Skip to site content

Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Scroll To Top

     Indian Health Manual

Transmittal Notice 63-40

TN 63-40
05/09/63

PURPOSE

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

MATERIAL TRANSMITTED

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.


MANUAL MAINTENANCE

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."


MATERIAL SUPERSEDED

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
CPU: 25ms Clock: 0s