Transmittal Notice 63-40
To prescribe the use of Form PHS-3574, Authorization for Contract or Non-Contract Medical Services (Other than Hospital or Dental Care), for use by all Indian Health facilities issuing authorization for contract medical care. This form has been developed with the cooperation of the Area Contract Medical Care Officers to provide for standardization of certain procedures in the Division's contract medical care activities. The attached material furnishes a sample of this form and gives instructions to the authorizing facilities for initiating, completing, and processing. Instructions to the vendor are on the reverse of the original copy of the 7-part snapout set.
/Carruth J. Wagner, M.D./
Carruth J. Wagner, M.D.
Assistant Surgeon General
Chief, Division of Indian Health
Part 2, Chapter 3, Table of Contents, revised page 2
Section 2-3, revised page 9
Exhibit 2-3.14(1), Instructions for completion and distribution - PHS-3574
Exhibit 2-3.14(2), Instructions for completion of individual items - PHS-3574
Exhibit 2-3.14(3), Distribution Chart - PHS-3574
Exhibit 2-3.14(4), Sample Form PHS-3574
PART 2, Chapter 3: Remove present Table of Contents and pages 9 and 10 and substitute attached revised pages.
Exhibits 2-3.14(1), (2), (3), and (4): File in proper sequence in Exhibits section of Manual.
PEN AND INK CHANGES:
Section 2-3.10F. Open Market Purchases: Delete last sentence reading "For this purpose medical authorization should be used as purchase orders."
All local Area forms used to authorize and/or provide for charges for services rendered by outside sources for contract medical care other than hospital or dental.
Indian Health Manual holders
Distribution: P-ABCDG and under d and B, C under d
Date: May 9, 1963
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