pursuant to a call or order that does not specify a period of thirty days or less. (c) "Retired member of a uniformed service" means a member or former member of a uniformed service who is entitled to retired, retirement, or retainer or equivalent pay as a result of service in a uniformed service, other than a member or former member entitled to retired or retirement pay under Title III of the Army and Air Force Vitalization and Retirement Equalization Act of 1948 who has served less than eight years on full-time duty in active military serv ice other than active duty for training,

(d) "Dependent" means any person who bears to a member or retired member of a uniformed service, or to a person who died while a member or retired member of a uniformed service, any of the following relationships:

(1) The lawful wife;

(2) The unremarried widow;

(3) The lawful husband, if he is in fact dependent on the member or retired member for over one-half of his support;

(4) The unremarried widower, if he was in fact dependent upon the member or retired member at the time of her death for over one-half of his support because of a mental or physical incapacity;

(5) An unmarried legitimate child (including an adopted child or stepchild), if such child has not passed his twenty-first birthday;

(6) A parent or parent-in-law, if the said parent or parent-in-law is, or was at the time of the member's or retired member's death, in fact dependent on said member or retired member for over one-half of his support and is, or was, at the time of the member's or retired member's death, actually residing in the household of said member or retired member. For the purposes of this part the requirement of actually residing in the household shall be fulfilled when the parent or parent-in-law actually resides, or was residing at the time of death of a member or retired member, in a dwelling place provided or maintained by said member or retired member; or

(7) An unmarried legitimate child (including an adopted child or stepchild) who (i) has passed his twenty-first birthday if the child is incapable of selfsupport because of a mental or physical incapacity that existed prior to his reaching the age of twenty-one and is, or was at the time of the member's or

etired member's death, in fact dependnt on him for over one-half of his suport, or (ii) has not passed his twentyhird birthday and is enrolled in a fullime course of study in an institution of igher learning as approved by the Secetary of Defense or Secretary of Health, Education, and Welfare and is, or was at the time of the member's or the reired member's death, in fact dependent n him for over one-half of his support. (e) "Dependents eligible for civilian hedical care" means the lawful wife or he dependent lawful husband (spouses) nd children who are dependents of members of the uniformed services.

(f) "Secretary of a uniformed service" heans the Secretary of the Army, Navy for the Navy and Marine Corps), or Air Force, or for the other uniformed servces (Coast Guard, Public Health Servce, Coast and Geodetic Survey), the Becretary of Health, Education, and Welfare. The latter may delegate his futies and responsibilities in relation to ependent medical care to The Surgeon General of the Public Health Service.

(g) "The United States" means all of he States and the District of Columbia. (h) "Executive agent" means the party who acts for the uniformed services in negotiating and administering contracts for medical (physicians) and hospital services under the policy guidance of the Department of Defense.

(i) "Contractor" means the legal entity with which the Government enters into a contract for the purpose of implenenting Chapter 55, Title 10, United States Code, such as a State medical ociety, an insurance company, Blue Shield, or Blue Cross.

(j) Miscellaneous medical and technial terminology:

(1) Diagnosis. A determination of the xistence and nature, or absence, of disase or injury by history with physical ind mental findings, including physical xaminations and the utilization of medcally accepted diagnostic procedures, .g., laboratory tests and pathology and K-ray examinations.

(2) Outpatient care. The medical services which are normally performed in locations such as the home, a physician's office, or the outpatient department of a hospital, clinic, or dispensary.

(3) Maternity and infant care. Medical and surgical care for the mother incident to pregnancy including prenatal care, delivery, postnatal care, in

cluding care of the infant, and treatment of complications of pregnancy.

(4) Domiciliary care. Care which is normally given in a nursing home, convalescent home, or similar institution to a patient who requires personal care rather than active and definitive treatment in a hospital for an acute medical or surgical condition. It includes but is not limited to nursing care required as a result of old age or chronic disease.

(5) Chronic disease. This term shail be construed to include nonacute conditions and disabilities in which the prognosis indicates long continued duration of the ailment.

(6) Nervous and mental disorders, This term means those conditions classified as neuroses, psychoneuroses, psychopathies, or psychoses.

(7) Dental care as a necessary adjunct to medical or surgical treatment. Dental care determined by the cognizant physician and dentist to be required for the proper treatment of a medical or surgical condition.

(8) Adjuncts to medical care. Prosthetic devices such as artificial limbs, artificial eyes, hearing aids, orthopedic footwear, spectacles, and similar medical supports or aids.

(9) Adjuncts to dental care. Removable or fixed prosthetic or fixed prosthodontic restorations and similar dental supports or aids.

§ 70.104 Administration.

(a) The Secretary of Defense has jurisdiction over the Army, Navy, Air Force, Marine Corps, and the Coast, Guard when operating as a service with the Navy.

