[Federal Register Volume 74, Number 173 (Wednesday, September 9, 2009)]
[Notices]
[Pages 46436-46440]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-21422]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

[System Number 09-17-0003]


Privacy Act of 1974; Report of an Altered System of Records 
Medical Staff Credentials and Privileges Records

AGENCY: Department of Health and Human Services (HHS), Indian Health 
Service (IHS).

ACTION: Amendment of one altered Privacy Act system of records.

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SUMMARY: Pursuant to the provisions of the Privacy Act of 1974, as 
amended, 5 U.S.C. 552a(e)(4), the IHS has amended and is publishing the 
proposed alteration of a system of records, System No. 09-17-0003, 
``Medical Staff Credentials and Privileges Records.'' The amended and 
altered system of records makes several administrative revisions which 
includes the deletion of the Social Security Numbers (SSNs) language to 
comply with the Office of Management and Budget (OMB) Memorandum (M)07-
16, Safeguarding Against and Responding to the Breach of Personally 
Identifiable Information (May 22, 2007); and the HHS Directive 
Memorandum of October 6, 2008 to all Operating Division Heads to 
develop and execute a plan to eliminate the unnecessary collection and 
use of SSNs; and the inclusion of a new routine use to comply with OMB 
(M)07-16 and the HHS Memorandum dated September 19, 2007 to incorporate 
Notification of Breach Routine Use language; and the update of the 
Appendix 1 of the SOR.

DATES: Effective Dates: IHS filed an altered system report with the 
Chair of the House Committee on Oversight and Government Reform, the 
Chair of the Senate Committee on Homeland Security and Governmental 
Affairs, and the Administrator, Office of Information and Regulatory 
Affairs, OMB on September 9, 2009. To ensure that all parties have 
adequate time in which to comment, the altered SOR will become 
effective 40 days from the publication of the notice, or from the date 
it was submitted to OMB and the Congress, whichever is later, unless 
IHS receives comments on all portions of this notice.

ADDRESSES: The public should address comments to: Mr. William Tibbitts, 
IHS Privacy Act Officer, Division of Regulatory Affairs, Office of 
Management Services, 801 Thompson Avenue, TMP Suite 450, Rockville, MD 
20852-1627; call non-toll free (301) 443-1116; send via facsimile to 
(301) 443-2316, or send your e-mail requests, comments, and return 
address to: [email protected].

FOR FURTHER INFORMATION CONTACT: Contact Paul Fowler, D.O., J.D., IRS 
Risk Management Officer, Office of Clinical and Preventive Services, 
Suite 331, 801 Thompson Avenue, Rockville, Maryland 20852 or via the 
Internet at [email protected].

SUPPLEMENTARY INFORMATION: As required by the Privacy Act of 1974, as 
amended, 5 U.S.C. 552a(e)(4), this document sets forth the amendment of 
the proposed alteration of a system of records maintained by the IRS. 
The purpose of altering System No. 09-17-0003, ``Medical Staff 
Credentials and Privileges Records,'' is to enable IRS to reflect 
current program changes, statutory and implementation changes. The 
exclusion of SSN language; the inclusion of a new routine use and 
revision or modification of the IHS addresses in Appendix 1 is 
necessary to this system of records.

    Dated: August 28, 2009.
Yvette Roubideaux,
Director of Indian Health Service.
09-17-0003

SYSTEM NAME:
    Indian Health Service Medical Staff Credentials and Privileges 
Records, HHS/IHS/OCPS.

SECURITY CLASSIFICATION:
    None.

SYSTEM LOCATION:
    Each IHS Area Office and each IHS Service Unit (see Appendix 1). 
Records may also be located at hospitals and offices of health care 
providers who are under contract to IHS. A current list of contractor 
sites is a available by writing to the appropriate System Manager (Area 
or Service Unit Director) at the address shown in Appendix 1.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    Prospective, current and former IHS medical staff members. The term 
IHS medical staff includes fully licensed individuals permitted by law 
to provide patient care services independently and without concurrent 
professional direction or supervision, within the scope of his/her 
license and in accordance with individually granted clinical 
privileges. The IHS medical staff includes physicians (M.D. and D.O.) 
and dentists and may include other health care practitioners such as 
psychologists, optometrists, podiatrists, audiologists, and, in some 
States, certified nurse midwives. Types of

