[Federal Register Volume 88, Number 87 (Friday, May 5, 2023)]
[Notices]
[Pages 29171-29175]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-09596]


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DEPARTMENT OF STATE

[Public Notice: 12065]


Privacy Act of 1974; System of Records

AGENCY:  Department of State.

ACTION: Notice of a modified system of records.

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SUMMARY: The information of the Bureau of Medical Services (MED) system 
is used and reviewed by medical and administrative personnel to provide 
health care to the individuals eligible to participate in the medical 
program, make clearance decisions for individuals eligible to 
participate in the health care program and for applicants to the 
Department of State, and as a reference for local medical capabilities. 
The system also serves to record and monitor the status of the 
professional credentials of Department of State Foreign Service, Civil 
Service and Locally Employed Staff healthcare providers.

DATES: In accordance with 5 U.S.C. 552a(e)(4) and (11), this modified 
system of records will be effective upon publication, except for the 
routine uses (u), (v), and (w) that are subject to a 30-day period 
during which interested persons may submit comments to the Department. 
Please submit any comments by June 5, 2023. Unless comments are 
received that would require a revision, this system of records will 
become effective on June 5, 2023.

ADDRESSES: Questions can be submitted by mail, email, or by calling 
Eric F. Stein, the Senior Agency Official for Privacy, on (202) 485-
2051. If mail, please write to: U.S Department of State; Office of 
Global Information Systems, A/GIS; Room 4534, 2201 C St. NW, 
Washington, DC 20520. If email, please address the email to the Senior 
Agency Official for Privacy, Eric F. Stein, at [email protected]. 
Please write ``Medical Records, State-24'' on the envelope or the 
subject line of your email.

FOR FURTHER INFORMATION CONTACT: Eric F. Stein, Senior Agency Official 
for Privacy; U.S. Department of State; Office of Global Information 
Services, A/GIS; Room 4534, 2201 C St. NW, Washington, DC 20520 or by 
calling (202) 485-2051.

SUPPLEMENTARY INFORMATION: The purpose of this modification is twofold: 
(1) to consolidate two existing records systems (State-71--Post 
Capabilities Database and State-24--Medical Records) into a single 
modified State-24, to accurately reflect the scope of Department 
medical records; and (2) to reflect the expansion of Medical Records to 
FedRAMP-authorized Cloud environments. The proposed merged System of 
Records will include substantive modifications to the following 
sections: Routine Uses, Categories of Records, Storage,

[[Page 29172]]

Retrievability, and Record Access Procedures. In addition, the 
Department is taking this opportunity to make minor administrative 
updates to the notice in the Security Classification and System 
Location sections.

SYSTEM NAME AND NUMBER:
    Medical Records, State-24.

SECURITY CLASSIFICATION:
    Sensitive but unclassified.

SYSTEM LOCATION:
    The Enterprise Server Operations Center (ESOC WEST) in Denver, 
Colorado. Some records may be stored within a government cloud provided 
system (Amazon Web Services and Microsoft Azure Gov) and within a 
FedRAMP authorized government cloud system provided, implemented, and 
overseen by the Department's Enterprise Server Operations Center 
(ESOC), 2201 C Street NW, Washington, DC 20520.

SYSTEM MANAGER(S):
    Director for Medical Informatics, Bureau of Medical Services, 2401 
E Street NW, Washington, DC 20522, [email protected].

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    Foreign Service Act of 1980, Sec. 904 (22 U.S.C. 4084); and 5 CFR 
part 792 (Federal Employees' Health, Counseling, and Work/Life 
Programs).

PURPOSE(S) OF THE SYSTEM:
    The records maintained in the systems include Personally 
Identifiable Information (PII) and Protected Health Information (PHI) 
and are used to enable MED's practitioners to provide the best medical 
care possible to a globally dispersed patient population. Records 
include patients' medical history/records, which are used to provide 
medical care, adjudicate medical clearances, and support medical 
evacuations. Additionally, the system describes the medical 
capabilities available at each Post to support employees under Chief of 
Mission authority. Moreover, the system also serves to provide medical 
clearances of applicants to the Department of State. The system also 
serves to record and monitor the current status of the professional 
credentials of Department of State Foreign Service, Civil Service and 
Locally Employed Staff healthcare providers.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    Applicants to the Department of State and their family members, 
U.S. Government employees and their family members, Locally Employed 
Staff, and any other individuals eligible to participate in the medical 
program of the U.S. Department of State as authorized by either section 
904 of the Foreign Service Act of 1980 (22 U.S.C. 4084) or other 
applicable legal authority. The Privacy Act defines an individual at 5 
U.S.C. 552a(a)(2) as a United States citizen or lawful permanent 
resident.

