MANUAL 
REGULATIONS 
CRIPPLED CHILDREN COMMISSION ADDENDA TO THE MANUAL OF REGULATIONS 
Re: Amendments to State 
Administrative Code, 
To: Judges of Probate and 
Approved Hospitals 
Gentlemen: 
Your attention is directed to the attached section and paragraphs of 
the Commission’s Manual of Regulations. 
In order that your Manual may be corrected to conform to the amend- 
ments made effective as of October 11, 1945, the following suggestions are 
offered: 
(1) Cut the amended paragraphs from the following pages of this 
section and 'paste them over paragraphs of like numbers in your 
Manual, or 
(2) Cross off the amended paragraphs of like number in your Manual 
and make reference to the amended section. 
CRIPPLED CHILDREN COMMISSION 
1 INTRODUCTION 
These regulations are promulgated by the Michigan 
Crippled Children Commission pursuant to the authority 
granted the Commission under Act 158 of the P. A. of 1937, 
as amended, and Act 283 of the P. A. of 1939, as amended, 
and are designed in the interest of greater efficiency of 
operation, uniformity of fees and rates and the standardiza- 
tion of policy and procedure. The uniform fee and rate 
schedules are applicable only to services rendered in ap- 
proved hospitals, and may be revised in accordance with 
authority granted in Act 158, Title VI, Section 16 and Act 
283, Section 5. 
(a) The title of Act 158 of the P. A. of 1937, as amend- 
ed, is “Crippled Children’s Act” and Act 283 of 
the P. A. of 1939 as amended, is “Afflicted Chil- 
dren’s Act” and hereinafter shall be referred to as 
Act 158 and Act 283. 
The regulations referring to the proper jurisdic- 
tion of children under state acts are identified by 
marginal notes, Act 158 (Crippled) or Act 283 
(Afflicted), or both where the regulations are ap- 
plicable under both acts. 
Included in the manual are copies of both acts re- 
ferred to above for convenience in identifying in- 
dex and paragraph reference to same. 
2 Renewal 
Court Orders 
Act 158 
Act 283 
(Code No. 8) 
7. Application for renewal Court Order shall be subject to: 
a. Issuance of new physician’s certificate. (If case is under active 
treatment or has been examined during the previous 12 month 
period and has been recommended to return, a new physician’s 
certificate will not be required). 
b. Re-investigation and re-determination of ability to repay. 
(1) Applicants for renewal Court Orders whose financial status 
has improved should comply with the terms of the original 
agreement, and the new agreement should be based on the 
applicant’s better ability to pay. 
(2) Applicants whose financial status has not improved and there 
appears to be no opportunity for meeting the terms of the 
agreement should be given consideration as to cancellation 
of this obligation to the state, for prior care as well as sub- 
sequent care. 
(3) If the court concurs with the current investigation and the 
applicant addresses a letter to the Commission setting forth 
the facts as to his financial condition, the Commission will 
consider cancellation of the obligation and refer the matter 
to the State Administrative Board for disposition. 
Act 158, Title III, Section J). Act 283, Section 3. 
Payments by 
Parents 
Act 158 
Act 283 
(Code No. 9) 
8. (2) PORTION OF CHARGES shall be construed to mean that 
portion of the actual cost of total service charges which ac- 
crued during the valid period of the Court Order, 
Definition 
Date of 
Application 
Act 158 
Act 283 
40. a. The date of application shall be construed to be the date applica- 
tion was made in person to the Judge of Probate by parent, hus- 
band, guardian or kindred, or the date Form MCCC-124 was 
received by the Judge of Probate or representative of the Com- 
mission. See 43-d, sections (1) and (2). 
Restricted Cases 
Advance Approval 
Act 158 
Act 283 
41. g. Refractions and glasses. Requests for glasses shall be given con- 
sideration only when a child’s condition is of such a nature as to 
require hospitalization for medical or surgical treatment of the 
eyes and glasses are a necessary part of the treatment following 
hospital care. Refractions and glasses for the treatment of stra- 
bismus and other conditions that can be cared for in a physician’s 
office are not acceptable. 