[[Page 46437]]

assignment categories of current and former IHS medical staff members 
include the following:
    Provisional--Those new members of the medical staff who are serving 
a required initial probationary period, as specified in the local 
medical staff bylaws. During this time, their qualifications for 
membership on the active or courtesy IHS medical staff are assessed.
    Active--Those members who are Federal employees and/or spend at 
least fifty percent of their professional time providing patient care 
related services in the facility.
    Temporary--Those members who provide services on a short-term basis 
or have applied for active medical staff membership and are awaiting a 
full credential review.
    Courtesy or Associate--Those members who generally provide services 
on a periodic or episodic basis (e.g., consultants for specialty 
clinics).

CATEGORIES OF RECORDS IN THE SYSTEM:
    Contains name, SSN, IHS medical staff membership and privileges 
applications and associated forms, employment data, liability insurance 
coverage, credentialing history of licensed health professionals, 
personal, educational, and demographic background information, 
professional performance information consisting of continuing 
education, performance awards, and adverse or disciplinary actions, and 
evaluations and approvals completed by IHS medical staff reviewers.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    Federal Records Act (44 U.S.C. 2901), Privacy Act of 1974, as 
amended (5 U.S.C. 552a), Indian Self Determination and Education and 
Assistance Act (25 U.S.C. 450), Snyder Act (25 U.S.C. 13), Indian 
Health Care Improvement Act (25 U.S.C. 1601 et seq.), Indian Health 
Service Transfer Act (42 U.S.C. 2001-2004).

PURPOSE(S):
    The purposes of this system are:
    1. To ensure that IHS medical staff members are qualified, 
competent and capable of delivering quality health services consistent 
with those of the medical community at large and that they are granted 
privileges commensurate with their training and competence and with the 
ability of the facility to provide adequate support equipment, 
services, and staff.
    2. To inform health care practitioner(s) and staff of health care 
facilities, State or county health professional societies or licensing 
boards to whom the subject individual may apply for clinical 
privileges, membership or licensure, of the subject individuals 
professional competence, character and ethical qualifications. This may 
include information regarding drug or alcohol abuse or dependency. 
Within the Department such releases may be made to personnel staffs of 
HHS Regional Offices.
    3. To provide adverse health care practice information to the 
National Practitioner Data Bank-Healthcare Integrity and Protection 
Data Bank (NPDB-HIPDB) established under Title IV of Public Law 99-660, 
the Health Care Quality Improvement Act of 1986, and Section 221(a) of 
Public Law 104-191, the Heath Insurance Portability and Accountability 
Act of 1996. The purpose of such a release is to provide information 
concerning a current or former IHS medical staff member whose 
professional health care activity failed to conform to generally 
accepted standards of professional medical practice.
    4. To provide health care practice information concerning current 
or former members of the IHS medical staff with Commissioned Corps 
status to the Division of Commissioned Personnel, U.S. Public Health 
Service, so that an informed decision may be made concerning the 
promotion, retention, or reassignment of the subject individual.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OF USERS AND THE PURPOSES OF SUCH USES:
    1. Records may be disclosed to organizations authorized to conduct 
evaluation studies concerning the delivery of health care services by 
the IHS (e.g., Joint Commission on the Accreditation of Healthcare 
Organizations).
    2. IHS may disclose records consisting of name, employment history 
and any professional qualification information concerning medical staff 
membership and privileges, professional competence, clinical judgment 
and personal character to a State or local government health 
professional licensing board, to the Federation of State Medical 
Boards, to the NPDB-RIPDB established under Title IV of Public Law 99-
660 and Section 221(a) of Public Law 104-191, and/or to a similar 
entity which has the authority to maintain records concerning the 
issuance, retention or revocation of licenses or registrations 
necessary to practice a health professional occupation or specialty.
    The purpose of this disclosure is to inform medical profession 
licensing boards and appropriate entities about the health care 
practices of a current, terminated, resigned, or retired IHS medical 
staff member whose professional health care activity significantly 
failed to conform to generally accepted standards of professional 
medical practice. This will be done within the guidelines for notice, 
hearing, and review as delineated in the medical staff bylaws for the 
IHS facility and/or within other HHS or IRS regulations or policies.
    3. IHS may disclose biographic data and information supplied by 
potential applicants to (a) references listed on the IHS medical staff 
and/or privileges application and associated forms for the purpose of 
evaluating the applicant's professional qualifications, experience, and 
suitability, and (b) a State or local government health profession 
licensing board, to a health-related professional organization, to the 
Federation of State Medical Boards, and to the NPDB HIPDB established 
under Title IV of Public Law 99-660 and Section 221(a) of Public Law 
104-191 or a similar entity for the purpose of verifying that all 
claimed background and employment data are valid and all claimed 
credentials are current and in good standing.
    4. Records may be disclosed to other Federal agencies (including 
the Office of Personnel Management for subject individuals applying for 
or maintaining Civil Service appointments)/to State and local 
governmental. agencies, and to organizations in the private sector to 
which the subject individual applies for clinical privileges, 
membership or licensure for the purpose of documenting the 
qualifications and competency of the subject individual to provide 
health services in his/her health profession based on the individual's 
professional performance while employed by the IHS.
    5. The Department may disclose information from this system of 
records to the Department of Justice (DOJ), or to a court or other 
tribunal, when (a) HHS, or any component thereof, or (b) any HHS 
employee in his or her official capacity; or (c) any HHS employee in 
his or her individual capacity where the DOJ (or HHS, where it is 
authorized to do so) has agreed to represent the employee; or (d) the 
United States or any agency thereof where HHS determines that the 
litigation is likely to affect HHS or any of its components, is a party 
to litigation or has an interest in such litigation, and HHS determines 
that the use of such records by the DOJ, the court or other tribunal is 
relevant and necessary to the litigation and would help in the 
effective representation of the governmental

