a station or hospital of the Service.



Sec. 35.22  Attendants.

    Patients shall be transferred by such means and accompanied by such 
medical, nursing, or other attendants as may be necessary to protect the 
health and safety of the patient and other persons likely to come into 
contact with him, including in the case of a prisoner such guards as may 
be necessary to assure his safekeeping. A female patient requiring the 
services of attendants shall be accompanied by at least one female 
attendant. Medical or nursing attendants shall be qualified to care for 
persons suffering from the type of disease or disorder with which the 
patient is afflicted and shall be provided with equipment and medicines 
necessary for the care of the patient.



         Subpart C_Disposition of Articles Produced by Patients



Sec. 35.31  Retention by patients.

    Subject to the rules of the station or hospital, patients may be 
accorded the privilege of retaining articles produced by them in the 
course of their curative treatment with the aid of materials furnished 
by the Service. Articles not retained by patients shall be disposed of 
as provided in this subpart. The provisions of this subpart do not apply 
to the products of industrial activities established for narcotic 
addicts.



Sec. 35.32  Board of appraisers.

    The officer in charge shall appoint, from the personnel of the 
station or hospital, a board of three persons to serve at his pleasure. 
The board shall provide for the sale of articles having commercial value 
and shall keep appropriate records of such articles and their 
disposition.



Sec. 35.33  Sale; prices; deposit of proceeds.

    The board shall determine and redetermine from time to time the 
prices at which articles are to be sold, and in doing so shall consider 
the cost of materials used, reasonable handling charges, and the fair 
market value of the articles. The sale price shall be indicated on each 
article by tag or other appropriate means, and a list of articles 
offered for sale and their respective sale prices shall be posted from 
time to time in the hospital or station area. In its discretion, the 
board may offer such articles for purchase by

[[Page 117]]

other patients or by charitable organizations before offering them for 
purchase to the general public. No article shall be sold or resold to 
any officer or employee of the Service. Moneys received from the sale of 
articles shall be deposited into the Treasury to the credit of the 
appropriation from which the materials for making such articles were 
purchased.



Sec. 35.34  Resale.

    No article purchased under the provisions of this subpart shall be 
resold in the hospital or station area at a price to exceed the sale 
price fixed by the board for such article.



Sec. 35.35  Unsalable articles.

    Articles having no commercial value shall be stored, destroyed, or 
otherwise disposed of as the officer in charge may direct.



      Subpart D_Disposal of Money and Effects of Deceased Patients



Sec. 35.41  Inventory.

    Promptly after the death of a patient in a station or hospital of 
the Service, an inventory of his money and effects left therein shall be 
made by two or more officers or employees of the Service designated for 
such purpose by the officer in charge.



Sec. 35.42  Notice upon death.

    The officer in charge shall notify in writing all persons known to 
him to whom delivery of the patient's money and effects might be made 
hereunder, and, in the case of an alien patient, a consul of the country 
of his apparent nationality. Each person so notified shall be requested 
to furnish information concerning (a) the existence or whereabouts of 
any persons to whom delivery of the deceased patient's money and effects 
may be made pursuant to these provisions, and (b) the permanent 
residence or home of the deceased.



Sec. 35.43  Delivery only upon filing claim; forms; procedure.

    (a) Delivery of the money and effects of a deceased patient shall be 
made only to a person who has filed a claim therefor on a form 
prescribed by the Surgeon General.
    (b) A claimant shall furnish, in addition to the information on the 
prescribed form, such additional information as the officer in charge 
may consider necessary to establish the identity of the claimant and the 
truth of his statements.
    (c) A person filing a claim as a legal representative shall be 
required to present letters of administration or a certificate of a 
court attesting his qualification or appointment.
    (d) If a claim is made after the money, or proceeds from the sale of 
the effects, of a deceased patient have been deposited in the Treasury, 
the claim shall be referred to the General Accounting Office. If the 
claim is for checks or evidences of indebtedness of the United States 
which have been trasnsmitted to the issuing agency pursuant to 
Sec. Sec. 35.47 and 35.48, the claimant shall be referred to such 
agency.



Sec. 35.44  Delivery to legal representative; to other claimants if value is 

$1,000 or less.

    The money and effects of the deceased patient shall in all cases be 
delivered to the legal representative, if any, of his estate. If the 
value is $1,000 or less, and the officer in charge has neither notice 
nor other knowledge of the appointment or qualification of a legal 
representative, nor reason to believe that a legal representative will 
be appointed or qualified, he shall deliver all the money and effects, 
as soon as practicable after the expiration of 10 days from the sending 
of notices to one of the following in the indicated order of priority:
    (a) A person, if any, designated in writing by the patient to 
receive the same.
    (b) The patient's surviving spouse.
    (c) The patient's child or children in equal parts.
    (d) The patient's parent or parents in equal parts.
    (e) Any other person who would be entitled to receive the money and 
effects under the law of the patient's domicile: Provided, That delivery 
of such money and effects may be made immediately upon application by 
one

[[Page 118]]

of the persons specified above if the officer in charge has neither 
notice nor other knowledge that a person higher in the indicated order 
of priority exists.



Sec. 35.45  Disposition of effects; exceptions.

    Irrespective of the provisions of this subpart, the officer in 
charge may (a) release from among the effects of the deceased patient so 
much of the patient's clothing as may be necessary for use in 
preparation of his body for burial and (b) cause to be destroyed, or 
otherwise disposed of, such used toilet articles of the patient as 
appear to have no commercial or other value.



Sec. 35.46  Conflicting claims.

    In any case in which conflicting claims are filed or the officer in 
charge considers it to be in the interest of persons who may be 
ultimately entitled thereto, delivery may be withheld from all persons 
other than a duly qualified legal representative.



Sec. 35.47  Disposition of Government checks.

    Notwithstanding any other provisions of this subpart, immediately 
upon completion of the inventory, checks drawn on the Treasurer of the 
United States shall be sent by safe means to the department, agency, or 
establishment of the Government of the United States issuing such 
checks. The transmittal shall be accompanied by a statement of the 
reasons therefor and of all available information which may aid the 
issuing unit in the disposition of the check transmitted. Notice of the 
disposition of any checks, with identifying information, shall be given 
to the person or persons, if any, to which money and effects are 
delivered in accordance with Sec. 35.44.



Sec. 35.48  Deposit of unclaimed money; sale of unclaimed effects and deposit 

of proceeds.

    If, within 120 days after sending of notices no claim has been filed 
pursuant to the provisions of Sec. 35.43, the patient's money, 
consisting of all types of United States currency and coin, shall be 
deposited in the Treasury to the credit of the trust-fund account 
entitled ``Money and Effects of Deceased Patients, Public Health 
Service.'' If, within six months after the death of a patient, no claim 
has been filed pursuant to the provisions of Sec. 35.43, his effects 
(including foreign currency and coin but excluding Postal Savings 
Certificates and other evidences of indebtedness of the United States) 
shall be sold at public auction or by sealed bids to the highest bidder 
and the proceeds deposited to the credit of the trust-fund account 
entitled ``Money and Effects of Deceased Patients, Public Health 
Service.'' Postal Savings Certificates and other evidences of 
indebtedness of the United States shall be transmitted to the issuing 
department or agency with a statement of the occasion therefor.



Sec. 35.49  Sale of unclaimed effects; procedures.

    The following provisions shall govern the sale of effects:
    (a) Notice. Reasonable advance notice of proposed sales shall be 
posted at such prominent places in the station or hospital area as the 
officer in charge may designate. In addition, a notice shall be posted 
at the nearest post office, and notices shall be sent by mail to all 
known persons to whom delivery of money and effects of the patient may 
be made under the provisions of this subpart. The officer or employee 
who posts or sends notices of sales shall make an appropriate affidavit 
on a copy of the notice as to his action in that respect, including in 
his affidavit the names of persons to whom copies of the notices were 
mailed and the mailing dates. The copy of the notice on which the 
affidavit appears shall be retained in the files of the station or 
hospital.
    (b) Form and contents of notice. Notice of proposed sales shall be 
given on a form prescribed by the Surgeon General. The notice shall 
include: an inventory of the effects to be offered for sale; the names 
of the patients from whom the effects were received; the precise date, 
time, and place when and where the sale will be held; a statement that 
the articles will be available for inspection immediately prior to sale, 
if sold at public auction, or on a day and during the hours appointed 
for

[[Page 119]]

the inspection of articles if sold by sealed bid; a statement that the 
sale is to be held pursuant to the provisions of the regulations in this 
part, that, if the articles are to be sold by sealed bid, the right to 
reject all bids is reserved, and that, if otherwise authorized, delivery 
will be made of effects or proceeds of sales to persons filing claims 
prior to the sale of effects or prior to the transmittal of proceeds to 
the Surgeon General.
    (c) Time and place of sales. All sales shall be held at reasonable 
hours and at such places within the station or hospital area as the 
officer in charge may designate.
    (d) Who shall conduct sales. All sales shall be conducted by the 
officer in charge or by a responsible officer or employee designated by 
him.
    (e) Sale and delivery. All effects offered for sale shall be sold to 
the highest bidder and delivered to him immediately upon payment of the 
sale price in cash or by postal money order or certified check and 
execution of an appropriate receipt by the person to whom delivery is 
made.



