Att. A6 - 42 CFR Part 34

§ 32.88

42 CFR Ch. I (10–1–07 Edition)

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

NONBENEFICIARIES: TEMPORARY
TREATMENT IN EMERGENCY

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

§ 32.111 Conditions and extent of treatment; charges.

§ 32.88

(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.

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.
§ 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.
§ 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.
§ 32.91 Purchase of services for Hansen’s disease patients.

bajohnson on PROD1PC69 with CFR

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 § 32.1(f) of this
part.
[46 FR 51918, Oct. 23, 1981]

PART 34—MEDICAL EXAMINATION
OF ALIENS
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.

§ 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]

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§ 34.2

§ 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.

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§ 34.3

42 CFR Ch. I (10–1–07 Edition)

(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.

bajohnson on PROD1PC69 with CFR

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

§ 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

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§ 34.4

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; 35.6×43.2
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]

§ 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.

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§ 34.5

42 CFR Ch. I (10–1–07 Edition)

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]

§ 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]

§ 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]

§ 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

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§ 34.8

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

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[56 FR 25003, May 31, 1991]

§ 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 phys-

ical 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

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42 CFR Ch. I (10–1–07 Edition)

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
Subpart A—General

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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
35.32
35.33
35.34
35.35

Retention by patients.
Board of appraisers.
Sale; prices; deposit of proceeds.
Resale.
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
§ 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

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