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party, provided, however, that in each case, HH determines that such 
disclosure is compatible with the purpose for which the records were 
collected.
    6. Records may be disclosed to a congressional office from the 
record of an individual in response to a verified inquiry from the 
congressional office made at the written request of that individual.
    7. In the event that a system of records maintained by the IHS to 
carry out its functions indicates a violation or potential violation of 
law, whether civil, criminal, or regulatory in nature, and whether 
arising by general statute or particular program statute, or by 
regulation, rule or order issued pursuant thereto, the relevant records 
in the system of records may be referred to the appropriate agency, 
whether Federal, State, or local, charged with enforcing or 
implementing the statute or rule, regulation or order issued pursuant 
thereto.
    8. To appropriate Federal agencies and Department contractors that 
have a need to know the information for the purpose of assisting the 
Department's efforts to respond to a suspected or confirmed breach of 
the security or confidentiality of information maintained in this 
system of records, and the information disclosed is relevant and 
necessary for that assistance.

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, 
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
    File folders and computer-based or electronic files.

RETRIEVABILITY:
    Indexed and retrieved by name, and any other identifying numbers 
necessary to establish the identity of an individual whose record is 
maintained in the system of records.

SAFEGUARDS:
    1. Authorized Users: Access is limited to authorized personnel for 
use in the performance of their official duties. Authorized personnel 
include: Physician Recruitment and other Health Professions Branch 
Staff and Area Governing Board Members at IHS Area Offices, and Service 
Unit Directors, Clinical Directors and members of the Credentials and 
Privilege Committee of each IHS Service Unit. At each location where 
records in this system will be maintained, a list of personnel or 
categories of personnel having an official need-to-know has been 
developed and is maintained.
    2. Physical Safeguards: Records are kept in locked metal filing 
cabinets or in locked desk drawers in secured rooms at all times when 
not actually in use during working hours and at all times during non-
working hours. Record storage areas, including file cabinets and desks, 
are not left unattended or unlocked during office hours, including 
lunch hours. Computer-based or electronic records are password 
protected security and any additional internal security for database 
(linked or unlinked).
    3. Procedural Safeguards: Persons who have an official need-to-know 
are entrusted with records from this system of records and are 
instructed to safeguard the confidentiality of these records and to 
destroy all copies or to return such records when the need to know has 
expired. Instructions include the statutory penalties for 
noncompliance. Proper charge-out procedures are followed for the 
removal of records from the area in which they are maintained. Before 
an employee who will control disclosure of records can work with the 
records (i.e., employees who report to the system manager) the system 
manager or designee ensures that the employee has received training in 
the safeguards applicable to the records and is aware of the actions to 
take to restrict disclosure. When copying records for authorized 
purposes, care is taken to ensure that any imperfect pages are not left 
in the reproduction room where they can be read but are destroyed or 
obliterated.
    4. Implementation Guidelines: DHHS Chapter 45-13 and supplementary 
Chapter PHS.hf:45-13 of the General Administration Manual; DHHS, 
``Automated Information Systems Security Program Handbook,'' as 
amended; DHHS IRM Policy HHS-IRM-2000-0005, ``IRM Policy for IT 
Security for Remove Access; OMB Circular A-130 ``Management of Federal 
Information Resources''; and E-Government Act of 2002 (Pub. L. 107-347, 
44 U.S.C. Ch 36).
    5. Retention and disposal: Records are maintained by IHS for at 
least ten years after the individual's termination of employment or 
association with IHS. Records of unsuccessful applicants for medical 
staff membership will be retained for three years after his/her 
rejection. After these periods of retention expire, records are 
destroyed by shredding or burning.