First Admissions 
Authorizations 
Act 158 
Act 283 
43. d. (1) To obtain the signature of the parents, husband, guardian or 
kindred on Form MCCC-124, if State aid is required to meet 
the cost of hospitalization and medical treatment, submit a 
copy to the Judge of Probate within 10 days from the date 
of admission. (Refer to 40 (a) and (b), and 73.) 
NOTE: The acceptance of temporary application for State aid on Form 
MCCC-12U shall be limited to ten (10) days from the date received by 
the Judge of Probate or representative of the Commission. 
Emergency 
Re-admissions 
Without New 
Court Order 
Act 283 
44. a. Emergency cases may be readmitted for treatment of any accept- 
able condition during the valid term of the Court Order providing 
the hospital submits notification of emergency readmission on 
Form MCCC-A-5-56 and Hospital Service Request Form MCCC-6- 
R within 10 days, which shall serve: 
3 (1) In lieu of a physician’s certificate. 
(2) As authority to bill first 15 days from date of entrance. 
(3) If need is indicated beyond 15 day period another service 
request (Form MCCC-6-R) must be submitted. 
N on-Emergency 
Re-admissions 
Without New 
Court Order 
Act 158 
Act 283 
b. Non-emergency cases may be readmitted as in-patients during 
the valid term of the Court Order in accordance with the follow- 
ing: 
(1) For treatment of the same condition without a letter of 
authorization if the Court Order is valid and the return was 
recommended by the physician or surgeon and incorporated 
in the last hospital report, Form MCCC-57. 
(2) For treatment of the same condition by a letter of authoriza- 
tion from the Judge of Probate if return recommendations 
were not made at the time of last visit. 
(3) For treatment of a condition other than that for which the 
child was originally admitted by a letter of authorization 
from the Judge of Probate and a new physician’s certificate. 
NOTE: The procedure of notification of admission for non-emergency 
cases under (3) above shall be the same as is required for emergency 
cases under 1+U-a. 
c. Letter of authorization is not required for out-patient readmission 
if Court Order is valid and the return was recommended by the 
physician or surgeon and incorporated in the last Hospital Service 
Report Form, MCCC-57. 
(1) If recommendations for return were not made at time of last 
visit, a letter of authorization from the Judge of Probate is 
required in accordance with 7. 
NOTE: Acceptance of emergency or non-emergency readmissions with- 
out new Court Order shall be subject to reinvestigation of the economic 
status if it is known that the financial status of the parent, husband, 
guardian or kindred has changed. 
53. b. Is hereby revoked. 
N europsychiatric 
Institute 
Act 283 
58. Entrance to the Neuropsychiatric Institute shall be on authority of 
a court order issued to the Neuropsychiatric Institute. 
a. A psychiatric examination for determination of need of treatment 
at the Neuropsychiatric Institute shall be made by a psychiatrist 
who is registered to practice medicine in the state, and who is 
approved by the Commission, and shall be reported on Form 
MCCC-121, N.P.I. (physician’s certificate) and attached to the 
Court Order. Such certificate shall give the complete findings of 
the psychiatrist and his recommendations. 
Approved 
Hospitals 
Act 158 
Act 283 
70. a. Hospitals which comply with the standards as set forth by Michi- 
gan Crippled Children Commission (refer to Section 7), may be 
approved. All applications for approval shall be made on forms 
supplied by the Commission. 
4 b. A court order is authority for the original acute care, (15 days 
afflicted and 15 days crippled), provided need for acute care is 
justified. 
(Exception: 81), 
Extension 
Acute and 
Convalescent 
Periods 
Act 158 
Act 283 
76. a. When a period of care is required beyond the acute allowance of 
15 days for afflicted and 15 days for crippled (unless otherwise 
stipulated) the hospital shall request extension of services indi- 
cating the necessity for further care. 
b. Crippled (acute, maximum) 15 days 
Afflicted (acute, maximum) 15 days 
Crippled (convalescent, maximum) 30 days 
Afflicted (convalescent, maximum) 30 days 
Determination of 
Convalescent 
Periods of Care 
Act 158 
Act 283 
g. When progress report does not indicate the need for further acute 
care, the convalescent rates established by the Commission shall 
prevail. 
Out-Patient 78. c. if the crippled child is returned to the out-patient department for 
treatment of an afflicted condition which is treated simultaneously 
with the orthopedic condition, such treatment shall be rendered 
under the existing 158 Court Order as supplementary treatment. 