CATEGORIES OF RECORDS IN THE SYSTEM:
    Categories of records include full name; Social Security number 
(Department of State Employees and applicants only); date of birth; 
address; email address; phone number; State Global Identifier (SGID); 
reports of medical examinations and related documents, images, and 
other items; reports of treatments and other health services rendered 
to individuals; immunization records; narrative summaries of hospital 
treatments; personal medical histories; reports of on-the-job injuries 
or illnesses; reports on medical evacuation; and/or any other types of 
individually identifiable health information generated or used in the 
course of conducting health care operations. This system includes 
records that contain protected health information and does not include 
records maintained by the Department of State and/or other employers in 
their capacity as employers.
    This system also includes certain records maintained as part of the 
Department's Employee Assistance Program pursuant to 5 CFR part 792. 
The system also includes a directory of MED staff, and professional 
credentials of MED providers. The directory may include addresses, 
emails, and phone numbers for direct-hire Foreign Service, Civil 
Service, and Locally Employed Staff medical personnel. The credentials 
that are maintained include copies of licenses and certifications 
(Professional, Clinical, Drug Enforcement Administration (DEA), 
clinical privileges information, and National Provider Identifier 
(NPI)). For use by MED clinical staff, the system maintains directories 
and high-level assessments of the location and quality of medical 
resources offered in the areas surrounding most Post locations. This 
system also includes the medical clearance records of applicants to the 
Department of State who are in the final stages of their application 
process and may further include the medical clearance records of their 
family members.

RECORD SOURCE CATEGORIES:
    Information contained in these records comes from applicants, 
patients, hospitals, clinics, laboratories, private medical providers, 
employers, and medical professionals employed by the Department of 
State.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OF USERS AND PURPOSES OF SUCH USES:
    Medical Records may be disclosed:
    A. To another health care provider, a group health plan, a health 
insurance issuer, or a health maintenance organization for purposes of 
carrying out treatment, payment, or health care operations;
    B. To a parent, guardian or other person acting in loco parentis 
with respect to the subject of the information;
    C. To a health oversight agency or public health authority 
authorized by law to investigate or otherwise oversee the relevant 
conduct or conditions of the Department of State's medical program, or 
for such oversight activities as audits; civil, administrative, or 
criminal proceedings or actions; inspections; and licensure or 
disciplinary action;
    D. To a public health authority (domestic or foreign) that is 
authorized by law to collect or receive protected health information 
for the purpose of preventing or controlling disease, injury, or 
disability, including, but not limited to, the reporting of disease, 
injury, vital events such as birth or death, and the conduct of public 
health surveillance, public health investigations, and public health 
interventions;
    E. To the U.S. Department of Health and Human Services (HHS), when 
required by the Secretary of HHS;
    F. To a public health authority or other appropriate government 
authority (domestic or foreign) authorized by law to receive reports of 
child abuse or neglect;
    G. To a person subject to the jurisdiction of the Food and Drug 
Administration (FDA) with respect to an FDA-regulated product or 
activity for which that person has responsibility, for the purpose of 
activities related to the quality, safety, or effectiveness of such 
FDA-regulated product or activity;
    H. To a person who may have been exposed to a communicable disease 
or may otherwise be at risk of contracting or spreading a disease or 
condition, to the extent MED is authorized by law to notify such person 
and as necessary in the conduct of a public health intervention or 
investigation;
    I. To a government authority (domestic or foreign), including a 
social service or protective services agency, authorized by law to 
receive reports of abuse, neglect or domestic violence (1)