SYSTEM MANAGER(S) AND ADDRESS:
    See Appendix 1.

POLICY COORDINATING OFFICIAL:
    Director, Office of Clinical and Preventive Services, IHS, 801 
Thompson Avenue, Suite 300, Rockville, Maryland 20852. The IHS Clinical 
Directors at all IHS Service Units listed in Appendix 1 are System 
Managers. IHS medical staff credentials and privileges files are stored 
at these locations. Other addresses listed in Appendix 1 are locations 
at which all or parts of these records may also be stored (Physician 
Recruiter at IRS Area Offices). Post Office box designations appearing 
in Appendix 1 should be specified when making requests by mail.

NOTIFICATION PROCEDURE:
    Requests must be made to the appropriate System Manager (Clinical 
Director for the appropriate Service Unit) listed in Appendix 1.

REQUESTS BY MAIL:
    Requests for information and/or access to records received by mail 
must contain information providing the identity of the writer and a 
reasonable description of the record desired. Written requests must 
contain, at a minimum, the name, signature, and address of the 
requester, and for unsuccessful applicants the date when the 
application was submitted, and for current or former IHS health care 
providers the dates and locations of service. We may request additional 
identification when we hold records for different persons with the same 
name or where an apparent discrepancy exists between information 
contained in the record and that provided by the individual requesting 
access to the record.

OTHER NAMES USED:
    Where an individual is seeking to obtain information about himself/
herself which may be retrieved by a different name than his/her current 
name, he/she shall be required to produce evidence to verify that he/
she is the person whose record he/she seeks.

REQUESTS IN PERSON:
    A subject individual who appears in person at a specific location 
(where he or she currently works or formerly worked) seeking access or 
disclosure of records contained in this system of records relating to 
him/her shall provide the information described in ``Requests by mail'' 
(above) and at least one piece of tangible identification such as a 
driver's license or passport.

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REQUESTS BY TELEPHONE:
    Since positive identification of the caller cannot be established, 
telephone requests are not honored.

RECORD ACCESS PROCEDURES:
SAME AS NOTIFICATION PROCEDURE:
    Requesters should also provide a reasonable description of the 
record being sought. Requesters may also request an accounting of 
disclosures that have been made of their records, if any.

CONTESTING RECORD PROCEDURES:
    Write to the appropriate Service Unit Clinical Director at the 
address specified in Appendix 1 and reasonably identify the record, 
specify the information being contested, and state the corrective 
action sought, and the reasons for requesting the correction, along 
with supporting information to show how the record is inaccurate, 
incomplete, untimely, or irrelevant.

RECORD SOURCE CATEGORIES:
    Subject individual, IRS health care personnel, references supplied 
by the subject individual, professional societies or associations, 
specialty boards, colleges and universities attended by the subject 
individual, former employers, health facilities or health providers 
with which the subject individual was associated, liability insurance 
carriers, organizations providing cardiopulmonary resuscitation 
training to the subject individual, State and local health and health 
care licensing or certifying organizations, and organizations which 
serve as repositories of information on health care professionals.

SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
    None.

