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Transmittal Notice 73-5


TN 73-5
09/10/73

BACKGROUND:

This transmittal forwards a revision of Part 4, Chapter 3, Section 3 of the Indian Health Manual.  This section establishes Indian Health Service policy, procedures and scope of reporting of contract health services (excluding dental) provided to Indian and Alaska Native people.  This system utilizes a computer to provide the needed reports for administration and planning at all levels.  The revised forms to be used in connection with these procedures are:

HSM-43 (Rev. 7-73), Contract Health Service - "Authorization for Payment of Hospital Service Rendered"

HSM-64 (Rev. 7-73), Contract Health Service - "Authorization for Payment of Services Rendered (Other than Hospital Inpatient or Dental)"

/Emery A. Johnson, M.D./
Emery A. Johnson, M.D.
Assistant Surgeon General
Director, Indian Health Service


MATERIAL TRANSMITTED:

Table of Contents
Part 4, Chapter 3, Section 3, Pages 1-4
Appendix I, Pages 1-4
Appendix II, Pages 1-17
Exhibit 4-3.3D.3 and E.3, Distribution Chart Forms HSM-43 and HSM-64
Exhibit 4-3.3D.1, Contract Health Service - "Authorization for Payment of Hospital Services Rendered", HSM-34 (Rev. 7-73)
Exhibit 4-3.3E.1, Contract Health Service - "Authorization for Payment of Services Rendered (Other than Hospital Inpatient or Dental)", HSM-64 (Rev. 7-73)


Date:  September 10, 1973


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