(i) All applicants for immigrant visas, (ii) All students and exchange visitors who are required by a consular authority to have a medical examination upon application for a nonimmigrant visa,

(iii) All other applicants for a nonimmigrant visa who are required by a consular authority to have a medical examination if such X-ray examination and serologic test are considered necessary by the medical examiner, and

(iv) All aliens outside the United States who apply for conditional entry, and all aliens in the United States who apply for adjustment of status, under the immigration laws and regulations: Provided, however, That a chest X-ray examination for tuberculosis shall not be required in any case if the alien is 10 years of age or under, and a serologic test for syphilis shall not be required in any case if the alien is 14 years of age or under, unless the medical examiner has reasons to suspect that the applicant has tuberculosis or syphilis: Provided, further, That additional exceptions to the chest X-ray examination requirement may be authorized by the Chief of the Division of Foreign Quarantine of the Public Health Service.

(2) How and where performed. (i) All X-ray films used in medical examinations performed under the regulations in this part shall be at least 70 mm. in size. In case of abnormal findings in the lungs, a full-sized film (approximately 14 x 17 inches; 35.6 x 43.2 cm.) shall be used on which to base the diagnosis.

(ii) When necessary X-ray and laboratory facilities are not available to the medical examiner, the applicant shall furnish a chest X-ray film, a reading thereof, and a serologic test report in order that the medical examination may be completed. If X-ray or serologic test facilities necessary for the completion of the examination of a visa applicant or of an applicant for conditional entry are not available in the community where the examination is made, the medical examiner shall so state on the medical examination form and the procedures will be completed at the time of examination at the U.S. port of entry.

(iii) The X-ray reading and serologic test report shall be included in the medical examination report. When the medical examiner's conclusions are based

on a study of more than one X-ray film, the medical examination report shall inIclude at least a summary statement of findings in the earlier films, followed by a complete reading of the last film, and dates and details of any laboratory tests for tuberculosis.

(3) Procedure for transmitting records. For aliens issued immigrant visas, the medical examination report 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 by the medical examiner at the U.S. port of entry. The X-ray film shall be included in this envelope or, in the case of large films, shall be placed in a separate envelope which shall be sealed and given to the alien for presentation at the port of entry. For aliens issued nonimmigrant visas and for applicants for conditional entry, the medical examination report and the X-ray film shall be placed in an envelope which shall be sealed and given to the alien for presentation at the U.S. port of entry. When more than one X-ray film is used as a basis for the medical examiner's conclusions, all films shall be included. However, the X-ray film or films used in connection with the examination shall not be required to be attached to the visa or otherwise presented to the medical examiner at the U.S. port of entry when an exception to this requirement is authorized by the Chief of the Division of Foreign Quarantine of the Public Health Service.

(4) Failure to present records. If, on examination at the time determination of admissibility is to be made at the U.S. port of entry, no X-ray film or medical examination report, including X-ray reading and serologic test report, is presented in accordance with the provisions of this paragraph, a medical hold shall be issued pending completion of any necessary examination procedures.

[21 F.R. 9829, Dec. 12, 1956, as amended at 30 F.R. 16112, Dec. 28, 1965]

§ 34.5 Aliens free of defect, disease, or disability.

If an alien is found to have no physical or mental defect, disease, or disability and no history of a previous attack of insanity, the medical examiner shall so indicate to the consular or immigration authority concerned.

A Class A certificate or Class A notification shall be issued with respect to aliens who:

(a) Are mentally retarded;
(b) Are insane;

(c) Have had one or more attacks of insanity;

(d) Are afflicted with psychopathic personality, sexual deviation, or a mental defect;

(e) Are narcotic drug addicts or chronic alcoholics;

(f) Are afflicted with any dangerous contagious disease; Provided, however, That a Class A certificate or Class A notification of a mental defect, disease, or disability shall in no case be issued with respect to an alien having only mental shortcomings due to ignorance, or suffering only from a mental condition (1) attributable to remediable physical causes or (2) of a temporary nature, caused by a toxin, drug, or disease. [30 F.R. 16112, Dec. 28, 1965]

§ 34.8

Certificates and notifications; Class B.

A Class B certificate or Class B notification shall be issued with respect to an alien who has a physical defect, disease, or disability serious in degree or permanent in nature amounting to a substantial departure from normal physical well-being. The certificate, or notification, shall state the nature and extent of the defect; the degree to which the alien is incapable of normal physical activity; and the extent to which the condition is remediable.

$ 34.9 Class A or Class B certificates; helpless aliens.

If an alien with respect to whom a Class A or Class B certificate is issued is helpless from sickness, mental or physical disability, or infancy, the medical examiner shall so state in the certificate.

A Class C certificate or Class C notification shall be issued with respect to an alien who has a defect, disease, or disability other than those for which a Class A or B certificate (or notification) is required to be issued

§ 34.11 Deferral of examination; adequacy of facilities.

(a) Whenever, upon an examination, it appears to the medical officer in charge that there is doubt about the physical or mental condition of an alien, completion of the examination shall be deferred for such observation and further examination of the alien as may be reasonably necessary to determine his physical or mental condition.