Appendix 1: System Managers and IRS Locations Under Their Jurisdiction 
Where Records Are Maintained

    Director, Aberdeen Area Indian Health Service, Room 309, Federal 
Building, 115 Fourth Avenue, SE., Aberdeen, South Dakota 57401.
    Director, Cheyenne River Service Unit, Eagle Butte Indian 
Hospital, P.O. Box 1012, Eagle Butte, South Dakota 57625.
    Director, Crow Creek Service Unit, Ft. Thompson Indian Health 
Center, P.O. Box 200, Ft. Thompson, South Dakota 57339.
    Director, Fort Berthold Service Unit, Fort Berthold Indian 
Health Center, P.O. Box 400, New Town, North Dakota 58763.
    Director, Carl T. Curtis Health Center, P.O. Box 250, Macy, 
Nebraska 68039.
    Director, Fort Totten Service Unit, Fort Totten Indian Health 
Center, P.O. Box 200, Fort Totten, North Dakota 58335.
    Director, Kyle Indian Health Center, P.O. Box 540, Kyle, South 
Dakota 57752.
    Director, Lower Brule Indian Health Center, P.O. Box 191, Lower 
Brule, South Dakota 57548.
    Director, McLaughlin Indian Health Center, P.O. Box 879, 
McLaughlin, South Dakota 57642.
    Director, Omaha-Winnebago Service Unit, Winnebago, Indian 
Hospital, Winnebago, Nebraska 68071.
    Director, Pine Ridge Service Unit, Pine Ridge Indian Hospital, 
Pine Ridge, South Dakota 57770.
    Director, Rapid City Service Unit, Rapid City Indian Hospital, 
3200 Canyon Lake Drive, Rapid City, South Dakota 57701.
    Director, Rosebud Service Unit, Rosebud Indian Hospital, 
Rosebud, South Dakota 57570.
    Director, Sisseton-Wahpeton Service Unit, Sisseton Indian 
Hospital, P.O. Box 189, Sisseton, South Dakota 57262.
    Director, Standing Rock Service Unit, Fort Yates Indian 
Hospital, P.O. Box J, Fort Yates, North Dakota 58538.
    Director, Trenton-Williston Indian Health Center, P.O. Box 210, 
Trenton, North Dakota 58853.
    Director, Turtle Mountain Service Unit, Belcourt Indian 
Hospital, P.O. Box 160, Belcourt, North Dakota 58316.
    Director, Wanblee Indian Health Center, 100 Clinic Drive, 
Wanblee, South Dakota 57577.
    Director, Yankton-Wagner Service Unit, Wagner Indian Hospital, 
110 Washington Street, Wagner, South Dakota 57380.
    Director, Youth Regional Treatment Center, P.O. Box 68, 
Mobridge, South Dakota 57601.
    Director, Sac &; Fox Health Center, 307 Meskwaki Road, Tama, 
Iowa 52339.
    Director, Santee Health Center, RR2, P.O. Box 160L, Niobrara, 
Nebraska 68760.
    Director, Alaska Area Native Health Service, 4141 Ambassador 
Drive, Suite 300, Anchorage, Alaska 99508-5928.
    Director, Albuquerque Area Health Service, 5300 Homestead Road, 
NE, Albuquerque, New Mexico 87110.
    Director, Acoma-Canoncito-Laguna Service Unit, Acoma-Canoncito-
Laguna Indian Hospital, P.O. Box 130, San Fidel, New Mexico 87049.
    Director, To-Hajille Health Center, P.O. Box 3528, Canoncito, 
New Mexico 87026.
    Director, New Sunrise Treatment Center, P.O. Box 219, San Fidel, 
New Mexico 87049.
    Director, Albuquerque Service Unit, Albuquerque Indian Hospital, 
801 Vassar Drive, NE., Albuquerque, New Mexico 87106.
    Director, Albuquerque Indian Dental Clinic, P.O. Box 67830, 
Albuquerque, New Mexico 87193.
    Director, Santa Fe Service Unit, Santa Fe Indian Hospital, 1700 
Cerrillos Road, Santa Fe, New Mexico 87505.
