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RULES AND REGULATIONS

7178
tient day will be charged for one patient day.
401.2 Eligibility fo r adm ission, m ed ical care, and treatm ent. All persons in need of hospitalization, medical care, or treatment are eligible for admission to the hospital either as in-patients or out patients as their medical condition may indicate. Each admission shall be condi tioned upon the capacity and facilities of the hospital available to receive and treat the patient.
401.3 Exam inations fo r admission.
Each applicant for admission as an in patient shall be examined pursuant to the direction of the Superintendent for determination by him or his designee of the eligibility of the applicant for admis sion under this part.
401.4 Agreem ents fo r paym ent. All full-pay and part-pay patients or their responsible representatives will be re quired to execute an agreement to pay the costs of their hospitalization and other services as specified in this part.
401.5 A d v a n c e paym ents. Pay ments are to be made weekly, in advance for in-patient hospitalization, except in those cases where the patient enters the hospital for a definite number of days constituting less than a week. In such cases payment shall be made in advance for the number of days the patient ex pects to remain in the hospital. How ever, the hospital may waive the requirements of this section in those cases in which it determines that the patient, his responsible representative, or other individual or organization who un dertakes the payment for his hospitaliza tion and care, is financially responsible.
In such cases, full settlement shall be made as soon as practicable.
401.6 Incom e schedule fo r d eter m ination o f rates. The ability of a pa tient to pay for his hospitalization and other services shall be determined in accordance with the following Income Schedule. A patient whose total family income per month falls in Column A
shall be considered to be an indigent patient who shall not be charged any amount for his hospitalization and other services. A patient whose total family income per month falls in Column B
shall be considered to be a part-pay patient who shall be charged a modified rate for his hospitalization and other services as set forth in 401.8. A patient whose total family income per month falls in Column C shall be considered to be a full-pay patient who shall be charged the rates set forth in 401.7 for his hospitalization and other services.

401.7 In -p atien t ra tes; fu ll-pay p a
tients. Pull-pay patients shall pay the following rates:

2. There shall be the following extra charges for . full-pay, general hospital patients:
a Drugs not regularly stocked on the wards, prescriptions which must be com pounded, and biologicals.
b X-ray see 401,12 a and b .
c Laboratory. There shall be a flat charge of $10.00 for laboratory work. How ever, there shall be no charge for laboratory work for obstetrics, pulmonary tuberculosis, tonsils and adenoids cases, or for children under 7 years.
d Operating room and anesthesia. Ma jor surgery, $15.00; Minor surgery, $10.00.
e Delivery room and anesthesia. $10.00.
f Miscellaneous:
1 Physical therapy treatments. $2.00 per treatment.
2 Casts. See 401.12 g.
3 Ambulance service. Trip within city lim itsday or night rate, $5.00 per trip.
M aternity Cases
1. Schedule of rates for full-pay maternity cases:
Ward__________ - ______________$9.00 a day.
Delivery room__________________ $10.00.
T onsillectomy Cases
1. Schedule of rates for full-pay tonsillec tomy cases:
Patients 7 years and over. Private room $28 00 for minimum of 2 days; $9.00 each day thereafter. Ward$23.00 for minimum of 2
days; $6.50 each day thereafter.
Patients under 7 years. Ward$16.50 for minimum of 2 days; $3.25 each day there after.
2. The above rates include operating room, anesthesia, prescribed drugs and medications, laboratory, and other special services for ton sillectomy cases.
T uberculosis Hospital
1. Schedule of rates for full-pay tubercu losis cases: All rooms $19.25 a week. All X-ray, laboratory, and other special charges are included in this rate.
401.8 In -p atien t ra tes; p art-p ay p a
tients. Part-pay patients shall pay rates in accordance with the following ftate Schedule:
G eneral H ospital RATE SCHEDULE

Rates per day Family income deviation from Col umn B of Income Schedule, 401.6

Pa tients 7 and over
Chil dren under 7

$0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50

$0.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25

INCOME SCHEDULE

Number in family
1
2
3
4_________
5 .________
6 -
7
8
8_________
10 or more..