(b) The Secretary of Health, Education, and Welfare has jurisdiction over the Public Health Service and for medical care purposes over the Coast and Geodetic Survey, and the Coast Guard when not in service with the Navy. Subpart B-Determination of Eligibility and Identification of Dependents

medical care, the uniformed services will utilize DD Form 1172, "Application for Uniformed Services Identification and Privilege Card". Modifications of DD Forms 1172 and 11731 may be made subject to the approval of the Secretary of Defense.

(1) Medicare eligibility date. Each DD Form 1173, "Uniformed Services Identification and Privilege Card", issued will show the date on which a dependent became eligible to receive civilian medical and hospital care at Government expense. This eligibility date will be determined in accordance with Department of Defense Instruction No. 1000.7, Subject: "Uniformed Services Identification and Privilege Card".

(b) The Secretaries of the uniformed services and their designees are hereby authorized to make determinations of dependency for purposes of this part. § 70.202 Identification of dependents.

(a) Upon an affirmative determination by the Secretary of a uniformed service or his designee that a dependent is eligible for medical care, such dependent will be issued a "Uniformed Services Identification and Privilege Card", DD Form 1173. The DD Form 1173 will serve as the primary means of identifying dependents eligible for medical care.

(b) The administrative provisions governing the application for the DD Form 1173 and its issuance to dependents of members and dependents of retired members of the uniformed services and dependents of a person who died while a member or a retired member of a uniformed service, will be as prescribed by the Secretary of the uniformed service concerned. However, such regulations for active duty members with dependents will include but not be limited to provisions for the following:

(1) Issuance. Application for, and issuance of, DD Form 1173 will be accomplished at the following times:

(i) Upon entry on active duty for a period in excess of 30 days.

(v) Upon retirement or death. (2) Surrender. The DD Form 1173 shall be surrendered:

(i) Whenever a new card is issued except to replace loss.

(ii) Upon expiration date.

(iii) Whenever the cardholder becomes ineligible.

(iv) Upon death, retirement, or release of member to inactive duty.

(3) Expiration date. The DD Form 1173 shall be effective for the contracted period of service of the sponsor upon whom the entitlement is based in the case of dependents of the uniformed services, or in the case of minors the twenty-first birthday if it occurs prior to the termination of the service of the sponsor, except that for entitlement to medical care, the provisions of § 70.103 (d) (7) will apply. The departments will insure that sponsors are directed to notify the appropriate authority immedi ately upon any change in status that would terminate or modify the right to any of the benefits for which the card may be used.

(4) Dependents listed. Each dependent, ten years or over, entitled to medical care, will be issued DD Form 1173. Certification of minor dependents, under ten years of age, for eligibility for medcal care will be the responsibility of the dependent, accompanying parent, member, or acting guardian.

(5) Entitlement to care in civilian facilities. All DD Forms 1173 will contain an appropriate notation as to those de pendents who have entitlement to medical care at both medical facilities of the uniformed services and civilian medical facilities. Thus, each card covering dependent eligible for civilian medical care (see § 70.103 (e)) will have a notation thereon showing that care in civilian facilities is authorized even though the situations in which such care may be obtained at Government expense are limited. For example, such a dependent residing with the sponsor, or living in an area to which the sponsor is assigned, and whose right of election has been restricted pursuant to § 70.302. shall be entitled to receive medical care in civilian facilities at Government expense only in the case of an emergency and under other circumstances outlined in this part or in the Joint Regulations.

(c) The issuance and use of the DD Form 1173 will be accomplished by all the uniformed services.

Subpart C—Determination of Sources From Which Eligible Dependents Receive Medical Care

70.301 Among uniformed services facilities.

Normally, a dependent requesting care at a uniformed services facility will be expected to use the facilities servicing he area in which the dependent resides. 70.302 Between civilian medical facilities and uniformed services facilities within the United States and Puerto Rico.

(a) Dependents eligible for civilian medical care who are not residing with Cheir sponsors, or in an area to which heir sponsor is assigned, shall have right of election between uniformed Services medical facilities and civilian medical facilities.

(b) Outpatient medical care at Government expense for dependents eligible for civilian medical care is not authorized from civilian sources, except that certain specified treatment for such dependents who are not hospitalized, will be authorized when in accordance with §§ 70.502(f); 70.503 (d) (1), (2), and (3); or 70.506(i).

(c) Dependents eligible for civilian medical care who reside with their sponsors, or in an area to which their sponsor is assigned, shall have right of election between uniformed services medical facilities and civilian medical facilities except that the Secretary of a uniformed service with the approval of the Secretary of Defense or the Secretary of Health, Education, and Welfare, as appropriate, may require such dependents In a prescribed area to seek medical care in a uniformed services medical facility if he finds that:

(1) The uniformed services medical facility is adequate to care for the dependents of members assigned to that area; and

(2) The use of civilian medical facilities by the dependents in that area has affected adversely the optimum economic utilization of the uniformed services medical facility.