(b) When, in the judgment of the medical officer in charge, a medical examination in the United States or in a territory or possession thereof cannot be satisfactorily completed at a station or place at which it is undertaken, such examination shall be discontinued and such officer shall request of the Immigration Service that the alien be removed to a place where the examination may be satisfactorily completed.

§ 34.12 Applicability of Foreign Quarantine Regulations.

Aliens arriving at a port of the United States shall be subject to the applicable provisions of Part 71 of this chapter (Foreign Quarantine Regulations of the Public Health Service) with respect to examination and sanitary and quarantine measures.

§ 34.13 Medical and other care; death.

(a) Upon request by the Immigration Service, an alien detained by it shall be admitted to a hospital or station of the Public Health Service and receive therein necessary medical, surgical, and dental care. An alien found to be in need of emergency care in the course of an examination or reexamination in the United States, or in a territory or possession thereof, shall be given such care to the extent deemed practicable by the medical officer in charge, and if in need of further care he shall be referred to the immigration authority concerned, with the medical examiner's recommendations concerning such further care.

(b) In case of death of an alien the body shall be delivered to the consular or immigration authority concerned; but

if such death occurs in the United States, or in a territory or possession thereof, public burial shall be provided upon request of the Immigration Service and subject to its agreement to pay the burial expenses. Autopsies shall not be performed unless approved by the Immigration Service.

§ 34.14 Reexamination; convening of boards; expert witnesses; reports.

(a) The Surgeon General or, when authorized, the medical officer in charge, shall convene a board of medical officers to reexamine an alien

(1) Upon the request of the Immigration Service for a reexamination by such a board, or

(2) Upon an appeal by an alien who, having received a medical examination in connection with determination of admissibility to the United States (including examination on arrival and adjustment of status as provided in the immigration laws and regulations) has been certified for: mental retardation; insanity; one or more previous attacks of insanity; psychopathic personality; sexual deviation; mental defect; narcotic drug addiction; or chronic alcoholism.

(b) Such a board shall consist of three, when practicable, but in no case less than two, medical officers. If a board of two officers is unable to reach agreement, a new board shall be convened and shall reexamine the alien. In the event that a board consists of three medical officers, the decision of the majority thereof shall prevail.

(c) Reexamination shall include:

(1) A medical examination by the board. If the mental condition of the alien is in question and the board does not include at least one officer who has had special training in the diagnosis of mental defects, diseases, and disabilities, the board shall designate a physician with such training who shall also examine the alien, and his report shall be included in the record.

(2) A review of all records submitted by the alien, other witnesses, or the board.

(3) Use of any laboratory or diagnostic methods or tests deemed advisable.

(4) Consideration of statements regarding the alien's physical or mental condition made by a physician after his examination of the alien.

(d) An alien who is to be reexamined shall be notified of the time and place

of his reexamination not less than five days prior thereto.

(e) The alien may introduce as witnesses before the board such physicians or medical experts as the board may in its discretion permit, at his own cost and expense: 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 medical certificates 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, 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 case to the end that all of the material and relevant facts may be adduced.

(g) The findings and conclusions of the board shall be based on its medical examination of the alien 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 Immigration Service, and shall also give prompt notice thereof to the alien if the reexamination has been held upon his appeal. The board's report to the Immigration Service shall specifically affirm, modify, or reject the findings and conclusions of prior examining medical officers.

(i) If the board finds that an alien reexamined by it has a defect, disease, or disability, ur has had one or more attacks of insanity, not previously certified, it shall issue its certificate in accordance with the applicable provisions of this part.

(j) 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 Surgeon General.

[21 FR. 9829, Dec. 12, 1956, as amended at 30 F.R. 16112, Dec. 28, 1965]

PART 35-HOSPITAL AND STATION

Sec.

35.1

35.2

35.3

35.4

35.5

35.6

35.7

35.8

85.9

MANAGEMENT

Subpart A-General

Hospital and station rules. Compliance with hospital rules. Noncompliance; deprivation of privileges.

Noncompliance; discharge or transfer. Entitlement to care after discharge or transfer by reason of noncompli

ance.

Admissions; determination of eligibility for care.

Admissions: designation of person to be notified.

Safekeeping of money and effects; withdrawals.

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.

Sec. 35.48

35.49 35.50

35.51

Deposit of unclaimed money; sale of unclaimed effects and deposit of proceeds.

Sale of unclaimed effects; procedures Disposition of unsold effects. Manner of delivery; costs, receipts. 35.52 Delivery of possession only; title unaffected.

AUTHORITY: The provisions of this Part 35 issued under sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216. Sec. 321, 58 Stat. 695, as amended; 42 U.S.C. 248.

SOURCE: The provisions of this Part 35 appear at 21 F.R. 9830, Dec. 12, 1956, unless otherwise noted.

§ 35.1

Subpart A-General

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. general rules governing the conduct and privileges of patients, and of members of the public while on the premises, shall be posted in prominent places.

(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.

§ 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 § 35.4. § 35.6 Admissions; determination eligibility for care.

of

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. § 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. § 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 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 § 35.10. § 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 § 35.49, and the proceeds deposited into the Treasury and credited to the above account.

§ 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 judgment 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