Sec. 35.50  Disposition of unsold effects.

    The officer in charge shall dispose of effects offered for sale but 
remaining unsold in such manner as he considers to be proper, but, if 
practicable, such effects shall be used for the benefit of other 
patients of the Service.



Sec. 35.51  Manner of delivery; costs, receipts.

    (a) If a person entitled under this subpart to receive the money and 
effects of a patient is unable to take possession thereof at the station 
or hospital, they shall be sent to him at the expense of the United 
States in the most economical manner available. The records of the 
station or hospital shall show the names and addresses of persons to 
whom money or effects have been sent, the date of sending, the means 
used, an itemized list of the money or effects sent, and a statement by 
a witnessing officer or employee verifying the foregoing from his own 
observation.
    (b) If not delivered personally by an authorized officer or employee 
of the Service, money, evidences of indebtedness, and other valuable 
papers and documents shall be sent by registered mail (or other safe 
means).
    (c) Persons receiving the money and effects of a patient shall be 
required to execute an itemized receipt therefor.



Sec. 35.52  Delivery of possession only; title unaffected.

    Except for delivery of effects to purchasers at sales held in 
accordance with Sec. 35.49, delivery or deposit under this subpart of 
the money or effects, or the proceeds of a sale of the effects, of a 
deceased patient constitutes only a transfer of possession and is not 
intended to affect in any manner the title to such money, effects, or 
proceeds.



           Subpart E_Contributions for the Benefit of Patients

    Authority: Sec. 215, 58 Stat. 690, as amended, 63 Stat. 835 (42 
U.S.C. 216); sec. 321, 58 Stat. 695, as amended, 62 Stat. 1017 (42 
U.S.C. 248).

    Source: 42 FR 60742, Nov. 29, 1977, unless otherwise noted.



Sec. 35.61  Applicability.

    This subpart sets forth the policies and procedures governing the 
acceptance and administration of contributions of money or property 
intended solely for the benefit of all patients in a ward or unit or a 
particular hospital or station of the Public Health Service, excluding 
outpatient clinics. Such contributions are distinguishable from (a) 
monies or other valuables belonging to specific patients which are 
accepted and held in custody for the convenience of the patient until 
such time as he or she wishes to withdraw them, and (b) gifts to the 
United States to support Public Health Service functions under section 
501 of the Public Health Service Act or other statutory provisions, 
which may be accepted and administered only in accordance with such 
statutory provisions or other applicable laws.



Sec. 35.62  Acceptance of contributions.

    (a) The officer in charge of a hospital or station or his delegate 
may accept contributions of money or personal property which are donated 
for the

[[Page 120]]

general benefit of all patients within the hospital or station (or a 
ward or unit thereof) without further specification or conditions as to 
use. Contributions tendered subject to conditions by the donor, such as 
expenditure or use only on behalf of certain patients or for specific 
purposes, may not be accepted.
    (b) Contribution of money or property shall be accepted in writing.



Sec. 35.63  Report of and accounting for contributions.

    (a) Contributions of money accepted pursuant to Sec. 35.62 
(hereinafter referred to as ``patient fund'') will be treated 
consistently with Federal deposit rules and as supplemented with 
appropriate procedures of the facility. This regulation is not intended 
to exclude contributions for the benefit of patients from proper 
accountability and control of funds and property.
    (b) Contributions of property accepted pursuant to Sec. 35.62 shall 
be recorded and accounted for in the same manner as other property of a 
similar kind maintained in the hospital or station, but with suitable 
identification so that it can be distinguished from government-owned 
property.



Sec. 35.64  Donors.

    Authorized contributions may be accepted from patients, employees 
and other individuals, and agencies and organizations.



Sec. 35.65  Acceptable personal property.

    Contributions of personal property which may be accepted pursuant to 
Sec. 35.62 include, but are not limited to, recreational equipment, 
furniture, radios and television sets. After its useful life, any cash 
proceeds realized upon disposition of such property shall be deposited 
to the credit of the patient fund and shall be available for expenditure 
pursuant to Sec. 35.66(c).



Sec. 35.66  Expenditure of cash contributions.

    (a) Officials authorized to accept contributions shall not maintain 
control over the actual obligation or expenditure of such monies.
    (b) Only those officers or employees specifically designated in 
writing by the officer in charge for such purpose may obligate and 
expend monies from the patient fund. The names of officials so 
designated shall be provided to the relevant fiscal control office.
    (c) Subject to availability of sufficient funds, monies in the 
patient fund may be expended for materials, services or activities which 
contribute to the well-being or morale of patients, including but not 
limited to provision of reading and entertainment materials, recreation 
activities, and, in appropriate cases, necessary financial support 
(including travel expenses, meals, and lodging) of relatives, guardians, 
or friends of patients to enable such persons to be available for the 
patient's comfort and support.
    (d) Officers in charge may issue such additional instructions, not 
inconsistent with this subpart, as may be necessary to implement its 
provisions.



PART 37_SPECIFICATIONS FOR MEDICAL EXAMINATIONS OF UNDERGROUND COAL MINERS--

Table of Contents




               Subpart_Chest Roentgenographic Examinations

Sec.
37.1 Scope.
37.2 Definitions.
37.3 Chest roentgenograms required for miners.
37.4 Plans for chest roentgenographic examinations.
37.5 Approval of plans.
37.6 Chest roentgenographic examinations conducted by the Secretary.
37.7 Transfer of affected miner to less dusty area.
37.8 Roentgenographic examination at miner's expense.
37.20 Miner identification document.

    Specifications for Performing Chest Roentgenographic Examinations

37.40 General provisions.
37.41 Chest roentgenogram specifications.
37.42 Approval of roentgenographic facilities.
37.43 Protection against radiation emitted by roentgenographic 
          equipment.

  Specifications for Interpretation, Classification, and Submission of 
                          Chest Roentgenograms

37.50 Interpreting and classifying chest roentgenograms.
37.51 Proficiency in the use of systems for classifying the 
          pneumoconioses.

[[Page 121]]

37.52 Method of obtaining definitive interpretations.
37.53 Notification of abnormal roentgenographic findings.
37.60 Submitting required chest roentgenograms and miner identification 
          documents.

                   Review and Availability of Records

37.70 Review of interpretations.
37.80 Availablity of records.

                            Subpart_Autopsies

37.200 Scope.
37.201 Definitions.
37.202 Payment for autopsy.
37.203 Autopsy specifications.
37.204 Procedure for obtaining payment.

    Authority: Sec. 203, 83 Stat. 763; 30 U.S.C. 843, unless otherwise 
noted.

    Source: 43 FR 33715, Aug. 1, 1978, unless otherwise noted.



               Subpart_Chest Roentgenographic Examinations



Sec. 37.1  Scope.

    The provisions of this subpart set forth the specifications for 
giving, interpreting, classifying, and submitting chest roentgenograms 
required by section 203 of the act to be given to underground coal 
miners and new miners.



Sec. 37.2  Definitions.

    Any term defined in the Federal Mine Safety and Health Act of 1977 
and not defined below shall have the meaning given it in the act. As 
used in this subpart:
    (a) Act means the Federal Mine Safety and Health Act of 1977 (30 
U.S.C. 801, et seq.).
    (b) ALOSH means the Appalachian Laboratory for Occupational Safety 
and Health, Box 4258, Morgantown, WV 26505. Although the Division of 
Respiratory Disease Studies, National Institute for Occupational Safety 
and Health, has programmatic responsibility for the chest 
roentgenographic examination program, the Institute's facility in 
Morgantown--ALOSH--is used throughout this subpart in referring to the 
administration of the program.
    (c) Chest roentgenogram means a single posteroanterior 
roentgenographic projection or radiograph of the chest at full 
inspiration recorded on roentgenographic film.
    (d) Convenient time and place with respect to the conduct of any 
examination under this subpart means that the examination must be given 
at a reasonable hour in the locality in which the miner resides or a 
location that is equally accessible to the miner. For example, 
examinations at the mine during, immediately preceding, or immediately 
following work and a ``no appointment'' examination at a medical 
facility in a community easily accessible to the residences of a 
majority of the miners working at the mine, shall be considered of 
equivalent convenience for purposes of this paragraph.
    (e) Institute and NIOSH mean the National Institute for Occupational 
Safety and Health Center for Disease Control, Public Health Service, 
Department of Health and Human Services.
    (f) ILO-U/C Classification means the classification of radiographs 
of the pneumoconioses devised in 1971 by an international committee of 
the International Labor Office and described in ``Medical Radiography 
and Photography,'' volume 48, No. 3, December 1972. ``ILO 
Classification'' means the classification of radiographs of the 
pneumoconioses revised in 1980 by an international committee of the 
International Labor Office and described in ``Medical Radiography and 
Photography'' volume 57, No. 1, 1981, and in ILO publication 22 (revised 
1980) from the ILO Occupational Safety and Health Series.
    (g) Miner means any individual including any coal mine construction 
worker who is working in or at any underground coal mine, but does not 
include any surface worker who does not have direct contact with 
underground coal mining or with coal processing operations.
    (h) Operator means any owner, lessee, or other person who operates, 
controls, or supervises an underground coal mine or any independent 
contractor performing services or construction at such mine.
    (i) Panel of `B' Readers means the U.S. Public Health Service 
Consultant Panel of ``B'' Readers, c/o ALOSH, P.O. Box 4258, Morgantown, 
WV 26505.

