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47. Notice to employees of their rights and duties.-The Commission. has distributed throughout the Federal service copies of placards for posting on bulletin boards and other convenient places, outlining briefly the rights and duties of employees under the Compensation Act. These placards should be kept posted in conspicuous places for the information and guidance of employees. Additional placards may be secured from the Commission upon request.

48. Insane injured employees to be transferred to hospital for insane.When practicable, insane injured employees entitled to the benefits of the Compensation Act will be transferred either to a designated hospital for the insane or to the Government Hospital for the Insane at Washington, D. C. Requests for such transfer should in each case be made to the Commission.

49. Preparation of reports and claims.—It is suggested that, in order to secure uniformity in the method of preparing forms, such work be delegated to one person in each establishment wherever practicable. This method will insure uniform handling of the forms used in connection with the reporting of injuries and in making claims for compensation, and will enable the person so delegated to thoroughly familiarize himself with the rules and regulations governing the operation of the Compensation Act, and result in the avoidance of errors due to a misunderstanding of the details of some of the forms.

50. Mailing of reports and claims.-Each establishment sending reports of injuries, claims, or other forms to the Commission should, wherever practicable, mail them, without folding, in large envelopes, and they should be sent immediately after the information called for has been inserted in the proper places.

51. Requests for forms.-Supplies of forms to be used in reporting injuries and deaths, and in making claims for compensation therefor, may be obtained direct from the Commission upon request. Post offices other than those of the first class may obtain these supplies. direct from the nearest first-class post office, as stated in the notice appearing in the November 5, 1917, issue of the Daily Bulletin of Orders Affecting the Postal Service.

INSTRUCTIONS GOVERNING MEDICAL, SURGICAL, AND HOSPITAL SERVICES.

52. Medical and hospital service to which injured employee is entitled. When civil employees of the United States are injured while in the performance of their duties, they are (by the terms of sec. 9 of the Federal Compensation Act of Sept. 7, 1916) entitled to "reasonable medical, surgical, and hospital services and supplies" for the injury, whether or not disability has arisen.

53. Medical and hospital service available.-A list of all available United States dispensaries and hospitals will be furnished by the Commission to medical officers and the heads of establishments upon request.

A list of available United States medical officers, dispensaries, and hospitals, and private physicians, dispensaries, and hospitals designated and approved by the Commission will be published and distributed from time to time.

Civilians employed by the United States in the vicinity of a permanent or fixed Army hospital, who sustain personal injuries while in the performance of duty, will be admitted thereto, when beds are available, upon the written request of the officers under whom they are employed. Such request will be addressed to the officer in charge of the hospital and will recite the facts of employment and of personal injury while in the performance of duty. Injured civilian employees thus admitted to hospital will be furnished medical and surgical care therein for a reasonable time: Provided, That this authority is not applicable to cases to which other United States hospitals are more convenient of access.

54. First-aid treatment by United States medical officers.-The medical officers stationed at navy yards, arsenals, industrial establishments, and other places of employment in the Federal service should cooperate in every way practicable with heads of departments to educate the employees as to the need for proper first aid and encourage them to report at the dispensary or first-aid station for examination and treatment of all injuries, even though they may appear to be trivial or slight. It is essential that adequate first aid should be provided. to injured employees immediately after the injury has occurred.

55. First-aid treatment in emergency. In all cases of injury where the emergency is such as to require it, any physician licensed to practice medicine and surgery under State laws may be called for first-aid treatment, but further treatment, if required, must be obtained from the United States medical officer or hospital or from the designated" physician or hospital, if available.

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56. Bills for emergency first-aid treatment by private physicians.-In rendering a bill for first-aid treatment obtained under emergency, the injured person or his representative should obtain an itemized statement from the physician rendering such aid. The bill should show the nature of the service rendered.

57. Ambulance service. In cases where the injury is so serious as to require such action, an ambulance (one owned by the United States hospital or the "designated" hospital, if available) should be called and the employee sent to the United States hospital or the "designated" hospital at once. When the United States hospital ambulance or the "designated" hospital ambulance is not available, the Commission will allow a reasonable charge for other ambulance service, but in all such cases the employee should be sent to the United States hospital or "designated" hospital, as the case may be. 58. First-aid dispensary treatment should be by medical officer or trained assistant.-Medical officers in charge of first-aid stations or dispensaries should treat all cases in person or see that they are properly treated by trained assistants (junior medical officers, nurses, or trained attendants). Prompt and courteous treatment of all employees will encourage them to cooperate in promoting the dispensary service.

59. Records of injuries.—Adequate written records should be kept of all persons applying for treatment who claim an injury, even though the medical officer feels confident that the employee is not entitled to benefits under the Compensation Act. If the case is in doubt and it is not impracticable, the injured employee should be required to return the next working-day for a second examination.