Otherwise, procedure under 4'i-b-S shall apply. 
Extension 
Physician’s 
Visits 
Act 158 
Act 283 
79. Request for physician’s bedside visits beyond the maximum (15 calls) 
must be included on the current Hospital Service Request, (Form 
MCCC-6-R), indicating the necessity of further calls, and signed by 
the physician. 
Method of 
Determining 
Patient Day 
Cost Ward 
Care to be 
Paid for 
Services 
Act 158 
Act 283 
85. a. Approved hospitals shall be paid ward cost up to but not in excess 
of: 
(1) Acute Care (Refer Sec. 30, Act 158, Sec. 13, Act 283) 
(2) Convalescent Care (Refer Sec. 30, Act 158, Sec. 13, Act 283) 
PROVIDED, That 
(1) No hospital shall be paid more per patient day than is charged 
private patients for ward care. 
(2) No hospital shall be paid more per patient day than is charged 
for ward care of patients whose care is paid for out of pub- 
lic funds. 
b. Costs shall be determined by the Commission in accordance with 
Bulletin No. 210, “Hospital Accounting and Statistics” of the 
American Hospital Association. 
(1) The cost per patient day as so determined will be the total 
in-patient cost of care both in private rooms and wards. 
(2) The cost per patient day will be adjusted by the application 
of the following formula to determine percentage of cost 
applicable to ward care: 
5 TABLE I 
Percent of patient days in rooms with two 
or more beds to total patient days in all 
Percent to be used in computing 
accommodations (excluding newborn 
reimbursable cost of in-patient 
infant days). 
More Than Not 
More Than 
service per patient day. 
Percent 
98 
100 
100 
96 
98 
99 
94 
96 
98 
92 
94 
97 
90 
92 
96 
88 
90 
95 
86 
88 
94 
84 
86 
93 
82 
84 
92 
80 
82 
91 
78 
80 
90 
76 
78 
89 
74 
76 
88 
72 
74 
87 
70 
72 
86 
0 
70 
85 
Approved 
Rates 
Act 158 
Act 283 
86. The approved rates to be paid hospitals for acute and convalescent 
care shall be determined semi-annually and effective April 1 and 
October 1 of each year. The factors considered in making the deter- 
mination are as follows: 
a. Cost per patient day, including adult and child patient days (ex- 
cluding newborn infant days) reported on Form MCCC-225-R. 
NOTE; Refer to exhibit E, Bulletin 210. 
b. Certification of charges for in-patient services to (private) ward 
patients, inclusive of adults, child patients and extras. 
c. Certification of in-patient services for infant care. 
d. Certification of in-patient services charged for ward patients paid 
for out of public funds, reported on Form MCCC-227-R. 
Approved Extras 
in Addition to 
the Patient Day 
Rate 
Act 158 
Act 283 
87. The following are approved extras in addition to the maximum per 
patient day rate as determined from the analysis of cost provided 
for in 86: 
Braces, appliances Schedule 
Nursing Care (special) Local R.N. Rate 
Telephone calls, telegrams See ft 96 
Blood (donors) $5.00-100 cc 
Glasses $7.50 Maximum 
Physicians’-Surgeons’ Fees Schedule 
Filing Dates 
For Reports 
88. a. A cost analysis and certification of charges for ward services shall 
be filed with the Commission on or before March 15 and Septem- 
ber 15 of each year for the preceding 6 month period, ending 
December 31 and June 30. 
Adjustment 
Due to 
Delinquent 
Reports 
b. Hospitals failing to file cost analysis shall be paid at a patient 
day rate that shall be established by the Commission from time to 
time. 
c. Notification of approved rates for acute and convalescent periods 
shall be directed to each approved hospital indicating effective 
date. 
6 d. Foster and Boarding Home Care By Negotiation 
Notarization 
of Reports 
e. All reports of cost analysis shall be signed by the superintendent 
of the hospital and notarized. 
NOTE: The maximum per patient day rate will be subject to adjustment 
and allowed at whichever rate is lower in accordance with the analysis of 
Forms MCCC-225-R and MCCC-227-R as required under H 85 and 86. 