Family incme per month A
$74 or less____
$94 or less____
$109 or less___
$119 or less___
$129 or less___
$139 or less___
$149 or less___
$159 or less___
$169 or less___
$179 or less___

B
$75-$99
95- 119
110-134
120-144
130-154
140-164
150-174
160-184
170-194
180-204

O
$100 or more.
$120 or more.
$135 or more.
$145 or more.
$155 or more.
$165 or more.
$175 or more.
$185 or more.
$195 or more.
$205 or more.

T onsillectomy C ases
The above Rate Schedule shall also apply to tonsillectomy cases. The rates so deter mined include operating room, anesthesia, G eneral Hospital prescribed drugs and medications, laboratory, 1.
Schedule of rates for full-pay generaland other special services.
hospital cases:
T uberculosis Hospital Private rooms__________________$9.00 a day.
The above Rate Schedule is modified as Ward__________________________$6.50 a day.
follows for tuberculosis patients:
Children under 7 years of age__ $3.25 a day.

Minimum through $2 over minimum.$2.01 through $4 over minimum
$4.01 through $7 over minimum_______
$7.01 through $10 over minimum______
$10.01 through $13 over minimum_____
$13.01 through $16 over minimum_____
$16.01 through $19 over minimum_____
$19.01 through $22 over minimum_____
$22.01 through $24 over minimum_____

All X-ray, laboratory, and special services are included in the above rate schedule.

M aternity Cases
The above Rate Schedule shall also apply to maternity cases.

RATE SCHEDULE

Family income deviation from column B of Income S c h e d u l e Rates per week
401.6:
all patients Minimum through $2 over minimum $2. 75
$2.01 through $5 over minimum----- 5. 50
$5.01 through $8 over minimum----- 8. 25
$8.01 through $11 over minimum------11.00
$11.01 through $14 over minimum_13.75
$14.01 through $17 over minimum 16.50
$17.07 through $20 over minimum 19.25

401.9 O ut-patient ra tes; referred patients. Referred patients shall pay for X-ray, laboratory, and other special serv ices in accordance with the schedules set forth in 401.12.
401.10 O ut-patient ra tes; em er gency patients. The fee for treatment of emergency patients shall be $2.00 per treatment, but if suturing is required, then the fee shall be $2.50. Emergency patients shall also pay for X-ray, labor atory, and other special services in ac cordance with the schedules set forth in 401.12. The fee for prescribed drugs and medications shall be $0.35 for each prescription filled. The hospital may waive payment of any of the fees pre scribed by this section if it determines that the patient is financially unable to pay such fees.
401.11 O ut-patient ra tes; clinic p a
tients. The fee for care or treatment of clinic patients shall be $2.00 for each visit to the clinic. This fee will include all X-ray, laboratory, and other special serv ices necessary. The fee for prescribed drugs and medications shall be $0.35 for each prescription filled. No charge shall be made for care or treatment of clinic patients at the tuberculosis, venereal dis ease, maternal or child welfare clinics.
The hospital may waive payment of any of the fees prescribed in this section if it determines that the patient is financially unable to pay such fees.
401.12 R ates fo r X -ray, laboratory, an d oth er special services a X -ray exam inations.
Dental__ __________________________
Chest________________ t--------------------Gastroduodenal series----------------------Abdomen___________________________
Barium Colon Enema-----------------------Gall Bladder with dye-----------------------G. I. Complete Stomach, Colon, Gall Bladder____ ___,__________________
Skull:
4 views_________________________
2 views_________________________
Mastoids_____________________ _______
Sinuses_____________________________
Shoulder extremities-----------------------Elbow________________________ ______
Pelvis__________________ _____________
Hip
Femur______________________________
Tibia l _______________________ -
Knee________________________________
Hand or F o o t-_________ ____________
Ankle_____ ________________________ -

$5.00
7.00
1 0.00
8.00

1 0 .0 0

12. 50
25.00
12.50
7.50
7.50
7. 50
7.50
5.00
8.00
8. 00

7.50
7.50
7.80
5.00
7.50