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Transmittal Notice 63-41

TN 63-41


In accordance with Section 2-3.13, Contract Patient Care, Form PHS-2514, Authorization for Contract or Noncontract Hospitalization (Indian Beneficiaries) has been revised in line with recommendations discussed and reviewed by Field Contract Care Officers and Headquarters personnel.  A new provision of the revised form is information on admissions of infants under one year which will aid in follow-up studies.  Also a separate section of the form has been provided for information on hospital births.  This form is prescribed for use by all Indian Health facilities issuing authorization for contract patient care in conformance with present policy of developing standardization in CMC procedures.  Attached is a sample copy of the final form together with instructions to authorizing facilities for completion and processing.  Instructions to vendor are on the reverse of original copy of the 8-part snap-out set.

/Carruth J. Wagner, M.D./
Carruth J. Wagner, M.D.
Assistant Surgeon General
Chief, Division of Indian Health


PART 2, Chapter 3, revised page 9.
Exhibit 2-3.13(1), Instructions for completion and distribution - PHS-2514.
Exhibit 2-3.13(2), Instructions for completion individual items - PHS-2514.
Exhibit 2-3.13(3), Distribution Chart - PHS-2514.
Exhibit 2-3.13(4), Sample Form PHS-2514.


Scheduled for July 1, 1963, however, a delay in distribution makes it necessary to extend this date.  Present stocks dated 10/56 should be used pending receipt of revised form at which time use of the new revision becomes mandatory.  Old stocks should then be destroyed.


DIH Operating Memorandum No. 57-40 of Janualry 16, 1957.
Form PHS-2514 dated 10/56.


Substitute the revised page 9, Sec. 2-3.13 of 5/9/63.
File Exhibits in proper sequence in Exhibits section of manual.
Add new material to Table of Contents.

Distribution:  P_ABCDG under d and B, C under d
(Indian Health Manual holders)
Date:  August 5, 1963