60. Medical treatment without written request.-Medical officers stationed in places of employment should not require that employees present written requests for treatment, and such treatment should be furnished to injured employees who are able to come to the dispensary throughout the period of disability so far as practicable.

61. Requests for medical treatment.-An employee applying for treatment to a United States medical officer, dispensary, or hospital outside of the establishment in which the employee works, or to a designated" physician, dispensary, or hospital, should present a request for treatment on form C. A. 16, or a letter from his official superior. This request should recite the facts that the bearer—giving

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the name is an employee of the United States, employed at-giving the name of the office or establishment-that he was injured in the performance of duty on-giving the date and that treatment is requested for the results of said injury under section 9 of the Compensation Act. In case it has been impracticable for the employee to obtain a request for treatment, the medical officer, hospital, or " designated" physician may furnish temporary treatment upon the statement of the injured employee giving the facts, together with the name of the Government establishment in which he is employed. In such instances a proper request for treatment should, however, be obtained within 48 hours thereafter from the employee's official superior.

62. Car fare to secure medical and hospital service. In order that injured employees may be furnished as complete medical and surgical service as possible, the Commission will pay the necessary car fare of those who are able to return to the dispensary for treatment. The medical officers at dispensaries are requested to inform injured employees in all cases suitable for dispensary treatment what treatment they are prepared to furnish at the dispensary. Where it is practicable, it is requested that car tickets be furnished as required to injured employees for the purpose of securing such treatment, and monthly accounts rendered to the Commission by the officers in charge of dispensaries for reimbursement for the car tickets furnished.

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63. Medical treatment will be given at dispensaries and hospitals wherever practicable.-In places where there are United States dispensaries and hospitals available for treatment of injured civil employees and where arrangements have been made with hospitals designated" by the Commission to furnish out-patient and hospital services, all injured employees will be treated either as outpatients or hospital patients, and no injured employee will be furnished treatment in his home, unless such arrangement is approved by the Commission. The Commission has ruled that where adequate dispensary and hospital service is provided, such provision constitutes "reasonable medical, surgical, and hospital services," in accordance with the terms of the Compensation Act, and payment for treatment in the homes will not be allowed, except as above provided.

64. Dispensary service.-Injured employees entitled to the benefits of the Compensation Act, whose injuries are of such a nature that they can be properly treated in a dispensary, will be furnished proper treatment upon application at the United States dispensary or" designated" dispensary.

65. Hospital service in emergency.-Arrangements should be made by the official superior with the United States hospital or" designated" hospital, or if there is neither, then with the private hospital,

to respond to calls with the ambulance in cases of emergency, and to admit injured employees to hospital without delay, provided the call is received from proper Government officials. In all cases a request on form C. A. 16 or a letter of request (see sec. 61) should accompany the injured employee to hospital or be obtained from the official superior within 48 hours from the time of admission.

The medical officer should be at once notified of any case transferred to hospital, so that he may furnish such treatment as may be required of him under the circumstances.

66. Hospital service-Approval of medical officer.-In places where there is a United States medical officer or "designated" physician and whenever emergency does not require immediate action, the approval of the medical officer or "designated" physician should be obtained before the patient is transferred to hospital.

67. Examinations and records preceding hospital treatment. In all cases where an employee reports in person or by proxy at the dispensary or hospital, requesting treatment on account of disability alleged to be due to injury, and it is found that his disability requires hospital treatment, a record should be made and kept showing the date, name, color, age, sex, and occupation of the employee, the place of employment, the nature of disability, the date of the injury, and, where a request for treatment is presented, the name of the person signing the request.

68. Requests for medical or hospital service when official superior has doubt as to employee's right to treatment.-If, for any reason, the official superior is in doubt as to whether or not an injured employee is entitled to medical relief under the Compensation Act, he should immediately communicate the circumstances, outlining his doubt, to the Commission, and furnish said injured employee a request, form C. A. 16, or letter, which should state the reason's for his doubts and request the medical officer or "designated" hospital officials to furnish relief until a decision can be reached as to whether or not the case is a proper one for treatment under the Compensation Act. The employee should be kept in hospital under observation and treatment until the official superior of the employee or medical officer or "designated " hospital official is convinced that the employee is not entiled to the benefits of the Compensation Act. In these cases, the Compensation Commission will be responsible for the payment for treatment up to and including the date on which it is decided the employee is not entitled to medical relief under the Compensation Act, but in such cases no surgical operation should be performed, except in case of emergency, in advance of a decision by the Commission.

69. Hospital treatment pending determination of injured employee's right to treatment.-If there is reason to doubt that an employee is

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