Overnight 
Stay 
Act 158 
Act 283 
f. When a clinic or out-patient case must remain in the hospital 
over night for adjustment of casts or appliance, the hospital may 
bill for one (1) day at the approved per patient day rate effective 
for the date of service. 
g. When overnight hospital accommodations are necessary as a result 
of conveyance or travel conditions, hospitals may bill one (1) day 
at the approved convalescent rate. 
Out-patient 
Services 
Act 158 
Act 283 
h. Reported on Form MCCC-57 (158 and 283) $1.00 per visit 
(Report must be complete as to service rendered, findings, and recommendations 
of examining physician as regards further treatment and return date.) 
Act 283 (only) Reported on Form MCCC A-5-56 (283) 50 per visit 
Act 158, Title IX, Section SO, Title 111, Section U. Act 283, Sections 3, 10, IS. 
Telegrams 
Telephone 
Calls 
Act 158 
Act 283 
(Code No. 96) 
99, For other reasons pertinent to the patient’s physical condition: 
NOTE: Unexplained telephone calls qualifying under sections (a), (b), (c), and 
(d) above, or the failure to submit copies of telegrams prior to or with billings 
will not be given consideration for payment at a later date. 
Policy 
Michigan Hospital 
and Medical 
Certificates 
Act 158 
Act 283 
102. a. During the first thirty (30) days for each disability (admission) 
the Commission accepts no responsibility for payment of any 
service charges provided by a certificate of the Michigan Hospital 
or Medical Service. 
Approved Extras 
Full Rate 
Period 
Act 158 
Act 283 
(Code No. 99) 
b. Exceptions: The Commission will approve services which are not 
included in the certificates during the full rate period, as follows: 
1. Tissue examination (non-participating hospitals only) . .$2.50 
2. X-rays (Limited to $15.00 during 12 month period). .Schedule 
3. Braces—appliances Schedule 
4. Telephone and Telegrams If 96 
5. Glasses (Cost plus 10%) $7,50 Maximum 
6. Nursing Care Local R. N. Rate 
7. Blood Transfusion (Donors) lOOcc $5.00 
8. Physicians’ and Surgeons’ Fees Schedule 
NOTE: The provision for a $15.00 maximum allowance for x-rays during 
a twelve (12) month period shall be in addition to any allowance for 
x-rays provided by the Michigan Medical Service Certificate or any other 
hospital insurance certificate. 
Partial Rate 
Period 
Act 158 
Act 283 
(Code No. 100) 
103. a. Effective with the thirty-first (31st) day, and inclusive of the 
one hundred and twentieth (120th) day, the Commission will pay 
one-half of the approved per patient day rate determined for the 
hospital and effective as of the dates of service. 
7 b. The following are approved extras during the (partial rate 
period) WHEN THEY ARE NOT INCLUDED in Michigan Hos- 
pital or Medical Certificates, payable as follows: 
a. 
Braces, appliances 
Full Rate 
Schedule 
X 
Half Rate 
Schedule 
b. 
Telephone, telegrams 
c. 
Glasses 
X 
d. 
Nursing care (special) 
e. 
Blood transfusion (donors) 
Physicians’ and Surgeons’ fees 
X 
f. 
g. 
Daily care 
X 
h. 
X-rays (included in maximum).... 
X 
Physicians’ 
and Surgeons’ 
Fees 
Act 158 
Act 283 
(Code No. 111c) 
105. c. Additional physician’s calls beyond the original 15 calls must be 
included on the current Hospital Service Request, (Form MCCC- 
6-R), indicating the need and number of additional calls. 
Separate 
Warrants 
Act 158 
Act 283 
(Code No. 106) 
107. Compensation for physicians, surgeons, nurses, blood donors, regis- 
tered anaesthetists, and hospitals rendering service under these acts 
shall be paid by the Auditor General on separate warrants, drawn to 
their order and delivered to the hospital. 
Form 
MCCC-101 
(Code No. 105) 
110. Individual service invoice Form MCCC-101, is used for billing all 
approved services for each case. (See Rules 85 to 88, inclusive). 
Anaesthetists’ 
Services 
Act 158 
Act 283 
(Code No. 12S) 
303. When anaesthetics are administered by other than salaried employees 
of the hospital, billing shall be in the name of the medical doctor or 
registered anaesthetist performing the service. 