[[Page 122]]

    (j) Preemployment physical examination means any medical examination 
which includes a chest roentgenographic examination given in accordance 
with the specifications of this subpart to a person not previously 
employed by the same operator or at the same mine for which that person 
is being considered for employment.
    (k) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved may be delegated.
    (l) MSHA means the Mine Safety and Health Administration, Department 
of Labor.

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7563, Mar. 1, 1984]



Sec. 37.3  Chest roentgenograms required for miners.

    (a) Voluntary examinations. Every operator shall provide to each 
miner who is employed in or at any of its underground coal mines and who 
was employed in underground coal mining prior to December 30, 1969, or 
who has completed the required examinations under Sec. 37.3(b) an 
opportunity for a chest roentgenogram in accordance with this subpart:
    (1) Following August 1, 1978 ALOSH will notify the operator of each 
underground coal mine of a period within which the operator may provide 
examinations to each miner employed at its coal mine. The period shall 
begin no sooner than the effective date of these regulations and end no 
later than a date specified by ALOSH separately for each coal mine. The 
termination date of the period will be approximately 5 years from the 
date of the first examination which was made on a miner employed by the 
operator in its coal mine under the former regulations of this subpart 
adopted July 27, 1973. Within the period specified by ALOSH for each 
mine, the operator may select a 6-month period within which to provide 
examinations in accordance with a plan approved under Sec. 37.5.

    Example: ALOSH finds that between July 27, 1973, and March 31, 1975, 
the first roentgenogram for a miner who was employed at mine Y and who 
was employed in underground coal mining prior to December 30, 1969, was 
made on January 1, 1974. ALOSH will notify the operator of mine Y that 
the operator may select and designate on its plan a 6-month period 
within which to offer its examinations to its miners employed at mine Y. 
The 6-month period shall be scheduled between August 1, 1978 and January 
1, 1979 (5 years after January 1, 1974).

    (2) For all future voluntary examinations, ALOSH will notify the 
operator of each underground coal mine when sufficient time has elapsed 
since the end of the previous 6-month period of examinations. ALOSH will 
specify to the operator of each mine a period within which the operator 
may provide examinations to its miners employed at its coal mine. The 
period shall begin no sooner than 3\1/2\ years and end no later than 
4\1/2\ years subsequent to the ending date of the previous 6-month 
period specified for a coal mine either by the operator on an approved 
plan or by ALOSH if the operator did not submit an approved plan. Within 
the period specified by ALOSH for each mine, the operator may select a 
6-month period within which to provide examinations in accordance with a 
plan approved under Sec. 37.5.

    Example: ALOSH finds that examinations were previously provided to 
miners employed at mine Y in a 6-month period from July 1, 1979, to 
December 31, 1979. ALOSH notifies the operator at least 3 months before 
July 1, 1983 (3\1/2\ years after December 31, 1979) that the operator 
may select and designate on its plan the next 6-month period within 
which to offer examinations to its miners employed at mine Y. The 6-
month period shall be scheduled between July 1, 1983, and July 1, 1984 
(between 3\1/2\ and 4\1/2\ years after December 31, 1979).

    (3) Within either the next or future period(s) specified by ALOSH to 
the operator for each of its coal mines, the operator of the coal mine 
may select a different 6-month period for each of its mines within which 
to offer examinations. In the event the operator does not submit an 
approved plan, ALOSH will specify a 6-month period to the operator 
within which miners shall have the opportunity for examinations.
    (b) Mandatory examinations. Every operator shall provide to each 
miner who begins working in or at a coal mine for the first time after 
December 30, 1969:
    (1) An initial chest roentgenogram as soon as possible, but in no 
event later

[[Page 123]]

than 6 months after commencement of employment. A preemployment physical 
examination which was made within the 6 months prior to the date on 
which the miner started to work will be considered as fulfilling this 
requirement. An initial chest roentgenogram given to a miner according 
to former regulations for this subpart prior to August 1, 1978 will also 
be considered as fulfilling this requirement.
    (2) A second chest roentgenogram, in accordance with this subpart, 3 
years following the initial examination if the miner is still engaged in 
underground coal mining. A second roentgenogram given to a miner 
according to former regulations under this subpart prior to August 1, 
1978 will be considered as fulfilling this requirement.
    (3) A third chest roentgenogram 2 years following the second chest 
roentgenogram if the miner is still engaged in underground coal mining 
and if the second roentgenogram shows evidence of category 1, category 
2, category 3 simple pneumoconioses, or complicated pneumoconioses (ILO 
Classification).
    (c) ALOSH will notify the miner when he or she is due to receive the 
second or third mandatory examination under (b) of this section. 
Similarly, ALOSH will notify the coal mine operator when the miner is to 
be given a second examination. The operator will be notified concerning 
a miner's third examination only with the miner's written consent, and 
the notice to the operator shall not state the medical reason for the 
examination nor that it is the third examination in the series. If the 
miner is notified by ALOSH that the third mandatory examination is due 
and the operator is not so notified, availability of the 
roentgenographic examination under the operator's plan shall constitute 
the operator's compliance with the requirement to provide a third 
mandatory examination even if the miner refuses to take the examination.
    (d) The opportunity for chest roentgenograms to be available by an 
operator for purposes of this subpart shall be provided in accordance 
with a plan which has been submitted and approved in accordance with 
this subpart.
    (e) Any examinations conducted by the Secretary in the National 
Study of Coal Workers' Pneumoconiosis after January 1, 1977, but before 
August 1, 1978 shall satisfy the requirements of this section with 
respect to the specific examination given (see Sec. 37.6(d)).

[43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978, as amended at 49 
FR 7563, Mar. 1, 1984]



Sec. 37.4  Plans for chest roentgenographic examinations.

    (a) Every plan for chest roentgenographic examinations of miners 
shall be submitted on forms prescribed by the Secretary to ALOSH within 
120 calendar days after August 1, 1978. In the case of a person who 
after August 1, 1978, becomes an operator of a mine for which no plan 
has been approved, that person shall submit a plan within 60 days after 
such event occurs. A separate plan shall be submitted by the operator 
and by each construction contractor for each underground coal mine which 
has a MSHA identification number. The plan shall include:
    (1) The name, address, and telephone number of the operator(s) 
submitting the plan;
    (2) The name, MSHA identification number for respirable dust 
measurements, and address of the mine included in the plan;
    (3) The proposed beginning and ending date of the 6-month period for 
voluntary examinations (see Sec. 37.3(a)) and the estimated number of 
miners to be given or offered examinations during the 6-month period 
under the plan;
    (4) The name and location of the approved X-ray facility or 
facilities, and the approximate date(s) and time(s) of day during which 
the roentgenograms will be given to miners to enable a determination of 
whether the examinations will be conducted at a convenient time and 
place;
    (5) If a mobile facility is proposed, the plan shall provide that 
each miner be given adequate notice of the opportunity to have the 
examination and that no miner shall have to wait for an examination more 
than 1 hour before or after his or her work shift. In addition, the plan 
shall include:
    (i) The number of change houses at the mine.
    (ii) One or more alternate nonmobile approved facilities for the 
reexamination of miners and for the mandatory

