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civil surgeon before a medical notifica- ination procedures. A medias tion may be issued.

document may be issued for als (3) Sputum smear examination. All (1) Are not in possession of a aliens subject to the chest X-ray exam- medical notification, if required: ination requirement and for whom the (2) Have a medical notificatio radiograph shows an abnormality con

is incomplete; sistent with pulmonary tuberculosis

(3) Have a medical notification shall be required to have a sputum

is not written in English; smear examination for acid-fast bacilli. (4) Are suspected to have an e (4) How and where performed. All

able medical condition. chest X-ray films used in medical ex

(e) The Attorney General, afte aminations performed under the regu

sultation with the Secretary of lations in this part shall be large

and the Secretary of Healt: enough to encompass the entire chest

Human Services, may in emner (approximately 14 by 17 inches; 35.6x43.2

circumstances permit the medio

amination of refugees to be con cm.). Serologic testing for HIV shall be

in the United States. a sensitive and specific test, confirmed when positive by a test such as the

(1) All medical examinations sts

carried out in accordance with Western blot test or an equally reliable

technical instructions for phys. test. For aliens examined abroad, the

conducting the medical examinst serologic testing for HIV must be com

aliens as may be issued by the pleted abroad, except that the Attor

tor. Copies of such technical inse ney General after consultation with

tions are available upon request to the Secretary of State and the Sec

Director, Division of Quaresse retary of Health and Human Services

Mailstop E03, CDC, Atlanta GA 3033 may in emergency circumstances permit serologic testing of refugees for

(56 FR 25002, May 31, 1991) HIV to be completed in the United

8 34.4 Medical notifications. States. (5) Chest X-ray, laboratory, and treat

(a) Medical examiners shall is ment reports. The chest X-ray reading

medical notifications of their finci. and serologic test results for syphilis

of the presence or absence of Class : and HIV shall be included in the medi

Class B medical conditions. The pre cal notification. When the medical ex

ence of such condition must have de aminer's conclusions are based on a

clearly established.

(b) Class A medical notifications. study of more than one chest X-ray

The medical examiner shall report t film, the medical notification shall include at least a summary statement of

her findings to the consular officer:

the INS by Class A medical notific findings of the earlier films, followed

tion which lists the specific condic by a complete reading of the last film,

for which the alien may be excluded: and dates and details of any laboratory

an alien is found to have: tests and treatment for tuberculosis.

(i) A communicable disease of put) (c) Procedure for transmitting records. health significance; For aliens issued immigrant visas, the

(ii)(A) A physical or mental disorder medical notification and chest X-ray and behavior associated with the film, if any, shall be placed in a sepa- order that may pose, or has posed a rate envelope which shall be sealed and threat to the property, safety, or we. attached to the alien's visa in such a fare of the alien or others; or manner as to be readily detached at (B) A history of a physical or menta the U.S. port of entry. When more than disorder and behavior associated with one chest X-ray film is used as a basis the disorder, which behavior has posco for the examiner's conclusions, all a threat to the property, safety, or we. films shall be included.

fare of the alien or others and which (d) Failure to present records. When a behavior is likely to recur or lead te determination of admissibility is to be other harmful behavior; made at the U.S. port of entry, a medi- (iii) Drug abuse or addition, cal hold document shall be issued pend- Provided, however, That a Class A medi: ing completion of any necessary exam- cal notification of a physical or mental

der, and behavior associated with report his findings to the consular or

disorder that may pose, or has INS officer. -d, a threat to the property, safety,

(56 FR 25003, May 31, 1991) Jelfare of the alien or others, shall o case be issued with respect to an

8 34.5 Postponement of medical examn having only mental shortcomings ination.

to ignorance, or suffering only n a condition attributable to reme

Whenever, upon an examination, the

medical examiner is unable to deterble physical causes or of a temary nature, caused by a toxin, medi

mine the physical or mental condition y prescribed drug, or disease.

of an alien, completion of the medical :) The medical notification shall

examination shall be postponed for te the nature and extent of the ab

such observation and further examina*mality; the degree to which the

tion of the alien as may be reasonably en is incapable of normal physical

necessary to determine his/her physical ivity; and the extent to which the

or mental condition. The examination adition is remediable. The medical

shall be postponed for aliens who have iminer shall indicate the likelihood,

an acute infectious disease until the at because of the condition, the ap

condition is resolved. The alien shall cant will require extensive medical

be referred for medical care as necre or institutionalization.