1 
304. Extension for bedside visits beyond the maximum (15 calls) must be 
included on the current Hospital Service Request (Form MCCC-6-R), 
indicating the necessity of further calls, signed by the physician. 
Extension for 
Bedside 
Visits 
(Code No. 12U) 
8 SECTION IX—HOSPITAL STANDARDS 
351. A hospital must be operated in a humanitarian spirit in which the 
best care of the patient is always the primary consideration. 
Act 158 
Act 283 
Registration 352. Hospitals shall be on the registered list of the American Medical 
Association. 
Approval 353. Approval by the American College of Surgeons is desirable. (In 
cities with a population of over 25,000, hospitals should he approved 
by the American College of Surgeons.) 
Capacity 354. Hospitals with a bed capacity of less than 25 will not be accepted 
where other hospitals are already available in the vicinity. 
Fire 
Inspection 
355. All hospitals must be approved as to elimination of fire hazards, 
either by the State Fire Marshal or, in the city of Detroit, by the City 
Fire Marshal. 
Equipment 356. Hospital must be a modern physical plant, equipped for the comfort 
and safety and scientific care of the patient. The building should 
be maintained in a sanitary condition, provided with fire protection, 
preferably fireproofed, and free from hazards. Equipment for diag- 
nosis and treatment should be reasonably complete for all types of 
work the staff purports to carry on in the hospital. Institutions 
accepting surgical and obstetric patients should provide a modernly 
equipped operating room, delivery room and nursery, all suitably 
safeguarded. 
By-Laws 
Regulations 
357. A hospital must have a clearly stated constitution, by-laws, rules and 
regulations setting forth organization, duties, responsibilities and 
relations. In order to prevent the by-laws from becoming antiquated 
and disregarded, they should be revised every three to five years by 
a committee of the medical staff and superintendent approved by the 
governing board. 
Each hospital is expected to use its initiative in evolving regulations 
which are applicable to its own needs and in addition, to adopt cer- 
tain major principles which are fundamental and are to be embodied 
in all medical staff by-laws, rules and regulations such as the fol- 
lowing : 
a. A statement of the necessary qualifications which the physician 
must have to be privileged to work in the hospital. 
b. An outline of procedure in extending privileges to physicians to 
work in the hospital. 
c. A descriptive outline of medical staff organization. 
d. Provision for keeping accurate and complete clinical records. 
e. A statement to the effect that the physician in charge of the 
patient shall be responsible for seeing that all tissue removed at 
operation is delivered to the hospital pathologist or recognized 
pathologist upon request of the Commission. 
f. Provision for routine examination of all patients on admission 
and recording pre-operative diagnosis prior to operation. 
9 g. A ruling permitting a surgical operation on consent of the patient 
or his legal representative, except in emergencies. 
h. A regulation insisting that physicians’ orders be in writing. 
i. A statement giving sole authority to the hospital superintendent 
in the admission of patients. 
j. A statement providing that major operative obstetrics or curet- 
tages shall not be performed except after consultation with at 
least one member of the regular staff who shall record his find- 
ings and recommendations in writing. 
Governing 
Board 
358. A hospital must have a carefully selected governing board having 
complete and supreme authority for the management of the institu- 
tion. This may be a board of trustees or directors, a partnership or 
an individual. 
Administrative 
Authority 
359, A hospital must have a competent, well-trained executive officer or 
administrator with authority and responsibility to carry out the 
policies of the institution as authorized by the governing board. 
Personnel 360. A hospital must have an adequate number of efficient personnel, 
properly organized and under competent supervision. Such person- 
nel to include graduate nurses, attendants, maids, office employees, 
dietitians, x-ray technicians and appropriate provisions for labora- 
tory procedures. 
Staff 361. A hospital should have an organized medical staff of ethical, com- 
petent physicians and surgeons for the efficient care of the patients 
and for carrying out the professional policies of the hospital, sub- 
ject to the approval of the governing board. 
The medical staff may or may not be divided into specialties or 
clinical departments depending on local conditions, but if possible 
should at least include departments of medicine, surgery and obstet- 
rics. In the larger hospitals (100 beds or over) the other main 
desirable divisions are otorhinolaryngology, gynecology, pediatrics, 
urology, orthopedics, ophthalmology, dermatology, neurology, psy- 
chiatry, anesthesia, radiology and pathology. 