[[Page 29173]]

to the extent such a disclosure is required by law; (2) where in the 
exercise of professional judgment, the disclosure is necessary to 
prevent serious harm to the individual or other potential victims; or 
(3) where, if the subject of the information is incapacitated, a law 
enforcement, or other public official authorized to receive the report, 
represents that the information sought is not intended to be used 
against the individual and that an immediate enforcement activity that 
depends upon the disclosure would be adversely affected by waiting 
until the individual is able to agree to the disclosure;
    J. To the Department of Justice, as required by law, for the 
purpose of submitting information to the National Instant Criminal 
Background Check System;
    K. In the course of any judicial or administrative proceeding in 
response to an order of a court or administrative tribunal;
    L. To a law enforcement official (1) as required by law or in 
compliance with a court order or court-ordered warrant, a subpoena or 
summons issued by a judicial officer, a grand jury subpoena, or an 
administrative request, including an administrative subpoena or 
summons; (2) in response to a request for the purposes of identifying 
or locating a suspect, fugitive, material witness, or missing person; 
in response to a request for such information about an individual who 
is or is suspected to be a victim of a crime; (3) to provide notice of 
the death of an individual if there is a belief that the death may have 
resulted from criminal conduct; (4) where it is believed in good faith 
that such information constitutes evidence of criminal conduct; or (5) 
in response to an emergency, where it is believed such disclosure is 
necessary to alert law enforcement to the commission and nature of a 
crime, the location of such crime or of the victim(s) of such crime, 
and the identity, description, and location of the perpetrator of such 
crime;
    M. As necessary in order to prevent or lessen a serious and 
imminent threat to the health or safety of a person or the public or to 
a person or persons reasonably able to prevent or lessen the threat, 
including the target of the threat;
    N. To authorized federal officials for the conduct of lawful 
intelligence, counter-intelligence, and other national security 
activities authorized by the National Security Act (50 U.S.C. 401, et 
seq.) and other applicable authorities (e.g., Executive Order 12333);
    O. To authorized federal officials for the provision of protective 
services to the President or other persons authorized by 18 U.S.C. 3056 
or to foreign heads of state or other persons authorized by 22 U.S.C. 
2709(a)(3), or for the conduct of investigations authorized by 18 
U.S.C. 871 and 879;
    P. To Department of State officials for the purposes of clearance 
and suitability determinations, including (1) for a national security 
clearance conducted pursuant to Executive Orders 10450 and 12698; (2) 
for medical clearance determinations, consistent with the Foreign 
Service Act, including sections 101(a)(4), 101(b)(5), 504, and 904;
    Q. To a medical transcription or translation service for MED's 
purposes of carrying out treatment or health care operations;
    R. To a correctional institution or a law enforcement official 
having lawful custody of an individual, if the correctional institution 
or law enforcement official represents that such information is 
necessary for the provision of health care to such individual, the 
health and safety of other individuals (including others at the 
correctional institution), or the administration and maintenance of the 
safety, security, and good order of the correctional institution;
    S. To a coroner or medical examiner for the purpose of identifying 
a deceased person, determining a cause of death, or other duties as 
authorized by law;
    T. To appropriate domestic or foreign government officials 
(including but not limited to the U.S. Department of Labor), as 
authorized by and to the extent necessary to comply with laws relating 
to workers' compensation or other similar programs, established by law, 
that provide benefits for work-related injuries or illnesses without 
regard to fault.
    U. To appropriate agencies, entities, and persons when (1) the 
Department of State suspects or has confirmed that there has been a 
breach of the system of records; (2) the Department of State has 
determined that as a result of the suspected or confirmed breach there 
is a risk of harm to individuals, the Department of State (including 
its information systems, programs, and operations), the Federal 
Government, or national security; and (3) the disclosure made to such 
agencies, entities, and persons is reasonably necessary to assist in 
connection with the Department of State efforts to respond to the 
suspected or confirmed breach or to prevent, minimize, or remedy such 
harm.
    V. To another Federal agency or Federal entity, when the Department 
of State determines that information from this system of records is 
reasonably necessary to assist the recipient agency or entity in (1) 
responding to a suspected or confirmed breach or (2) preventing, 
minimizing, or remedying the risk of harm to individuals, the recipient 
agency or entity (including its information systems, programs, and 
operations), the Federal Government, or national security, resulting 
from a suspected or confirmed breach.
    W. To private sector entities when required as part of U.S. Embassy 
services or the operations of the State Department Medical Program.
    The Department of State periodically publishes in the Federal 
Register its standard routine uses that apply to all of its Privacy Act 
systems of records. These notices appear in the form of a Prefatory 
Statement (published in Volume 73, Number 136, Public Notice 6290, on 
July 15, 2008). All these standard routine uses apply to Medical 
Records, State-24.