    Director, Santa Clara Health Center, RRS, Box 446, Espanola, New 
Mexico 87532.
    Director, San Felipe Health Center, P.O. Box 4344, San Felipe, 
New Mexico 87001.
    Director, Cochiti Health Center, P.O. Box 105, 255 Cochiti 
Street, Cochiti, New Mexico 87072.
    Director, Santo Domingo Health Center, P.O. Box 340, Santo 
Domingo, New Mexico 87052.
    Director, Southern Colorado-Ute Service Unit, P.O. Box 778, 
Ignacio, Colorado 81137.
    Director, Ignacio Indian Health Center, P.O. Box 889, Ignacio, 
Colorado 81137.
    Director, Ute Mountain Ute Health Center, Towaoc, Colorado 
81334.
    Director, Jicarilla Indian Health Center, P.O. Box 187, Dulce, 
New Mexico 87528.
    Director, Mescalero Service Unit, Mescalero Indian Hospital, 
P.O. Box 210, Mescalero, New Mexico 88340.
    Director, Taos/Picuris Indian Health Center, P.O. Box 1956, 1090 
Goat Springs Road, Taos, New Mexico 87571.
    Director, Zuni Service Unit, Zuni Indian Hospital, P.O. Box 467, 
Zuni, NM 87327.
    Director, Pine Hill Health Center, P.O. Box 310, Pine Hill, New 
Mexico 87357.
    Director, Bemidji Area Indian Health Service, 522 Minnesota 
Avenue, N.W., Bemidji, Minnesota 56601.
    Director, Red Lake Service Unit, PHS Indian Hospital, Highway 1, 
Red Lake, Minnesota 56671.
    Director, Leech Lake Service Unit, PHS Indian Hospital, 425 7th 
Street, NW., Cass Lake, Minnesota 56633.
    Director, White Earth Service Unit, PHS Indian Hospital, P.O. 
Box 358, White Earth, Minnesota 56591.
    Director, Billings Area Indian Health Service, P.O. Box 36600, 
2900 4th Avenue, North Billings, Montana 59101.
    Director, Blackfeet Service Unit, Browning Indian Hospital, P.O. 
Box 760, Browning, Montana 59417.
    Director, Heart Butte PHS Indian Health Clinic, Heart Butte, 
Montana 59448.
    Director, Crow Service Unit, Crow Indian Hospital, Crow Agency, 
Montana 59022.
    Director, Lodge Grass PHS Indian Health Center, Lodge Grass, 
Montana 59090.
    Director, Pryor P1-IS Indian Health Clinic, P.O. Box 9, Pryor, 
Montana 59066.
    Director, Fort Peck Service Unit, Poplar Indian Hospital, 
Poplar, Montana 59255.
    Director, Fort Belknap Service Unit, Harlem Indian Hospital, 
Harlem, Montana 59526.
    Director, Hays PHS Indian Health Clinic, Hays, Montana 59526.
    Director, Northern Cheyenne Service Unit, Lame Deer Indian 
Health Center, Lame Deer, Montana 59043.
    Director, Wind River Service Unit, Fort Washakie Indian Health 
Center, Fort Washakie, Wyoming 82514.
    Director, Arapahoe Indian Health Center, Arapahoe, Wyoming 
82510.
    Director, Chief Redstone Indian Health Center, Wolf Point, 
Montana 59201.
    Director, California Area Indian Health Service, John B. Moss 
Federal Building, 650 Capitol Mall, Suite 7-100, Sacramento, 
California 95814.
    Director, Nashville Area Indian Health Service, 711 Stewarts 
Ferry Pike, Nashville, Tennessee 37214-2634.
    Director, Catawba PHS Indian Nation of South Carolina, P.O. Box 
188, Catawba, South Carolina 29704.
    Director, Unity Regional Youth Treatment Center, P.O. Box 27 C-
201, Cherokee, North Carolina 28719.
    Director, Navajo Area Indian Health Service, P.O. Box 9020, 
Highway 264, Window Rock, Arizona 86515-9020.