Service 
Departments 
362. A hospital should have adequate diagnostic and therapeutic facilities 
with efficient technical service under competent medical supervision. 
a. For crippled children the hospital shall be approved by the Amer- 
ican College of Surgeons. It must maintain orthopedic equipment, 
a Physical Therapy Department, an approved attending Ortho- 
pedic Surgeon and an approved Physiotherapist. 
Other desirable services are: 
Pediatrics Department Anesthesia Department 
Clinical Laboratory Eye, Ear, Nose and Throat Dept. 
X-ray Department Out-Patient Department 
Surgical Department Orthopedic Department 
b. For afflicted children the following services shall be available: 
Clinical Laboratory X-ray Department 
Surgical Department Obstetrical Department 
10 Other desirable departments are: 
Pediatrics Department Orthopedic Department 
Physical Therapy Department Eye, Ear, Nose and Throat De- 
Out-Patient Department partment 
363. Accurate and complete medical records must be promptly written 
and filed in an accessible manner so as to be available for study, 
reference, follow-up and research. The following principles are basic 
requirements for an efficient department of medical records: 
a. Medical records room and equipment. The medical records room 
should be conveniently located, adequate in size, and equipped 
with necessary desks, typewriters, filing cabinets, and supplies 
including record forms. In small hospitals, these facilities may 
be readily combined with those in the business office. 
b. Personnel. The employment of a trained, tactful, and industrious 
medical records librarian is desirable. 
c. Plan to secure medical records. 
d. Supervision of medical records. 
e. Medical file and index. 
f. Preparation of monthly report. 
Medical 
Record 
Conferences 364. a hospital should have group conferences of the administrative staff 
and of the medical staff to review regularly and thoroughly their 
respective activities in order to keep the service and the scientific 
work on the highest plane of efficiency. 
Accounting 365. It is recommended that all approved hospitals adopt the accounting 
method approved and recommended by the American Hospital Asso- 
ciation. All hospitals that are approved in the future will be required 
to have adopted and be using this method. 
11 MICHIGAN CRIPPLED CHILDREN COMMISSION 
Honorable Harry F. Kelly, Governor, Ex Officio 
Commissioners 
Emmet Richards, Chairman Alpena 
George R. Cooke, Vice Chairman Detroit 
Maxwell Reynolds Marquette 
Roger V. Walker, M.D Detroit 
Nate S. Shapero Detroit 
Carleton Dean, M.D., Director STATEMENT OF POLICY 
IT is the intent of Act 158 of the P.A. of 1937 as amended 
by Act 227 of the P.A. of 1943 and Act 283 of the P.A. of 
1939 as amended by Act 225 of the P.A. of 1943, and the 
Michigan Crippled Children Commission that nowhere with- 
in the confines of the State of Michigan shall there be an 
afflicted or crippled child with a condition curable or cor- 
rectible, in need of hospital, medical or surgical treatment, 
who shall be denied such services when the husband, par- 
ent, guardian, kindred or other persons responsible for the 
care of the child are determined to be unable to meet these 
needs. 
All regulations contained hereunder, including fee and rate 
schedules, are subject to revision. 
The Commission. INTRODUCTION 
These regulations are promulgated by the Michigan 
Crippled Children Commission pursuant to the authority 
granted the Commission under Act 158 of the P.A. of 
1937, as amended by Act 227 of the P.A. of 1943, Title III, 
Section 4, and Act 283 of the P.A. of 1939, as amended by 
Act 225 of the P.A. of 1943, Section 3, and are designed in 
the interest of greater efficiency of operation, uniformity of 
fees and rates and the standardization of policy and proce- 
dure. The uniform fee and rate schedules are applicable 
only to services rendered in approved hospitals, and may be 
revised in accordance with authority granted in Act 158, 
Title VI, Section 16 and Act 283, Section 5. 
The title of Act 158 of the P.A. of 1937, as amended by 
Act 227 of the P.A. of 1943, is “Crippled Children’s Act” 
and Act 283 of the P.A. of 1939, as amended by Act 225 of 
the P.A. of 1943, is “Afflicted Children’s Act” and herein- 
after shall be referred to as Act 158 and Act 283. 