[[Page 124]]

examination of miners when necessary (see Sec. 37.3(b)), or an 
assurance that the mobile facility will return to the location(s) 
specified in the plan as frequently as necessary to provide for 
examinations in accordance with these regulations.
    (iii) The name and location of each change house at which 
examinations will be given. For mines with more than one change house, 
the examinations shall be given at each change house or at a change 
house located at a convenient place for each miner.
    (6) The name and address of the ``A'' or ``B'' reader who will 
interpret and classify the chest roentgenograms.
    (7) Assurances that: (i) The operator will not solicit a physician's 
roentgenographic or other findings concerning any miner employed by the 
operator,
    (ii) Instructions have been given to the person(s) giving the 
examinations that duplicate roentgenograms or copies of roentgenograms 
will not be made and that (except as may be necessary for the purpose of 
this subpart) the physician's roentgenographic and other findings, as 
well as the occupational history information obtained from a miner 
unless obtained prior to employment in a preemployment examination, and 
disclosed prior to employment, will not be disclosed in a manner which 
will permit identification of the employee with the information about 
him, and
    (iii) The roentgenographic examinations will be made at no charge to 
the miner.
    (b) Operators may provide for alternate facilities and ``A'' or 
``B'' readers in plans submitted for approval.
    (c) The change of operators of any mine operating under a plan 
approved pursuant to Sec. 37.5 shall not affect the plan of the 
operator which has transferred responsibility for the mine. Every plan 
shall be subject to revision in accordance with paragraph (d) of this 
section.
    (d) The operator shall advise ALOSH of any change in its plan. Each 
change in an approved plan is subject to the same review and approval as 
the originally approved plan.
    (e) The operator shall promptly display in a visible location on the 
bulletin board at the mine its proposed plan or proposed change in plan 
when it is submitted to ALOSH. The proposed plan or change in plan shall 
remain posted in a visible location on the bulletin board until ALOSH 
either grants or denies approval of it at which time the approved plan 
or denial of approval shall be permanently posted. In the case of an 
operator who is a construction contractor and who does not have a 
bulletin board, the construction contractor must otherwise notify its 
employees of the examination arrangements. Upon request, the contractor 
must show ALOSH written evidence that its employees have been notified.
    (f) Upon notification from ALOSH that sufficient time has elapsed 
since the previous period of examinations, the operator will resubmit 
its plan for each of its coal mines to ALOSH for approval for the next 
period of examinations (see Sec. 37.3(a)(2)). The plan shall include 
the proposed beginning and ending dates of the next period of 
examinations and all information required by paragraph (a) of this 
section.

[43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978]



Sec. 37.5  Approval of plans.

    (a) Approval of plans granted prior to August 1, 1978 is no longer 
effective.
    (b) If, after review of any plan submitted pursuant to this subpart, 
the Secretary determines that the action to be taken under the plan by 
the operator meets the specifications of this subpart and will 
effectively achieve its purpose, the Secretary will approve the plan and 
notify the operator(s) submitting the plan of the approval. Approval may 
be conditioned upon such terms as the Secretary deems necessary to carry 
out the purpose of section 203 of the act.
    (c) Where the Secretary has reason to believe that he will deny 
approval of a plan he will, prior to the denial, give reasonable notice 
in writing to the operator(s) of an opportunity to amend the plan. The 
notice shall specify the ground upon which approval is proposed to be 
denied.
    (d) If a plan is denied approval, the Secretary shall advise the 
operator(s) in writing of the reasons for the denial.

[[Page 125]]



Sec. 37.6  Chest roentgenographic examinations conducted by the Secretary.

    (a) The Secretary will give chest roentgenograms or make 
arrangements with an appropriate person, agency, or institution to give 
the chest roentgenograms and with ``A'' or ``B'' readers to interpret 
the roentgenograms required under this subpart in the locality where the 
miner resides, at the mine, or at a medical facility easily accessible 
to a mining community or mining communities, under the following 
circumstances:
    (1) Where, in the judgment of the Secretary, due to the lack of 
adequate medical or other necessary facilities or personnel at the mine 
or in the locality where the miner resides, the required 
roentgenographic examination cannot be given.
    (2) Where the operator has not submitted an approvable plan.
    (3) Where, after commencement of an operator's program pursuant to 
an approved plan and after notice to the operator of his failure to 
follow the approved plan and, after allowing 15 calendar days to bring 
the program into compliance, the Secretary determines and notifies the 
operator in writing that the operator's program still fails to comply 
with the approved plan.
    (b) The operator of the mine shall reimburse the Secretary or other 
person, agency, or institution as the Secretary may direct, for the cost 
of conducting each examination made in accordance with this section.
    (c) All examinations given or arranged by the Secretary will comply 
with the time requirements of Sec. 37.3. Whenever the Secretary gives 
or arranges for the examinations of miners at a time, a written notice 
of the arrangements will be sent to the operator who shall post the 
notice on the mine bulletin board.
    (d) Operators of mines selected by ALOSH to participate in the 
National Study of Coal Workers' Pneumoconiosis (an epidemiological study 
of respiratory diseases in coal miners) and who agree to cooperate will 
have all their miners afforded the opportunity to have a chest 
roentgenogram required hereunder at no cost to the operator. For future 
examinations and for mandatory examinations each participating operator 
shall submit an approvable plan.



Sec. 37.7  Transfer of affected miner to less dusty area.

    (a) Any miner who, in the judgment of the Secretary based upon the 
interpretation of one or more of the miner's chest roentgenograms, shows 
category 1 (1/0, 1/1, 1/2), category 2 (2/1, 2/2, 2/3), or category 3 
(3/2, 3/3, 3/4) simple pneumoconioses, or complicated pneumoconioses 
(ILO Classification) shall be afforded the option of transferring from 
his or her position to another position in an area of the mine where the 
concentration of respirable dust in the mine atmosphere is not more than 
1.0 mg/m\3\ of air, or if such level is not attainable in the mine, to a 
position in the mine where the concentration of respirable dust is the 
lowest attainable below 2.0 mg/m\3\ of air.
    (b) Any transfer under this section shall be in accordance with the 
procedures specified in part 90 of title 30, Code of Federal 
Regulations.

[43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978, as amended at 44 
FR 23085, Apr. 18, 1979; 49 FR 7563, Mar. 1, 1984]



Sec. 37.8  Roentgenographic examination at miner's expense.

    Any miner who wishes to obtain an examination at his or her own 
expense at an approved facility and to have submitted to NIOSH for him 
or her a complete examination may do so, provided that the examination 
is made no sooner than 6 months after the most recent examination of the 
miner submitted to ALOSH. ALOSH will provide an interpretation and 
report of the examinations made at the miner's expense in the same 
manner as if it were submitted under an operator's plan. Any change in 
the miner's transfer rights under the act which may result from this 
examination will be subject to the terms of Sec. 37.7.



Sec. 37.20  Miner identification document.

    As part of the roentgenographic examination, a miner identification 
document which includes an occupational history questionnaire shall be 
completed for each miner at the facility where the roentgenogram is made 
at

[[Page 126]]

the same time the chest roentgenogram required by this subpart is given.

    Specifications for Performing Chest Roentgenographic Examinations



Sec. 37.40  General provisions.

    (a) The chest roentgenographic examination shall be given at a 
convenient time and place.
    (b) The chest roentgenographic examination consists of the chest 
roentgenogram, and a complete Roentgenographic Interpretation Form (Form 
CDC/NIOSH (M) 2.8), and miner identification document.
    (c) A roentgenographic examination shall be made in a facility 
approved in accordance with Sec. 37.42 by or under the supervision of a 
physician who regularly makes chest roentgenograms and who has 
demonstrated ability to make chest roentgenograms of a quality to best 
ascertain the presence of pneumoconiosis.



Sec. 37.41  Chest roentgenogram specifications.

    (a) Every chest roentgenogram shall be a single posteroanterior 
projection at full inspiration on a film being no less than 14 by 17 
inches and no greater than 16 by 17 inches. The film and cassette shall 
be capable of being positioned both vertically and horizontally so that 
the chest roentgenogram will include both apices and costophrenic 
angles. If a miner is too large to permit the above requirements, then 
the projection shall include both apices with minimum loss of the 
costophrenic angle.
    (b) Miners shall be disrobed from the waist up at the time the 
roentgenogram is given. The facility shall provide a dressing area and 
for those miners who wish to use one, the facility shall provide a clean 
gown. Facilities shall be heated to a comfortable temperature.
    (c) Roentgenograms shall be made only with a diagnostic X-ray 
machine having a rotating anode tube with a maximum of a 2 mm. source 
(focal spot).
    (d) Except as provided in paragraph (e) of this section, 
roentgenograms shall be made with units having generators which comply 
with the following: (1) The generators of existing roentgenographic 
units acquired by the examining facility prior to July 27, 1973, shall 
have a minimum rating of 200 mA at 100 kVp.; (2) generators of units 
acquired subsequent to that date shall have a minimum rating of 300 mA 
at 125 kVp.

    Note: A generator with a rating of 150 kVp. is recommended.