essary. (c) Class B medical notifications. (1) If (56 FR 25003, May 31, 1991)

alien is found to have a physical or ental abnormality, disease, or dis- 8 34.6 Applicability of Foreign Quarbility serious in degree or permanent

antine Regulations. 1 nature amounting to a substantial

Aliens arriving at a port of the Uniteparture from normal well-being, the

ed States shall be subject to the appliledical examiner shall report his/her

cable provisions of 42 CFR part 71, ForEndings to the consular or INS officer

eign Quarantine, with respect to examy Class B medical notification which

ination and quarantine measures. ists the specific conditions found by he medical examiner. Provided, how

(56 FR 25003, May 31, 1991) ver, that a Class B medical notifica

8 34.7 Medical and other care; death. ion shall in no case be issued with repect to an alien having only mental (a) An alien detained by or in the shortcomings due to ignorance, or suf- custody of the INS may be provided ering only from a condition attrib- medical, surgical, psychiatric, or denutable to remediable physical causes or tal care by the Public Health Service of a temporary nature, caused by a through interagency agreements under toxin, medically prescribed drug, or which the INS shall reimburse the Pubdisease.

lic Health Service. Aliens found to be (2) The medical notification shall in need of emergency care in the course state the nature and extent of the ab- of medical examination shall be treatnormality, the degree to which the ed to the extent deemed practical by alien is incapable of normal physical the attending physician and if considactivity, and the extent to which the ered to be in need of further care, may condition is remediable. The medical be referred to the INS along with the examiner shall indicate the likelihood, physician's recommendations concernthat because of the condition, the ap ing such further care. plicant will require extensive medical (b) In case of the death of an alien, | care or institutionalization.

the body shall be delivered to the con(d) Other medical notifications. If as a sular or immigration authority con| result of the medical examination, the

cerned. If such death occurs in the | medical examiner does not find a Class United States, or in a territory or pos

A or Class B condition in an alien, the session thereof, public burial shall be

medical examiner shall so indicate on provided upon request of the INS and | the medical notification form and shall subject to its agreement to pay the 1



burial expenses. Autopsies shall not be ical examination or pertinent inte performed unless approved by the INS. tion elicited from the alien's te (56 FR 25003, May 31, 1991)


(3) Consideration of statements 8 34.8 Reexamination; convening of re- garding the alien's physical or DE

view boards; expert witnesses; re- condition made by a physician : ports.

his/her examination of the alien; (a) The Director shall

(4) An independent physical or I board of medical officers to reexamine chiatric examination of the alien an alien:

formed by the board, at the board's (1) Upon the request of the INS for a tion. reexamination by such a board; or

(d) An alien who is to be reexas (2) Upon an appeal to the INS by an shall be notified of the time and pa alien who, having received a medical of his/her reexamination not less the examination in connection with the de

days prior thereto. termination of admissiblity to the

(e) The alien, at his/her own cost E United States (including examination

expense, may introduce as witnes. on arrival and adjustment of status as

before the board such physicians provided in the immigration laws and

medical experts as the board may in regulations) has been certified for a

discretion permit; provided that t Class A condition.

alien shall be permitted to introduce u (b) For boards convened to reexamine

least one expert medical witness. Ia aliens certified as:

witnesses offered are not permitted : (1) Having a communicable disease of

the board to testify, the record of public health significance, the board shall consist of three medical officers,

proceedings shall show the reason for

the denial of permission. at least one of whom is experienced in

(1) Witnesses before the board sbs. the diagnosis and treatment of the communicable disease for which medi

be given a reasonable opportunity :

examine the medical notification as cal notification has been made, and the decision of the majority of the board

other records involved in the reexas shall prevail;

ination and to present all relevant so (2)(i) Having a physical or mental

material evidence orally or in writis disorder and behavior associated with

until such time as the proceedings en the disorder that may pose, or has

declared by the board to be closed. Der posed, a threat to the property, safety,

ing the course of the hearing the or welfare of the alien or others; or

alien's attorney or representative sha" (ii) Having a history of a physical or

be permitted to examine the alien and mental disorder and behavior associ

he/she, or the alien, shall be permitted ated with the disorder, which behavior

to examine any witnesses offered in the has posed a threat to the property,

alien's behalf and to cross-examine ans safety, or welfare of the alien or others