POLICIES AND PRACTICES FOR STORAGE OF RECORDS:
    Records are stored electronically. A description of standard 
Department of State policies concerning storage of electronic records 
is found at https://fam.state.gov/FAM/05FAM/05FAM0440.html.

POLICIES AND PRACTICES FOR RETRIEVAL OF RECORDS:
    Patient records are retrievable by individual name and/or date of 
birth, or patient identification number. MED practitioner records are 
retrieval by name or Post. Post capability records are retrievable by 
Post name.

POLICIES AND PRACTICES FOR RETENTION AND DISPOSAL OF RECORDS:
    Records are retired and destroyed in accordance with published 
Department of State Records Disposition Schedules as approved by the 
National Archives and Records Administration (NARA) and outlined at 
https://foia.state.gov/Learn/RecordsDisposition.aspx. Additionally, 
patient information will be retained in the system for no less than the 
period of time specified in Disposition Authorities and will be 
archived rather than destroyed when the retention period has passed. 
Medical Program Files (permanent) will be transferred to the National 
Archives 25 years after the end of the calendar year in which the file 
was last updated. Non-Occupational Individual Medical Case Files 
(temporary) will be archived by MED no earlier than 10 years after the 
most recent encounter. Occupational Individual Medical Case Files (long 
term--temporary) will be archived by MED no earlier than 30 years after 
employee separation or when the

[[Page 29174]]

Official Personnel Folder is destroyed, whichever is longer. More 
specific information may be obtained by writing to the following 
address: U.S. Department of State; Director, Office of Information 
Programs and Services; A/GIS/IPS; 2201 C Street NW, Room B-266; 
Washington, DC 20520.

ADMINISTRATIVE, TECHNICAL, AND PHYSICAL SAFEGUARDS:
    All Department of State network users are given cyber security 
awareness training which covers the procedures for handling Sensitive 
but Unclassified (SBU) information, including personally identifiable 
information (PII). Annual refresher training is mandatory. In addition, 
all Department OpenNet users are required to take the Foreign Service 
Institute distance learning course instructing employees on privacy and 
security requirements, including the rules of behavior for handling PII 
and the potential consequences if it is handled improperly. Before 
being granted access to Medical Records, a user must first be granted 
access to the Department of State computer systems.
    Department of State employees and contractors may remotely access 
this system of records using non-Department owned information 
technology. Such access is subject to approval by the Department's 
mobile and remote access program and is limited to information 
maintained in unclassified information systems. Remote access to the 
Department's information systems is configured in compliance with OMB 
Circular A-130 multifactor authentication requirements and includes a 
time-out function. All Department of State employees and contractors 
with authorized access to records maintained in this system of records 
have undergone a thorough background security investigation. Access to 
the Department of State, its annexes, and Posts abroad is controlled by 
security guards and admission is limited to those individuals 
possessing a valid identification card or individuals under proper 
escort. Access to computerized files is password-protected and under 
the direct supervision of the system manager. The system manager has 
the capability of printing audit trails of access from the computer 
media, thereby permitting regular and ad hoc monitoring of computer 
usage. When it is determined that a user no longer needs access, the 
user account is disabled.
    The safeguards in the following paragraphs apply only to records 
that are maintained in government-certified cloud systems. All cloud 
systems that provide IT services and process Department of State 
information must be specifically authorized by the Department of State 
Authorizing Official and Senior Agency Official for Privacy.
    Information that conforms with Department-specific definitions for 
Federal Information Security Modernization Act (FISMA) low, moderate, 
or high categorization are permissible for cloud usage and must 
specifically be authorized by the Department's Cloud Program Management 
Office and the Department of State Authorizing Official. Specific 
security measures and safeguards will depend on the FISMA 
categorization of the information in a given cloud system. In 
accordance with Department policy, systems that process more sensitive 
information will require more stringent controls and review by 
Department cybersecurity experts prior to approval. Prior to operation, 
all Cloud systems must comply with applicable security measures that 
are outlined in FISMA, FedRAMP, OMB regulations, National Institute of 
Standards and Technology's (NIST) Special Publications (SP) and Federal 
Information Processing Standards (FIPS) and Department of State 
policies and standards.
    All data stored in cloud environments categorized above a low FISMA 
impact risk level must be encrypted at rest and in-transit using a 
federally-approved encryption mechanism. The encryption keys shall be 
generated, maintained, and controlled in a Department data center by 
the Department key management authority. Deviations from these 
encryption requirements must be approved in writing by the Department 
of State Authorizing Official. High FISMA impact risk level systems 
will additionally be subject to continual auditing and monitoring, 
multifactor authentication mechanism utilizing Public Key 
Infrastructure (PKI) and NIST 800 53 controls concerning 
virtualization, servers, storage, and networking, as well as stringent 
measures to sanitize data from the cloud service once the contract is 
terminated.