    (e) Roentgenograms made with battery-powered mobile or portable 
equipment shall be made with units having a minimum rating of 100 mA at 
110 kVp. at 500 Hz, or of 200 mA at 110 kVp. at 60 Hz.
    (f) Capacitor discharge and field emission units may be used if the 
model of such units is approved by ALOSH for quality, performance, and 
safety. ALOSH will consider such units for approval when listed by a 
facility seeking approval under Sec. 37.42 of this subpart.
    (g) Roentgenograms shall be given only with equipment having a beam-
limiting device which does not cause large unexposed boundaries. The 
beam limiting device shall provide rectangular collimation and shall be 
of the type described in part F of the suggested State regulations for 
the control of radiation or (for beam limiting devices manufactured 
after August 1, 1974) of the type specified in 21 CFR 1020.31. The use 
of such a device shall be discernible from an examination of the 
roentgenogram.
    (h) To insure high quality chest roentgenograms:
    (1) The maximum exposure time shall not exceed \1/20\ of a second 
except that with single phase units with a rating less than 300 mA at 
125 kVp. and subjects with chests over 28 cm. posteroanterior, the 
exposure may be increased to not more than \1/10\ of a second;
    (2) The source or focal spot to film distance shall be at least 6 
feet;
    (3) Medium speed film and medium speed intensifying screens are 
recommended. However, any film-screen combination, the rated ``speed'' 
of which is at least 100 and does not exceed 300, which produces 
roentgenograms with spatial resolution, contrast, latitude and quantum 
mottle

[[Page 127]]

similar to those of systems designated as ``medium speed'' may be 
employed;
    (4) Film-screen contact shall be maintained and verified at 6 month 
or shorter intervals;
    (5) Intensifying screens shall be inspected at least once a month 
and cleaned when necessary by the method recommended by the 
manufacturer;
    (6) All intensifying screens in a cassette shall be of the same type 
and made by the same manufacturer;
    (7) When using over 90 kV., a suitable grid or other means of 
reducing scattered radiation shall be used;
    (8) The geometry of the radiographic system shall insure that the 
central axis (ray) of the primary beam is perpendicular to the plane of 
the film surface and impinges on the center of the film;
    (9) A formal quality assurance program shall be established at each 
facility.
    (i) Radiographic processing:
    (1) Either automatic or manual film processing is acceptable. A 
constant time-temperature technique shall be meticulously employed for 
manual processing.
    (2) If mineral or other impurities in the processing water introduce 
difficulty in obtaining a high-quality roentgenogram, a suitable filter 
or purification system shall be used.
    (j) Before the miner is advised that the examination is concluded, 
the roentgenogram shall be processed and inspected and accepted for 
quality by the physician, or if the physician is not available, 
acceptance may be made by the radiologic technologist. In a case of a 
substandard roentgenogram, another shall be immediately made. All 
substandard roentgenograms shall be clearly marked as rejected and 
promptly sent to ALOSH for disposal.
    (k) An electric power supply shall be used which complies with the 
voltage, current, and regulation specified by the manufacturer of the 
machine.
    (l) A densitometric test object may be required on each 
roentgenogram for an objective evaluation of film quality at the 
discretion of ALOSH.
    (m) Each roentgenogram made hereunder shall be permanently and 
legibly marked with the name and address or ALOSH approval number of the 
facility at which it is made, the social security number of the miner, 
and the date of the roentgenogram. No other identifying markings shall 
be recorded on the roentgenogram.

[43 FR 33715, Aug. 1, 1978, as amended at 52 FR 7866, Mar. 13, 1987]



Sec. 37.42  Approval of roentgenographic facilities.

    (a) Approval of roentgenographic facilities given prior to January 
1, 1976, shall terminate upon August 1, 1978 unless each of the 
following conditions have been met:
    (1) The facility must verify that it still meets the requirements 
set forth in the regulations for the second round of roentgenographic 
examinations (38 FR 20076) and it has not changed equipment since it was 
approved by NIOSH.
    (2) From July 27, 1973, to January 1, 1976, the facility submitted 
to ALOSH at least 50 roentgenograms which were interpreted by one or 
more ``B'' readers not employed by the facility who found no more than 5 
percent of all the roentgenograms unreadable.
    (b) Other facilities will be eligible to participate in this program 
when they demonstrate their ability to make high quality diagnostic 
chest roentgenograms by submitting to ALOSH six or more sample chest 
roentgenograms made and processed at the applicant facility and which 
are of acceptable quality to the Panel of ``B'' readers. Applicants 
shall also submit a roentgenogram of a plastic step-wedge object 
(available on loan from ALOSH) which was made and processed at the same 
time with the same technique as the roentgenograms submitted and 
processed at the facility for which approval is sought. At least one 
chest roentgenogram and one test object roentgenogram shall have been 
made with each unit to be used hereunder. All roentgenograms shall have 
been made within 15 calendar days prior to submission and shall be 
marked to identify the facility where each roentgenogram was made, the 
X-ray machine used, and the date each was made. The chest roentgenograms 
will be returned and may be the same roentgenograms submitted pursuant 
to Sec. 37.51.

    Note: The plastic step-wedge object is described in an article by E. 
Dale Trout and

[[Page 128]]

John P. Kelley appearing in ``The American Journal of Roentgenology, 
Radium Therapy and Nuclear Medicine,'' Vol. 117, No. 4, April 1973.

    (c) Each roentgenographic facility submitting chest roentgenograms 
for approval under this section shall complete and include an X-ray 
facility document describing each X-ray unit to be used to make chest 
roentgenograms under the act. The form shall include: (1) The date of 
the last radiation safety inspection by an appropriate licensing agency 
or, if no such agency exists, by a qualified expert as defined in NCRP 
Report No. 33 (see Sec. 37.43); (2) the deficiencies found; (3) a 
statement that all the deficiencies have been corrected; and (4) the 
date of acquisition of the X-ray unit. To be acceptable, the radiation 
safety inspection shall have been made within 1 year preceding the date 
of application.
    (d) Roentgenograms submitted with applications for approval under 
this section will be evaluated by the panel of ``B'' Readers or by a 
qualified radiological physicist or consultant. Applicants will be 
advised of any reasons for denial of approval.
    (e) ALOSH or its representatives may make a physical inspection of 
the applicant's facility and any approved roentgenographic facility at 
any reasonable time to determine if the requirements of this subpart are 
being met.
    (f) ALOSH may require a facility periodically to resubmit 
roentgenograms of a plastic step-wedge object, sample roentgenograms, or 
a Roentgenographic Facility Document for quality control purposes. 
Approvals granted hereunder may be suspended or withdrawn by notice in 
writing when in the opinion of ALOSH the quality of roentgenograms or 
information submitted under this section warrants such action. A copy of 
a notice withdrawing approval will be sent to each operator who has 
listed the facility as its facility for giving chest roentgenograms and 
shall be displayed on the mine bulletin board adjacent to the operator's 
approved plan. The approved plan will be reevaluated by ALOSH in light 
of this change.

[43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978]



Sec. 37.43  Protection against radiation emitted by roentgenographic 

equipment.

    Except as otherwise specified in Sec. 37.41, roentgenographic 
equipment, its use and the facilities (including mobile facilities) in 
which such equipment is used, shall conform to applicable State and 
Federal regulations (See 21 CFR part 1000). Where no applicable 
regulations exist, roentgenographic equipment, its use and the 
facilities (including mobile facilities) in which such equipment is used 
shall conform to the recommendations of the National Council on 
Radiation Protection and Measurements in NCRP Report No. 33 ``Medical X-
ray and Gamma-Ray Protection for Energies up to 10 MeV--Equipment Design 
and Use'' (issued February 1, 1968), in NCRP Report No. 48, ``Medical 
Radiation Protection for Medical and Allied Health Personnel'' (issued 
August 1, 1976), and in NCRP Report No. 49, ``Structural Shielding 
Design and Evaluation for Medical Use of X-rays and Gamma Rays of up to 
10 MeV'' (issued September 15, 1976). These documents are hereby 
incorporated by reference and made a part of this subpart. These 
documents are available for examination at ALOSH, 944 Chestnut Ridge 
Road, Morgantown, WV 26505, and at the National Institute for 
Occupational Safety and Health, 5600 Fishers Lane, Rockville, MD 20857. 
Copies of NCRP Reports Nos. 33, 48, and 49 may be purchased for $3, 
$4.50, and $3.50 each, respectively, from NCRP Publications, P.O. Box 
30175, Washington, DC 20014.

  Specifications for Interpretation, Classification, and Submission of 
                          Chest Roentgenograms



Sec. 37.50  Interpreting and classifying chest roentgenograms.

    (a) Chest roentgenograms shall be interpreted and classified in 
accordance with the ILO Classification system and recorded on a 
Roentgenographic Interpretation Form (Form CDC/NIOSH (M)2.8).
    (b) Roentgenograms shall be interpreted and classified only by a 
physician who regularly reads chest roentgenograms and who has 
demonstrated proficiency in classifying the

[[Page 129]]

pneumoconioses in accordance with Sec. 37.51.
    (c) All interpreters, whenever interpreting chest roentgenograms 
made under the Act, shall have immediately available for reference a 
complete set of the ILO International Classification of Radiographs for 
Pneumoconioses, 1980.

    Note: This set is available from the International Labor Office, 
1750 New York Avenue, NW., Washington, DC 20006 (Phone: 202/376-2315).

