§ 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

§ 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]

ed appropriate inpatient or outpatient treatment. If the diagnosis is not confirmed, the patient shall be discharged.

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

§ 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.

§ 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.

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]

NONBENEFICIARIES: TEMPORARY TREATMENT IN EMERGENCY

§ 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

Sec.

34.1 Applicability.

34.2

34.3

34.4

Definitions.

Examinations; female aliens.
Scope of examinations.

34.5 Aliens free of defect, disease, or disability.

34.6 Aliens afflicted with defect, disease, or disability.

34.7 Certificates and notifications; Class A. 34.8 Certificates and notifications; Class B. 34.9 Class A or Class B certificates; helpless aliens.

34.10 Certificates and notifications; Class C.

34.11 Deferral of examinations; adequacy of facilities.

34.12 Applicability of Foreign Quarantine Regulations.

34.13 Medical and other care; death. 34.14 Reexamination; convening of boards; expert witnesses; reports.

AUTHORITY: Sec. 215, 58 Stat. 690, as amended, sec. 234, 66 Stat. 198; 42 U.S.C. 216, 8 U.S.C. 1224; sec. 322, 325, 58 Stat. 696, as amended 697, as amended, secs. 212, 326, 66 Stat. 182, as amended 200; 42 U.S.C. 249, 252, 8 U.S.C. 1182, 1226.

SOURCE: 21 FR 9829, Dec. 12, 1956, unless otherwise noted.

§ 34.1 Applicability.

The provisions of this part shall apply to:

(a) The medical examination of (1) aliens applying for a visa at a consulate of the United States, (2) aliens arriving in the United States, and (3) aliens presented or referred by the Immigration Service in connection with determination of their admissibility into the United States, and

(b) The medical and other care, and burial, of aliens admitted to Public Health Service stations and hospitals at the request of the Immigration Service.

(1) Chancroid.

(2) Gonorrhea.

(3) Granuloma inguinale.

(4) Leprosy, infectious.

(5) Lymphogranuloma venereum.
(6) Syphilis, infectious stage.
(7) Tuberculosis, active.

(c) Medical certificate. A document issued to the Immigration Service by a medical examiner, reporting the presence of any physical or mental defect, disease, or disability, or the previous occurrence of one or more attacks of insanity, in an alien.

(d) Medical notification. A document issued to a consular authority by a medical examiner, reporting the presence of any physical or mental defect, disease, or disability or the previous occurrence of one or more attacks of insanity, in an alien. Medical notification shall be made on the form prescribed for reporting the results of the medical examination of applicants for visas.

(e) Medical officer. A physician of the Public Health Service assigned or detailed by the Surgeon General of the Public Health Service to make mental and physical examinations of aliens.

* (f) Medical officer in charge. A medical officer charged by the Surgeon General with responsibility for the

conduct and supervision of all medical examinations made at a designated place or in a designated area.

[21 FR 9829, Dec. 12, 1956, as amended at 26 FR 9856, Oct. 20, 1961; 35 FR 15289, Oct. 1, 1970]

§ 34.3 Examinations; female aliens.

Female aliens shall be examined only in the presence of a female nurse or other female, or by a female physician.

§ 34.4 Scope of examinations.

(a) General. In performing examinations and reexaminations, medical examiners shall give consideration to only those matters that relate to the physical or mental condition of the alien and shall issue certificates or notifications of a defect, disease, or disability or previous occurrence of one or more attacks of insanity as hereinafter provided only if the presence of such defect, disease, or disability or previous occurrence of one or more attacks of insanity has been clearly established.

(1) Persons subject to requirement for chest X-ray examination and serologic test. Except as provided in paragraph (a)(2) of this section, a chest Xray examination for tuberculosis and a serologic test for syphilis shall be required as part of the examination of:

(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.

(2) Exceptions. Neither a chest Xray examination nor a serologic test for syphilis shall be required if the alien is under the age of 15: Provided,

That a tuberculin test may be required where there is evidence of contact with a known case of tuberculosis or other reason to suspect infection with tuberculosis and a chest X-ray examination required in the event of a positive reaction, and a serologic test where there is reason to suspect infection with syphilis. Additional exceptions to the requirement for a chest Xray examination may be authorized for good cause upon application approved by the Director, Center for Disease Control, Health Services and Mental Health Administration.

(3) 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 Xray film, the medical examination report shall include 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.

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 Director, Center for Disease Control, Health Services and Mental Health

Administration.

(5) 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 FR 9829, Dec. 12, 1956, as amended at 30 FR 16112, Dec. 28, 1965; 37 FR 16937, Aug. 23, 1972]

§ 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.

§ 34.6 Aliens afflicted with defect, disease, or disability.

If an alien is found to have any physical or mental defect, disease, or disability or to have had one or more attacks of insanity, the medical examiner shall report his findings to the

(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 FR 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 fur