[[Page 46440]]

    Director, Chinle Service Unit, Chinle Comprehensive Health Care 
Facility, P.O. Drawer PH, Chinle, Arizona 86503.
    Director, Tsaile Health Center, P.O. Box 467, Navajo Routes 64 
&; 12, Tsaile, Arizona 86556.
    Director, Rock Point Field Clinic, c/o Tsaile Health Center, 
P.O. Box 647, Tsaile, Arizona 86557.
    Director, Pinon Health Center, P.O. Box 10, Pinon, Arizona 
86510.
    Director, Crownpoint Service Unit, Crownpoint Comprehensive 
Health Care Facility, P.O. Box 358, Crownpoint, New Mexico 87313.
    Director, Pueblo Pintado Health Station, c/o Crownpoint 
Comprehensive Health Care Facility, P.O. Box 358, Crownpoint, New 
Mexico 87313.
    Director, Fort Defiance Service Unit, Fort Defiance Indian 
Hospital, P.O. Box 649, Intersection of Navajo Routes N12 &; N7, 
Fort Defiance, Arizona 86515.
    Director, Nahata Dziil Health Center, P.O. Box 125, Sanders, 
Arizona 86512.
    Director, Gallup Service Unit, Gallup Indian Medical Center, 
P.O. Box 1337, 516 E. Nizhoni Boulevard, Gallup, New Mexico 87305.
    Director, Tohatchi Indian Health Center, P.O. Box 142, Tohatchi, 
New Mexico 87325.
    Director, Ft. Wingate Health Station, c/o Gallup Indian Medical 
Center, P.O. Box 1337, Gallup, New Mexico 87305.
    Director, Kayenta Service Unit, Kayenta Indian Health Center, 
P.O. Box 368, Kayenta, Arizona 86033.
    Director, Inscription House Health Center, P.O. Box 7397, 
Shonto, Arizona 86054.
    Director, Dennehotso Clinic, do Kayenta Health Center, P.O. Box 
368, Kayenta, Arizona 86033.
    Director, Shiprock Service Unit, Northern Navajo Medical Center, 
P.O. Box 160, U.S. Hwy 491 North, Shiprock, New Mexico 87420.
    Director, Dzilth-Na-O-Dith-Hle Indian Health Center, 6 Road 
7586, Bloomfield, New Mexico 87413.
    Director, Four Corners Regional Health Center, U.S. Hwy 160, 
Navajo Route 35-Red Mesa, HRC 6100, Box 30, Teec Nos Pos, AZ 86514
    Director, Sanostee Health Station, c/o Northern Navajo Medical 
Center, P.O. Box 160, Shiprock, New Mexico 87420.
    Director, Toadlena Health Station, c/o Northern Navajo Medical 
Center, P.O. Box 160, Shiprock, New Mexico 87420.
    Director, Teen Life Center, c/o Northern Navajo Medical Center, 
P.O. Box 160, Shiprock, New Mexico 87420.
    Director, Oklahoma City Area Indian Health Service, 701 Market 
Drive, Oklahoma City, Oklahoma 73114.
    Director, Claremore Service Unit, Claremore Comprehensive Indian 
Health Facility, West Will Rogers Boulevard and Moore, Claremore, 
Oklahoma 74017.
    Director, Clinton Service Unit, Clinton Indian Hospital, Route 
1, Box 3060, Clinton, Oklahoma 73601-9303.
    Director, El Reno PHS Indian Health Clinic, 1631A E. Highway 66, 
El Reno, Oklahoma 73036.
    Director, Watonga Indian Health Center, Route 1, Box 34-A, 
Watonga, Oklahoma 73772.
    Director, Haskell Service Unit, PHS Indian Health Center, 2415 
Massachusetts Avenue, Lawrence, Kansas 66044.
    Director, Lawton Service Unit, Lawton Indian Hospital, 1515 
Lawrie Tatum Road, Lawton, Oklahoma 73501.
    Director, Anadarko Indian Health Center, P.O. Box 828, Anadarko, 
Oklahoma 73005.
    Director, Carnegie Indian Health Center, P.O. Box 1120, 
Carnegie, Oklahoma 73150.
    Director, Holton Service Unit, PHS Indian Health Center, 100 
West 6th Street, Holton, Kansas 66436.
    Director, Pawnee Service Unit, Pawnee Indian Service Center, 
RR2, Box 1, Pawnee, Oklahoma 74058-9247.
    Director, Pawhuska Indian Health Center, 715 Grandview, 
Pawhuska, Oklahoma 74056.
    Director, Wewoka Indian Health Center, P.O. Box 1475, Wewoka, 
Oklahoma 74884.
    Director, Phoenix Area Indian Health Service, Two Renaissance 