    (d) In all view boxes used for making interpretations:
    (1) Fluorescent lamps shall be simultaneously replaced with new 
lamps at 6-month intervals;
    (2) All the fluorescent lamps in a panel of boxes shall have 
identical manufacturer's ratings as to intensity and color;
    (3) The glass, internal reflective surfaces, and the lamps shall be 
kept clean;
    (4) The unit shall be so situated as to minimize front surface 
glare.

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984]



Sec. 37.51  Proficiency in the use of systems for classifying the 

pneumoconioses.

    (a) First or ``A'' readers:
    (1) Approval as an ``A'' reader shall continue if established prior 
to (insert) effective date of these regulations).
    (2) Physicians who desire to be ``A'' readers must demonstrate their 
proficiency in classifying the pneumoconioses by either:
    (i) Submitting to ALOSH from the physician's files six sample chest 
roentgenograms which are considered properly classified by the Panel of 
``B'' readers. The six roentgenograms shall consist of two without 
pneumoconiosis, two with simple pneumoconiosis, and two with complicated 
pneumoconiosis. The films will be returned to the physician. The 
interpretations shall be on the Roentgenographic Interpretation Form 
(Form CDC/NIOSH (M) 2.8) (These may be the same roentgenograms submitted 
pursuant to Sec. 37.42), or;
    (ii) Satisfactory completion, since June 11, 1970, of a course 
approved by ALOSH on the ILO or ILO-U/C Classification systems or the 
UICC/Cincinnati classification system. As used in this subparagraph, 
``UICC/Cincinnati classification'' means the classification of the 
pneumoconioses devised in 1968 by a Working Committee of the 
International Union Against Cancer.
    (b) Final or ``B'' readers:
    (1) Approval as a ``B'' reader established prior to October 1, 1976, 
shall hereby be terminated.
    (2) Proficiency in evaluating chest roentgenograms for 
roentgenographic quality and in the use of the ILO Classification for 
interpreting chest roentgenograms for pneumoconiosis and other diseases 
shall be demonstrated by those physicians who desire to be ``B'' readers 
by taking and passing a specially designed proficiency examination given 
on behalf of or by ALOSH at a time and place specified by ALOSH. Each 
physician must bring a complete set of the ILO standard reference 
radiographs when taking the examination. Physicians who qualify under 
this provision need not be qualified under paragraph (a) of this 
section.
    (c) Physicians who wish to participate in the program shall make 
application on an Interpreting Physician Certification Document (Form 
CDC/NIOSH (M) 2.12).

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984]



Sec. 37.52  Method of obtaining definitive interpretations.

    (a) All chest roentgenograms which are first interpreted by an ``A'' 
or ``B'' reader will be submitted by ALOSH to a ``B'' reader qualified 
as described in Sec. 37.51. If there is agreement between the two 
interpreters as defined in paragraph (b) of this section the result 
shall be considered final and reported to MSHA for transmittal to the 
miner. When in the opinion of ALOSH substantial agreement is lacking, 
ALOSH shall obtain additional interpretations from the Panel of ``B'' 
readers. If interpretations are obtained from two or more ``B'' readers, 
and if two or more are in agreement then the highest major category 
shall be reported.
    (b) Two interpreters shall be considered to be in agreement when 
they

[[Page 130]]

both find either stage A, B, or C complicated pneumoconiosis, or their 
findings with regard to simple pneumoconiosis are both in the same major 
category, or (with one exception noted below) are within one minor 
category (ILO Classification 12-point scale) of each other. In the last 
situation, the higher of the two interpretations shall be reported. The 
only exception to the one minor category principle is a reading sequence 
of 0/1, 1/0, or 1/0, 0/1. When such a sequence occurs, it shall not be 
considered agreement, and a third (or more) interpretation shall be 
obtained until a consensus involving two or more readings in the same 
major category is obtained.

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984; 52 
FR 7866, Mar. 13, 1987]



Sec. 37.53  Notification of abnormal roentgenographic findings.

    (a) Findings of, or findings suggesting, enlarged heart, 
tuberculosis, lung cancer, or any other significant abnormal findings 
other than pneumoconiosis shall be communicated by the first physician 
to interpret and classify the roentgenogram to the designated physician 
of the miner indicated on the miner's identifcation document. A copy of 
the communication shall be submitted to ALOSH. ALOSH will notify the 
miner to contact his or her physician when any physician who interprets 
and classifies the miner's roentgenogram reports significant abnormal 
findings other than pneumoconiosis.
    (b) In addition, when ALOSH has more than one roentgenogram of a 
miner in its files and the most recent examination was interpreted to 
show enlarged heart, tuberculosis, cancer, complicated pneumoconiosis, 
and any other significant abnormal findings, ALOSH will submit all of 
the miner's roentgenograms in its files with their respective 
interprtations to a ``B'' reader. The ``B'' reader will report any 
significant changes or progression of disease or other comments to ALOSH 
and ALOSH shall submit a copy of the report to the miner's designated 
physician.
    (c) All final findings regarding pneumoconiosis will be sent to the 
miner by MSHA in accordance with section 203 of the act (see 30 CFR part 
90). Positive findings with regard to pneumoconiosis will be reported to 
the miner's designated physician by ALOSH.
    (d) ALOSH will make every reasonable effort to process the findings 
described in paragraph (c) of this section within 60 days of receipt of 
the information described in Sec. 37.60 in a complete and acceptable 
form. The information forwarded to MSHA will be in a form intended to 
facilitate prompt dispatch of the findings to the miner. The results of 
an examination made of a miner will not be processed by ALOSH if the 
examination was made within 6 months of the date of a previous 
acceptable examination.



Sec. 37.60  Submitting required chest roentgenograms and miner identification 

documents.

    (a) Each chest roentgenogram required to be made under this subpart, 
together with the completed roentgenographic interpretation form and the 
completed miner identification document, shall be sumitted together for 
each miner to ALOSH within 14 calendar days after the roentgenographic 
examination is given and become the property of ALOSH.
    (b) If ALOSH deems any part submitted under paragraph (a) of this 
section inadequate, it will notify the operator of the deficiency. The 
operator shall promptly make appropriate arrangements for the necessary 
reexamination.
    (c) Failure to comply with paragraph (a) or (b) of this section 
shall be cause to revoke approval of a plan or any other approval as may 
be appropriate. An approval which has been revoked may be reinstated at 
the discretion of ALOSH after it receives satisfactory assurances and 
evidence that all deficiencies have been corrected and that effective 
controls have been instituted to prevent a recurrence.
    (d) Chest roentgenograms and other required documents shall be 
submitted only for miners. Results of preemployment physical 
examinations of persons who are not hired shall not be submitted.
    (e) If a miner refuses to participate in all phases of the 
examination prescribed in this subpart, no report need

[[Page 131]]

be made. If a miner refuses to participate in any phase of the 
examination prescribed in this subpart, all the forms shall be submitted 
with his or her name and social security account number on each. If any 
of the forms cannot be completed because of the miner's refusal, it 
shall be marked ``Miner Refuses,'' and shall be submitted. No submission 
shall be made, however, without a completed miner identification 
document containing the miner's name, address, social security number 
and place of employment.

                   Review and Availability of Records



Sec. 37.70  Review of interpretations.

    (a) Any miner who believes the interpretation for pneumoconiosis 
reported to him or her by MSHA is in error may file a written request 
with ALOSH that his or her roentgenogram be reevaluated. If the 
interpretation was based on agreement between an ``A'' reader and a 
``B'' reader, ALOSH will obtain one or more additional interpretations 
by ``B'' readers as necessary to obtain agreement in accord with Sec. 
37.52(b), and MSHA shall report the results to the miner together with 
any rights which may accrue to the miner in accordance with Sec. 37.7. 
If the reported interpretation was based on agreement between two (or 
more) ``B'' readers, the reading will be accepted as conclusive and the 
miner shall be so informed by MSHA.
    (b) Any operator who is directed by MSHA to transfer a miner to a 
less dusty atmosphere based on the most recent examination made 
subsequent to August 1, 1978, may file a written request with ALOSH to 
review its findings. The standards set forth in paragraph (a) of this 
section apply and the operator and miner will be notified by MSHA 
whether the miner is entitled to the option to transfer.



Sec. 37.80  Availability of records.

    (a) Medical information and roentgenograms on miners will be 
released by ALOSH only with the written consent from the miner, or if 
the miner is deceased, written consent from the miner's widow, next of 
kin, or legal representative.
    (b) To the extent authorized, roentgenograms will be made available 
for examination only at ALOSH.



                            Subpart_Autopsies

    Authority: Sec. 508, 83 Stat. 803; 30 U.S.C. 957.

    Source: 36 FR 8870, May 14, 1971, unless otherwise noted.



Sec. 37.200  Scope.

    The provisions of this subpart set forth the conditions under which 
the Secretary will pay pathologists to obtain results of autopsies 
performed by them on miners.



Sec. 37.201  Definitions.