(d) When necessary restrictions on right of election for a particular medical facility are imposed, the Secretary of a uniformed service may prescribe a local geographic area which the medical

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facility concerned shall serve normally. In determining the boundaries of the geographic area, consideration shall be given to normal commuting time, distance, and usual geographic and transportation factors such as toll bridges or ferries which would increase unreasonably the time and expense of travel. It shall be the responsibility of the Secretary of a uniformed service, when imposing restrictions upon the right of election of a dependent, to insure liaison and coordination among all uniformed services and civilian medical facilities in and adjacent to the geographical area in which restrictions have been imposed. When any restrictions on right of election have been imposed or removed, the Executive Agent shall be so advised.

(e) In lieu of the restrictions described in paragraphs (c) and (d) of this section, the Secretary of Defense may specify a date as of which the restrictions described below will be effective. On and after the specified date, a restriction on right of election shall be effective as to dependents in the United States and Puerto Rico, who are eligible for civilian medical care, who reside with their sponsors, or in an area to which their sponsor is assigned, who require care authorized under this part from civilian sources but have not commenced receiving such care from civilian sources on the aforesaid specified date (or, in the case of a maternity patient, whose care by her civilian physician on that date has not reached the second trimester), and who reside in an area where adequate medical facilities of a uniformed service are available for such dependents. No restriction on right of election will be imposed on such dependents residing in areas where adequate medical facilities of a uniformed service are not available. However, in order that the restriction may be appropriately administered, each dependent who resides with the sponsor, or in an area to which the sponsor is assigned, and who requires care authorized under this part from civilian sources but has not commenced receiving such care from civilian sources on the specified date (or, in the case of a maternity patient, whose care by her civilian physician on that date has not reached the second trimester), will be required to contact a uniformed services installation. For

those residing in areas where an adequate medical facility of a uniformed service is not available, DD Form 1251, "Nonavailability Statement", authorizing care from civilian sources at Government expense will be issued. Such a statement may also be issued to a dependent residing with the sponsor, or residing in an area to which the sponsor is assigned, when the capability does not exist in the medical facility (or facilities) of the uniformed services in the area to provide the required care because of lack of necessary staff, facilities, or space. The DD Form 1251, issued in the manner described above, shall be evidence of entitlement of the dependent to care authorized under this part from civilian sources at Government expense. In determining whether a dependent covered under this § 70.302(e) is residing in an area where adequate medical facilities of a uniformed service are available, the criteria outlined in paragraphs (c) and (d) of this section shall apply. Detailed procedures concerning the format of the DD Form 1251 and the manner in which it is to be issued may be set forth in the Joint Regulations. Spouses and children are considered to be residing with their sponsor if they reside in the area to which the sponsor is assigned, in the area of his permanent duty station, or the home port or home yard of a ship, even though the sponsor may be temporarily away, by reason of temporary duty with his unit or ship, from the area to which he is assigned, the permanent duty station or his home port or home yard respectively, or by reason of the sponsor's absence on individual temporary duty or temporary additional duty order.

to preserve life, health, or to prevent undue suffering.

(2) During the period of absence on a trip of the eligible dependent from the area to which the sponsor is assigned. This exception is not to be used to circumvent the restrictions imposed on right of election.

(3) When an eligible dependent wife, whose husband dies while on acuve duty, is pregnant at the time of his death. (See § 70.505(d).)

(b) Additionally, the restrictions initially imposed by the Secretary of Defense on a specified date pursuant to § 70.302(e) and the requirement for a DD Form 1251 described therein shall be waived with regard to any eligible dependent who has commenced receiving care authorized under this part from civilian sources prior to that specified date (except that, for maternity patients, care in the second trimester by her civilian physician on that date must have commenced prior thereto). The dependent involved will be entitled to complete any care which was authorized under this part prior to the date specified by the Secretary of Defense and which has been commenced in accordance with the preceding sentence. § 70.304 Between civilian medical facilities and uniformed services facilities outside the United States and Puerto Rico.

Dependents eligible for civilian medical care who are not residing with their sponsors, or in an area to which their sponsor is assigned, shall have right of election between uniformed services medical facilities and professionally acceptable local civilian sources. Where medical facilities of the uniformed services are available within the area and are capable of providing the required care, spouses and children outside the United States and Puerto Rico who are residing with their sponsors, or in an area to which their sponsor is assigned, will utilize these facilities for such care. In areas where medical facilities of the uniformed services are nonexistent or incapable of providing adequate medical care, spouses and children who are residing with their sponsors, or in an area to which their sponsor is assigned, may be authorized civilian medical care from professionally acceptable local sources in accordance with this part.