Square, 40 North Central Avenue, Phoenix, Arizona 85004.
    Director, Colorado River Service Unit, Chemehuevi Indian Health 
Clinic, P.O. Box 1858, Havasu Landing, California 92363.
    Director, Colorado River Service Unit, Havasupai Indian Health 
Station, P.O. Box 129, Supai, Arizona 86435.
    Director, Colorado River Service Unit, Parker Indian Health 
Center, 12033 Agency Road, Parker, Arizona 85344.
    Director, Colorado River Service Unit, Peach Springs Indian 
Health Center, P.O. Box 190, Peach Springs, Arizona 86434.
    Director, Colorado River Service Unit, Sherman Indian High 
School, 9010 Magnolia Avenue, Riverside, California 92503.
    Director, Elko Service Unit, Newe Medical Clinic, 400 ``A'' Newe 
View, Ely, Nevada 89301.
    Director, Elko Service Unit, Southern Bands Health Center, 515 
Shoshone Circle, Elko, Nevada 89801.
    Director, Fort Yuma Service Unit, Fort Yuma Indian Hospital, 
P.O. Box 1368, Fort Yuma, Arizona 85366.
    Director, Reams Canyon Service Unit, Hopi Health Care Center, 
P.O. Box 4000, Polacca, Arizona 86042.
    Director, Phoenix Service Unit, Phoenix Indian Medical Center, 
4212 North 16th Street, Phoenix, Arizona 85016.
    Director, Phoenix Service Unit, Salt River Health Center, 10005 
East Osborn Road, Scottsdale, Arizona 85256.
    Director, San Carlos Service Unit, Bylas Indian Health Center, 
P.O. Box 208, Bylas, Arizona 85550.
    Director, San Carlos Service Unit, San Carlos Indian Hospital, 
P.O. Box 208, San Carlos, Arizona 85550.
    Director, Schurz Service Unit, Schurz Service Unit 
Administration, Drawer A, Schurz, Nevada 89427.
    Director, Fort McDermitt Clinic, P.O. Box 315, McDermitt, Nevada 
89421.
    Director, Unitah and Ouray Service Unit, Fort Duchesne Indian 
Health Center, P.O. Box 160, Ft. Duchesne, Utah 84026.
    Director, Whiteriver Service Unit, Cibecue Health Center, P.O. 
Box 37, Cibecue, Arizona 85941.
    Director, Whiteriver Service Unit, Whiteriver Indian Hospital, 
P.O. Box 860, Whiteriver, Arizona 85941.
    Director, Desert Vision Youth Wellness Center/RTC, P.O. Box 458, 
Sacaton, AZ 85247.
    Director, Portland Area Indian Health Service, Room 476, Federal 
Building, 1220 Southwest Third Avenue, Portland, Oregon 97204-2829.
    Director, Colville Service Unit, Colville Indian Health Center, 
P.O. Box 71-Agency Campus, Nespelem, Washington 99155.
    Director, Fort Hall Service Unit, Not-Tsoo Gah-Nee Health 
Center, P.O. Box 717, Fort Hall, Idaho 83203.
    Director, Warm Springs Service Unit, Warm Springs Indian Health 
Center, P.O. Box 1209, Warm Springs, Oregon 97761.
    Director, Weilpinit Service Unit, David C. Wynecoop Memorial 
Clinic, P.O. Box 357, Wellpinit, Washington 99040.
    Director, Western Oregon Service Unit, Chemawa Indian Health 
Center, 3750 Chemawa Road, NE., Salem, Oregon 97305-1198.
    Director, Yakama Service Unit, Yakama Indian Health Center, 401 
Buster Road, Toppenish, Washington 98948.
    Director, Tucson Area Indian Health Service, 7900 South ``J'' 
Stock Road, Tucson, Arizona 85746-9352.
    Director, Pascua Yaqui Service Unit, Division of Public Health, 
7900 South ``J'' Stock Road, Tucson, Arizona 85746.
    Director, San Xavier Indian Health Center, 7900 South ``J'' 
Stock Road, Tucson, Arizona 85746.
    Director, Sells Service Unit, Santa Rosa Indian Health Center, 
HCO1, Box 8700, Sells, Arizona 85634.
    Director, Sells Service Unit, Sells Indian Hospital, P.O. Box 
548, Sells, Arizona 85634.
    Director, Sells Service Unit, West Side Health Station, P.O. Box 
548, Sells, Arizona 85634.

[FR Doc. E9-21422 Filed 9-8-09; 8:45 am]
BILLING CODE 4165-16-M