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Transmittal Notice 04-09

TN 04-09


This chapter establishes the Indian Health Service (IHS) policy regarding a patient?s right to accept or refuse medical or surgical treatment.  Every person recognized as competent to make medical decisions has the right to determine whether or not he/she will receive treatment.  Whenever possible, the patient or his/her surrogate should have the opportunity to consider ahead of time if life-sustaining or life-prolonging treatment is desired. It is the responsibility of all health care providers to include their patients in the decision-making process and to adhere to Federal law governing patient self-determination.

/Charles W. Grim, D.D.S./
Charles W. Grim, D.D.S., M.H.S.A.
Assistant Surgeon General
Director, IHS


Part 3, Chapter 26, ?Patient Self-Determination and Advance Directives,? Indian Health Manual (IHM).


This chapter supersedes IHS Circular No. 92-2, ?Patient Self-Determination and Advance Directives - Policy,? dated March 19, 1992.


File the attached table of contents and IHM chapter in their appropriate place.

Log and file this Transmittal Notice in sequential order.

Distribution:  IHS-wide
Date"  January 14, 2005