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 exam

ination procedures. A medial
document may be issued for alien
(1) Are not in possession of at
medical notification, if required.
(2) Have a medical notification
is incomplete;

(3) Have a medical notification v is not written in English;

(4) Are suspected to have an e able medical condition.

(e) The Attorney General, after= sultation with the Secretary of S and the Secretary of Health Human Services, may in emery circumstances permit the medical: amination of refugees to be compe in the United States.

(f) All medical examinations sha carried out in accordance with E technical instructions for physic conducting the medical examinatio aliens as may be issued by the D tor. Copies of such technical instru tions are available upon request to 2 Director, Division of Quaranti Mailstop E03, CDC, Atlanta GA 3033 [56 FR 25002, May 31, 1991]

$34.4 Medical notifications.

(a) Medical examiners shall is medical notifications of their findig of the presence or absence of Class A Class B medical conditions. The pr ence of such condition must have be clearly established.

(b) Class A medical notifications. ( The medical examiner shall report b her findings to the consular officer: the INS by Class A medical notifis tion which lists the specific conditio for which the alien may be excluded an alien is found to have:

(i) A communicable disease of publi health significance;

(ii)(A) A physical or mental disorde and behavior associated with the di order that may pose, or has posed, threat to the property, safety, or we fare of the alien or others; or

(B) A history of a physical or mental disorder and behavior associated with the disorder, which behavior has poset a threat to the property, safety, or we fare of the alien or others and which behavior is likely to recur or lead t other harmful behavior;

(iii) Drug abuse or addition. Provided, however, That a Class A medi cal notification of a physical or mental

rder, and behavior associated with

disorder that may pose, or has d, a threat to the property, safety, welfare of the alien or others, shall O case be issued with respect to an n having only mental shortcomings

to ignorance, or suffering only in a condition attributable to remepazɔle physical causes or of a temary nature, caused by a toxin, mediy prescribed drug, or disease. ta) The medical notification shall ate the nature and extent of the abarmality; the degree to which the zen is incapable of normal physical aivity; and the extent to which the dition is remediable. The medical aminer shall indicate the likelihood, at because of the condition, the apcant will require extensive medical Ere or institutionalization.

(c) Class B medical notifications. (1) If alien is found to have a physical or ental abnormality, disease, or disility serious in degree or permanent nature amounting to a substantial eparture from normal well-being, the edical examiner shall report his/her ndings to the consular or INS officer y Class B medical notification which asts the specific conditions found by he medical examiner. Provided, howver, that a Class B medical notificaion shall in no case be issued with repect to an alien having only mental shortcomings due to ignorance, or sufering 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 exam

ination.

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

burial expenses. Autopsies shall not be performed unless approved by the INS. [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 infor tion elicited from the alien's met history;

(3) Consideration of statements garding the alien's physical or me condition made by a physician his/her examination of the alien; and (4) An independent physical or chiatric examination of the alien formed by the board, at the board's tion.

(d) An alien who is to be reexame shall be notified of the time and pr of his/her reexamination not less the days prior thereto.

(e) The alien, at his/her own costa expense, may introduce as witness before the board such physicians c medical experts as the board may in discretion permit; provided that t alien shall be permitted to introduce & least one expert medical witness. If an witnesses offered are not permitted the board to testify, the record of th proceedings shall show the reason fr the denial of permission.

(f) Witnesses before the board sha be given a reasonable opportunity t examine the medical notification and other records involved in the reexam ination and to present all relevant and material evidence orally or in writing until such time as the proceedings art declared by the board to be closed. Dur ing 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 rep resentative, 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

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

157-163 0-95--4

(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 afte charge or transfer by reason d'i compliance.

No person otherwise entitled to a treatment, or hospitalization at y ice facilities, or in other facilit the expense of the Service, shall. nied such care or treatment by res of his prior discharge or transfer t any such facility under the provi of § 35.4.

§35.6 Admissions; determination of a gibility for care.

Except as may otherwise be prove for specific classes of patients by 2 regulations of this chapter, the of in charge of the station or hospita: which application is made is authors to determine the eligibility of ap cants, as beneficiaries of the Serv for care and for treatment. Such det minations shall be subject to review: the chief of the division of the Serv responsible for administration of station or hospital concerned upon ferral made by the officer in charge doubtful cases or upon appeal made y an applicant who has been denied ca or treatment.

§ 35.7 Admissions; designation of pe son to be notified.

Every in-patient, at the time of mission to the hospital or station or s soon thereafter as practicable, shall requested to designate a person or per sons to be notified in case of emer gency.

$35.8

Safekeeping of money and fects; withdrawals.

(a) A place for the safekeeping money and effects of patients shall b provided at each station or hospital and an itemized receipt therefor shal be furnished to the patient and to any other person who places money or e fects therein for the benefit of the pe tient.

(b) Money and effects may be with drawn only by or on behalf of the p tient, by his legally appointed rep resentative authorized to receive of 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