witnesses called by the board. If the and which behavior is likely to recur or

alien does not have an attorney or rep lead to other harmful behavior; or

resentative, the board shall assist Ibe (iii) Being a drug abuser or addict;

alien in the presentation of his/her case (3) In circumstances covered by para

to the end that all of the material and graph (b)(2) of this section, the board relevant facts may be considered. shall consist of three medical officers, (8) The findings and conclusions of at least one of whom shall be a board the board shall be based on its medical certified psychiatrist, and the decision examination of the alien, if any, and on of the majority of the board shall pre

the evidence presented and made a part vail.

of the record of its proceedings. (c) Reexamination shall include:

(h) The board shall report its findings (1) Review of all records submitted by and conclusions to the INS, and shall the alien, other witnesses, or the also give prompt notice thereof to the board;

alien if his/her reexamination has been (2) Use of any laboratory or addi- based on his/her appeal. The board's retional studies which are deemed clini- port to the INS shall specifically afcally necessary as a result of the phys- firm, modify, or reject the findings and

35.22 Attendants.

usions of prior examining medical Eers. The board shall issue its medical ication in accordance with the apble provisions of this part if it

that an alien it has reexamined i Class A or Class B condition.

If the board finds that an alien it ceexamined does not have a Class A lass B condition, it shall issue its ical notification in accordance I the applicable provisions of this

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

- After submission of its report, the od shall not be reconvened, nor Il a new board be convened, in con-tion with the same application for - ission or for adjustment of status, Sept upon the express authorization he Director.

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 pro

ceeds. 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 unaf


FR 25004, May 31, 1991)

Subpart E-Contributions for the Benefit of




Subpart A-General c. 1 Hospital and station rules. 2 Compliance with hospital rules. ..3 Noncompliance; deprivation of privi

leges. . Noncompliance; discharge or transfer. 1.5 Entitlement to care after discharge or

transfer by reason of noncompliance. 5.6 Admissions; determination of eligi3 bility for care. 35.7 Admissions; designation of person to be

notified. 5.8 Safekeeping of money and effects; with

drawals. 15.9 Disposition of money and effects left by

other than deceased patients. 135.10 Destruction of effects dangerous to

health. 35.11 Clinical records; confidential. 35.12 Solicitation of legal business prohib

ited. * 35.13 Entry for negotiation of release or set

tlement. 35.14 Solicitation of legal business; negotia

tion of release or settlement; assistance

prohibited. - 35.15 Consent to operative procedures. 35.16 Autopsies and other post-mortem op

erations. 35.17 Fees and charges for copying, certifi

cation, search of records and related services.

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Subpart B-Transter of Patients

35.21 Authorization of transfer.

157-163 0-95_-4

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

$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.

$35.5 Entitlement to care ofte

charge or transfer by reason ét

compliance. No person otherwise entitled to. treatment, or hospitalization as ice facilities, or in other facilizz the expense of the Service, shall 3 nied such care or treatment by of his prior discharge or transfer any such facility under the proti of $35.4. 8 35.6 Admissions; determination of

gibility for care. Except as may otherwise be prep for specific classes of patients by a regulations of this chapter, the of in charge of the station or hospita which application is made is author to determine the eligibility of 4 cants, as beneficiaries of the Se for care and for treatment. Such der minations shall be subject to revier: the chief of the division of the Sex responsible for administration of station or hospital concerned upon ferral made by the officer in chary doubtful cases or upon appeal made. an applicant who has been denied cat or treatment.


$35.4 Noncompliance; discharge

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.

8 35.7 Admissions; designation of pe

son to be notified. Every in-patient, at the time of mission to the hospital or station 0% soon thereafter as practicable, shall requested to designate a person or p sons to be notified in case of em gency. $35.8 Safekeeping of money and e

fects; withdrawals. (a) A place for the safekeeping C money and effects of patients shall * provided at each station or hospita and an itemized receipt therefor shal be furnished to the patient and to any other person who places money ore fects therein for the benefit of the poi tient.

(b) Money and effects may be with drawn only by or on behalf of the pla tient, by his legally appointed res! 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


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