RECORD ACCESS PROCEDURES:
    Individuals who wish to gain access to or amend records pertaining 
to themselves should write to U.S. Department of State; Director, 
Office of Information Programs and Services; A/GIS/IPS; 2201 C Street 
NW, Room B-266; Washington, DC 20520. The individual must specify that 
he or she wishes the Medical Records to be checked. At a minimum, the 
individual must include: full name (including maiden name, if 
appropriate) and any other names used; current mailing address and zip 
code; date and place of birth; notarized signature or statement under 
penalty of perjury; a brief description of the circumstances that 
caused the creation of the record (including the city and/or country 
and the approximate dates) which gives the individual cause to believe 
that Medical Records include records pertaining to the individual. 
Detailed instructions on Department of State procedures for accessing 
and amending records can be found on the Department's FOIA website at 
https://foia.state.gov/Request/Guide.aspx.
    Further, patients can access their medical records through the 
patient portal, My Global Health (MGH). Patients can seek a printed 
copy of their medical records by submitting a request to Medical 
Records, Bureau of Medical Services (address above). Parents may also 
request medical records of dependent children. At a minimum, the 
individual requesting a copy of his or her medical records must include 
the following: name, date and place of birth, current mailing address 
and zip code, signature, a brief description of the circumstances that 
may have caused the creation of the records that are the subject of the 
request, and the approximate date(s) of those records.

CONTESTING RECORD PROCEDURES:
    Individuals who wish to contest record procedures should write to 
U.S. Department of State; Director, Office of Information Programs and 
Services; A/GIS/IPS; 2201 C Street NW, Room B-266; Washington, DC 
20520.

NOTIFICATION PROCEDURES:
    Individuals who have cause to believe that the Bureau of Medical 
Services might have medical records pertaining to them and want to 
request a copy of those medical records should write to write to U.S. 
Department of State; Director, Office of Information Programs and 
Services; A/GIS/IPS; 2201 C Street NW, Room B-266; Washington, DC 
20520. The individual must specify that he/she wishes the Medical 
Records to be checked. At a minimum, the individual must include: full 
name (including maiden name, if appropriate) and any other names used; 
current mailing address and zip code; date and place of birth; 
notarized signature or statement under penalty of perjury; a brief 
description of the circumstances that caused the creation of the record 
(including the city and/or country and the approximate dates) which 
gives the individual cause to believe that Medical Records include 
records pertaining to the individual.

[[Page 29175]]

EXEMPTIONS PROMULGATED FOR THE SYSTEM:
    None.

HISTORY:
    Post Capability Database (State-71)--previously published at 74 FR 
65586; Medical Records (State-24)--previously published at 74 FR 24891.

Eric F. Stein,
Deputy Assistant Secretary, Global Information Services (A/GIS), 
Department of State.
[FR Doc. 2023-09596 Filed 5-4-23; 8:45 am]
BILLING CODE 4710-36-P