    As used in this subpart:
    (a) Secretary means the Secretary of Health and Human Services.
    (b) Miner means any individual who during his life was employed in 
any underground coal mine.
    (c) Pathologist means
    (1) A physician certified in anatomic pathology or pathology by the 
American Board of Pathology or the American Osteopathic Board of 
Pathology,
    (2) A physician who possesses qualifications which are considered 
``Board of eligible'' by the American Board of Pathology or American 
Osteopathic Board of Pathology, or
    (3) An intern, resident, or other physician in a training program in 
pathology who performs the autopsy under the supervision of a 
pathologist as defined in paragraph (c) (1) or (2) of this section.
    (d) ALFORD means the Appalachian Laboratory for Occupational 
Respiratory Diseases, Public Health Service, Department of Health and 
Human Services, Post Office Box 4257, Morgantown, WV 26505.



Sec. 37.202  Payment for autopsy.

    (a) The Secretary will pay up to $200 to any pathologist who, after 
the effective date of the regulations in this part and with legal 
consent:
    (1) Performs an autopsy on a miner in accordance with this subpart; 
and
    (2) Submits the findings and other materials to ALFORD in accordance 
with this subpart within 180 calendar

[[Page 132]]

days after having performed the autopsy; and
    (3) Receives no other specific payment, fee, or reimbursement in 
connection with the autopsy from the miner's widow, his family, his 
estate, or any other Federal agency.
    (b) The Secretary will pay to any pathologist entitled to payment 
under paragraph (a) of this section and additional $10 if the 
pathologist can obtain and submits a good quality copy or original of a 
chest roentgenogram (posteroanterior view) made of the subject of the 
autopsy within 5 years prior to his death together with a copy of any 
interpretation made.

[35 FR 13206, Aug. 19, 1970, as amended at 38 FR 16353, June 22, 1973]



Sec. 37.203  Autopsy specifications.

    (a) Every autopsy for which a claim for payment is submitted 
pursuant to this part:
    (1) Shall be performed consistent with standard autopsy procedures 
such as those, for example, set forth in the ``Autopsy Manual'' prepared 
by the Armed Forces Institute of Pathology, July 1, 1960. (Technical 
Manual No. 8-300. NAVMED P-5065, Air Force Manual No. 160-19.) Copies of 
this document may be borrowed from ALFORD.
    (2) Shall include:
    (i) Gross and microscopic examination of the lungs, pulmonary 
pleura, and tracheobronchial lymph nodes;
    (ii) Weights of the heart and each lung (these and all other 
measurements required under this subparagraph shall be in the metric 
system);
    (iii) Circumference of each cardiac valve when opened;
    (iv) Thickness of right and left ventricles; these measurements 
shall be made perpendicular to the ventricular surface and shall not 
include trabeculations or pericardial fat. The right ventricle shall be 
measured at a point midway between the tricuspid valve and the apex, and 
the left ventricle shall be measured directly above the insertion of the 
anterior papillary muscle;
    (v) Size, number, consistency, location, description and other 
relevant details of all lesions of the lungs;
    (vi) Level of the diaphragm;
    (vii) From each type of suspected pneumoconiotic lesion, 
representative microscopic slides stained with hematoxylin eosin or 
other appropriate stain, and one formalin fixed, paraffin-impregnated 
block of tissue; a minimum of three stained slides and three blocks of 
tissue shall be submitted. When no such lesion is recognized, similar 
material shall be submitted from three separate areas of the lungs 
selected at random; a minimum of three stained slides and three formalin 
fixed, paraffin-impregnated blocks of tissue shall be submitted.
    (b) Needle biopsy techniques shall not be used.



Sec. 37.204  Procedure for obtaining payment.

    Every claim for payment under this subpart shall be submitted to 
ALFORD and shall include:
    (a) An invoice (in duplicate) on the pathologist's letterhead or 
billhead indicating the date of autopsy, the amount of the claim and a 
signed statement that the pathologist is not receiving any other 
specific compensation for the autopsy from the miner's widow, his 
surviving next-of-kin, the estate of the miner, or any other source.
    (b) Completed PHS Consent, Release and History Form (See Fig. 1). 
This form may be completed with the assistance of the pathologist, 
attending physician, family physician, or any other responsible person 
who can provide reliable information.
    (c) Report of autopsy:
    (1) The information, slides, and blocks of tissue required by this 
subpart.
    (2) Clinical abstract of terminal illness and other data that the 
pathologist determines is relevant.
    (3) Final summary, including final anatomical diagnoses, indicating 
presence or absence of simple and complicated pneumoconiosis, and 
correlation with clinical history if indicated.

[[Page 133]]

                                Figure 1

              U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

       Public Health Service--National Coal Workers' Autopsy Study

 Consent, Release, and History Form Federal Coal Mine Health and Safety 
                               Act of 1969

    I, ------------------, (Name) ------------ (Relationship) of ------
------------, (Name of deceased miner) do hereby authorize the 
performance of an autopsy (------------------) (Limitation, if any, on 
autopsy) on said deceased. I understand that the report and certain 
tissues as necessary will be released to the United States Public Health 
Service and to ------------------ (Name of Physician securing autopsy)

I understand that any claims in regard to the deceased for which I may 
sign a general release of medical information will result in the release 
of the information from the Public Health Service. I further understand 
that I shall not make any payment for the autopsy.

                    Occupational and Medical History

    1. Date of Birth of Deceased ------------. (Month, Day, Year)
    2. Social Security Number of Deceased ------------------.
    3. Date and Place of Death ------------, (Month, Day, Year) --------
---------- (City, County, State).
    4. Place of Last Mining Employment:
Name of Mine____________________________________________________________
Name of Mining Company__________________________________________________
Mine Address____________________________________________________________
    5. Last Job Title at Mine of Last Employment
(e.g., Continuous Miner Operator, motorman, foreman, etc.)
    6. Job Title of Principal Mining Occupation (that job to which miner 
devoted the most number of years)
                                                   (e.g., Same as above)
    7. Smoking History of Miner:
    (a) Did he ever smoke cigarettes? Yes
No______________________________________________________________________
    (b) If yes, for how many years?------------
Years.
    (c) If yes, how many cigarettes per day did he smoke on the 
average?----------------
                                                             (Number of)
Cigarettes per day.
    (d) Did he smoke cigarettes up until the time of his death? Yes ----
-- No ------
    (e) If no to (d), for how long before he died had he not been 
smoking cigarettes?
    8. Total Years in Surface and Underground Employment in Coal Mining, 
by State (If known) ------, (Years) ------------ (State).
    9. Total Years in Underground Coal Mining Employment, by State (If 
known) ------, (Years) ------------ (State).
________________________________________________________________________
                                                             (Signature)
________________________________________________________________________
                                                               (Address)
________________________________________________________________________
                                                                  (Date)
Interviewer:____________________________________________________________



PART 38_DISASTER ASSISTANCE FOR CRISIS COUNSELING AND TRAINING--Table of 

Contents




Sec.
38.1 Purpose; coordination.
38.2 Definitions.
38.3 Assistance; procedures, limitations.
38.4 Contracts.
38.5 Grant assistance.
38.6 Nondiscrimination.
38.7 Nonliability.
38.8 Criminal and civil penalties.
38.9 Federal audits.

    Authority: Sec. 413, Pub. L. 93-288. The Disaster Relief Act of 
1974, 88 Stat. 157, 42 U.S.C. 5183, EO 11795, 39 FR 25939, as amended by 
EO 11910, 41 FR 15681.

    Source: 41 FR 52052, Nov. 26, 1976, unless otherwise noted.



Sec. 38.1  Purpose; coordination.

    (a) Purpose. This part establishes standards and procedures for the 
implementation of section 413 of Pub. L. 93-288, the Disaster Relief Act 
of 1974 (42 U.S.C. 5183) which authorizes the provision, either directly 
or through financial assistance to State or local agencies or private 
mental health organizations, of:
    (1) Professional counseling services to victims of a major disaster 
in order to relieve mental health problems caused or aggravated by such 
a major disaster or its aftermath; and
    (2) Training of disaster workers to provide or assist in providing 
those professional counseling services.
    (b) Coordination. The Secretary, acting through the National 
Institute of Mental Health, will, as provided in 24 CFR 2205.51, carry 
out section 413 of the Act and this part in coordination with and under 
the general policy guidance of, the Administrator of the Federal 
Disaster Assistance Administration. Contracts and grants awarded under 
this part are subject to all applicable provisions of the Act and the 
implementing regulations promulgated by the Administrator (24 CFR part 
2205).

[[Page 134]]



Sec. 38.2  Definitions.

    All terms not defined herein shall have the same meaning as given 
them in the Act. As used in this part:
    (a) Act means the Disaster Relief Act of 1974 (42 U.S.C. 5121, et 
seq.).
    (b) Administrator means the Administrator, Federal Disaster 
Assistance Administration (FDAA), Department of Housing and Urban 
Development, and any other person to whom he delegates the authority.
    (c) Contractor means any public agency or private mental health 
organization which, pursuant to this part, contracts with the Secretary 
to provide professional mental health crisis counseling services or to 
provide mental health training for disaster workers.
    (d) Crisis means the existence of any life situation resulting from 
a major disaster or its aftermath which so effects the emotional and 
mental equilibrium of a disaster victim that professional mental health 
counseling services should be provided to help preclude possible 
damaging physical or psychological effects.
    (e) Disaster workers means mental health specialists such as 
psychiatrists, psychologists, psychiatric nurses, social workers, or 
qualified agents thereof.
    (f) Federal Coordinating Officer means the person appointed by the 
Administrator to coordinate Federal assistance in a major disaster.
    (g) Governor means the chief executive of a State.
    (h) Grantee means any public agency or private nonprofit mental 
health organization which, pursuant to this part, is awarded a grant for 
the purpose of providing professional mental health crisis counseling 
services or mental health training for disaster workers.
    (i) Major disaster means any hurricane, tornado, storm, flood, high-
water, wind-driven water, tidal wave, tsunami, earthquake, volcanic 
eruption, landslide, mudslide, snowstorm, drought, fire, explosion, or 
other catastrophe in any part of the United States which, in the 
determination of the President, causes damage of sufficient severity and 
magnitude to warrant major disaster assistance under the Act above and 
beyond emergency services by the Federal Government, to supplement the 
efforts and available resources of the States, local governments, and 
disaster relief organizations, in alleviating the damage, loss, 
hardship, or suffering caused thereby.
    (j) Regional Director means a director of a regional office of the 
Federal Disaster Assistance Administration (FDAA).
    (k) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (l) State means any of the fifty States, the District of Columbia, 
Puerto Rico, the Virgin Islands, Guam, American Samoa, the Canal Zone, 
or the Trust Territory of the Pacific Islands.
    (m) State Coordinating Officer means the person appointed by the 
Governor to act in cooperation with the appointed Federal Coordinating 
Officer.
    (n) Training means the specific instruction which may be required to 
enable disaster workers to provide professional mental health crisis 
counseling to victims of a major disaster or its aftermath.



Sec. 38.3  Assistance; procedures, limitations.

    (a) Application. In order to obtain assistance under this part, the 
Governor or his State Coordinating Officer must, not later than 60 days 
following a major disaster declaration by the President, file with the 
appropriate Regional Director a request which includes:
    (1) An estimate of the number of disaster victims who may need 
professional mental health crisis counseling services and of the number 
of disaster workers who may need training in the provision of such 
services;
    (2) Identification of the geographical areas in which the need 
exists;
    (3) An estimate of the period during which assistance under this 
part will be required and of the total funds which will be required to 
provide such assistance;
    (4) A description of the types of mental health problems caused or 
aggravated by the major disaster or its aftermath; and

[[Page 135]]

    (5) Identification of the State and local agencies and private 
mental health organizations capable of providing professional mental 
health crisis counseling to disaster victims or training of disaster 
workers.
    (b) Review, approval. The Secretary, upon notification by the 
Administrator of a State request for assistance under this part, will 
conduct a review to determine the extent to which such assistance is 
needed to supplement assistance programs provided by State and local 
governments and private organizations and, on the basis of that review, 
prepare and submit a recommendation and report for consideration by the 
Administrator. Upon approval by the Administrator and his advancement of 
funds for carrying out the approved assistance, the Secretary may, 
within the limits of the funds advanced, provide the approved services 
either directly or through a grant or contract.
    (c) Eligibility for services. (1) In order to be eligible for the 
professional mental health crisis counseling services available under 
this part an individual must:
    (i) Have been located within the designated major disaster area or 
have been a resident of such area at the time of the major disaster or 
its aftermath; and
    (ii) Have a mental health problem which was caused or aggravated by 
the major disaster or its aftermath.
    (2) Disaster workers who are available on short notice to provide 
professional mental health crisis counseling services in a major 
disaster area are eligible for training under this part.
    (d) Time limitation. Contracts and grants awarded under this part 
will not continue beyond 180 days after the first day services are 
provided pursuant to such contracts and grants, except that upon the 
recommendation of the Secretary (1) the Regional Director may extend the 
180 day period for up to 30 days or (2) the Administrator may extend the 
180 day period for more than 30 days.



Sec. 38.4  Contracts.

    (a) Eligibility. Public agencies and private mental health 
organizations which are determined by the Secretary to be capable of 
providing the professional mental health crisis counseling services or 
mental health training of disaster workers needed as a result of a major 
disaster are eligible for the award of a contract under this part.
    (b) Use of local agencies. Preference will be given to the extent 
feasible and practicable, to those agencies and organizations which are 
located or do business primarily in the area affected by the major 
disaster.
    (c) General requirements. Contracts under this part shall be entered 
into and carried out in accordance with the provisions of chapters 1 and 
3 of title 41 of the Code of Federal Regulations and all other 
applicable laws and regulations.
    (d) Payments. The Secretary shall from time to time make payments to 
the contractor of all or a portion of the contract award, either by way 
of reimbursement for expenses incurred or in advance for expenses to be 
incurred, to the extent he determines such payments are necessary to 
promote prompt initiation and advancement of the services to be provided 
under the contract. All payments not expended by the contractor within 
the period of the contract shall be returned to the Secretary.
    (e) Reports. Contractors shall submit the following reports to the 
Secretary:
    (1) Progress reports, to be submitted at the end of the first 30 
days of the contract period and every 30 days therafter;
    (2) A final report to be submitted within 60 days of the date upon 
which the contract terminates; and
    (3) Such additional reports as the Secretary may prescribe including 
those which may be required to enable the Federal Coordinating Officer 
to carry out his functions.



Sec. 38.5  Grant assistance.

    (a) Eligibility. Public agencies and private nonprofit mental health 
organizations which are determined by the Secretary to be capable of 
providing the professional mental health crisis counseling services or 
mental health training of disaster workers needed as a result of a major 
disaster are eligible for a grant award under this part.

[[Page 136]]

    (b) Application. The application shall contain:
    (1) A proposed plan for the provision of the services for which 
grant assistance is requested;
    (2) A proposed budget for the expenditure of the requested grant 
funds; and
    (3) Such other pertinent information and assurances as the Secretary 
may require.
    (c) Grant awards. (1) Preference will be given, to the extent 
feasible and practicable, to those public and private nonprofit agencies 
and organizations which are located or do business primarily in the area 
affected by the major disaster.
    (2) Within the limits of the funds advanced by the Administrator, 
the amount of any grant award shall be determined on the basis of the 
Secretary's estimate of the sum necessary to carry out the grant 
purpose.
    (3) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.
    (d) Other HHS regulations that apply. Several other regulations 
apply to grants under this grant. These include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of Title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

    (e) Expenditure of grant funds. Any funds granted pursuant to this 
part shall be expended solely for the purposes for which the funds were 
granted in accordance with the approved application and budget, the 
regulations of this part, the terms and the conditions of the award, and 
the applicable cost principles prescribed in subpart Q of 45 CFR part 
74.
    (f) Reports. In exceptional circumstances, a grantee may be required 
to submit special progress reports, in addition to those otherwise 
required, relating to the conduct and results of the approved grant.

[41 FR 52052, Nov. 26, 1976, as amended at 45 FR 57396, Aug. 28, 1980; 
49 FR 38109, Sept. 27, 1984]



Sec. 38.6  Nondiscrimination.

    Attention is called to the requirements of 24 CFR 2205.13 relating 
to nondiscrimination on the grounds of race. religion, sex, color, age, 
economic status, or national origin in the provision of disaster 
assistance.



Sec. 38.7  Nonliability.

    Attention is called to section 308 of the Act (42 U.S.C. 5148) which 
provides that the Federal Government shall not be liable for any claim 
based upon the exercise or performance of or the failure to exercise or 
perform a discretionary function or duty on the part of a Federal agency 
or an employee of the Federal Government in carrying out the provisions 
of the Act.



Sec. 38.8  Criminal and civil penalties.

    Attention is called to section 317 of the Act (42 U.S.C. 5157) which 
provides:

    (a) Any individual who fraudulently or willfully misstates any fact 
in connection with a request for assistance under this Act shall be 
fined not more than $10,000 or imprisoned for not more than one year or 
both for each violation.
    (b) Any individual who knowingly violates any order or regulation 
under this Act shall be subject to a civil penalty of not more than 
$5,000 for each violation.
    (c) Whoever knowingly misapplies the proceeds of a loan or other 
cash benefit obtained under any section of this Act shall be subject to 
a fine in an amount equal to one and one half times the original 
principal amount of the loan or cash benefit.

[[Page 137]]



Sec. 38.9  Federal audits.

    The Secretary, the Administrator, and the Comptroller General of the 
United States, or their duly authorized representatives shall have 
access to any books, documents, papers, and records that pertain to 
Federal funds, equipment, and supplies received under this part for the 
purpose of audit and examination.

[[Page 138]]