The regulations referring to the proper jurisdiction of chil- 
dren under state acts are identified by marginal notes, Act 
158 (Crippled) or Act 283 (Afflicted), or both where the 
regulations are applicable under both acts. 
Included in the manual are copies of both acts referred to 
above for convenience in identifying index and paragraph 
reference to same. 
Approved as to form and 
legality as required by 
Act 88, P. A. 1943. 
Dated April 26, 1944- CONTENTS 
Sections Page 
General Index 
1 Probate Court 1 
Location of Hospftal, Economic Investigation, Agree- 
ment to Repay, Court Orders (new and renewal), Appro- 
priation Allocation, Payments on Accounts. 
2 Probate Court and Hospital 7 
Application Limitations, Restricted Program, Admission 
Authorizations, Transfers, Contagious Diseases Re- 
chargeable to County, Cases not Acceptable. 
3 Hospital 12 
Forms (Application, Entrance, Discharge, Requests and 
Billing), Rates, O.P.D. Extras, Insurance Regulations, 
Billing Procedure, X-ray Schedule. 
4 Conveyor’s Manual 26 
5 Physician-Surgeon Schedule 30 
General Regulations, Itemized Schedule, Act 158-283 
Limitations, Billing Responsibility. 
6 Orthopedic Fee Schedule 
7 Brace-Appliance Schedule 
8 Investigator’s Manual 
9 Act 158 Crippled 
Act 283 Afflicted INDEX 
Page Para. 
Acceptable Signatures, Agreement to Repay 2 8(4) 
Accident Cases 12 75 
Accident Insurance 21 101 
Accounts, Payment on 6 25 
Statements of 6 23 
Statements of, Form MCCC- 13-A 5-a 
Actual Cost, Agreement to Repay 2 8(1) 
Acute Rates 15 88 
Admission Reports (See Entrance Reports) 
Admissions, Authorizations 8 43 
First, Authorizations 8 43 
Afflicted Child, Definition, Act 283, Section 2 
Residence Qualifications, Act 283, Sections 2 and 5 
Age Limitation 11 55 
Agreement to Repay, Acceptable Signatures 2 8(4) 
Actual Cost 2 8(1) 
Cancellation 2 8(5) 
Cancellation Renewal Court Order 2 7 (b) 
Certification by Judge of Probate 3 8 
Form MCCC-27 2-a 
Optional Provisions 2 8 
Portion of Charges 2 8 (2) 
Terms and Conditions 2 8(3) 
Aid to the Blind, Agreement Cancellation 2 8(5) 
Aid to Dependent Children, Agreement, Cancellation 2 8(5) 
Allocation Appropriation Formulae 45 17 
Allotment Cases, Quarterly 5 18 
Reserve 5 18(b&c) 
Uncommitted 5 18(c) 
Allotment Charges, Change of Classification 6 22 
Not Chargeable 5-6 19-21 
Special Cases 6 21 
Supplementary Treatment 5 20 
Allotment Release, Form MCCC-94 4-a 
Ambulance, Billing (Act 158) 4 16 (b) 
Schedule (Act 158) 4 16 
Wayne County 4 16 (c) 
Anaesthetic, Out-Patient Only 16 89 
Anaesthetists’ Services, Physicians 30 303 
Animal Inoculations, Michigan Hospital Service 22 102 
Appendicitis, Chronic, Restricted Cases 7 41 (c) 
Determination 20 97 
Appliances and Braces, Exception to Flat Rates 15 86 (b) 
Applicants, Eligible, Act 158, Title III, Section 4 
Act 283, Section 5 
Application for State Aid, Definition of 7 40 (a) 
Emergency Cases 8 43 
Form MCCC-124 7-a 
Time Limitation 7 40 (b) 
Appointment of Guardians 3 11 
Appropriation, Allocation, Formulae 4-5 17 
Approval, Boarding Homes, Act 158, Titles III & VIII, Sections 4-23 
Act 283, Section 10 
Convalescent Homes, Act 158, Titles III & VIII, Sections 4-23 
Act 283, Section 10 
Hospitals, Act 158, Titles III & VI, Sections 4-17 
Act 283, Section 3 
Investigators 1 2 
Approved Hospitals 12 70 
Approved Rates 15 88 
Assignment of Benefits, Insurance, Form MCCC-61 6-a 
Attendants, Advance Payment 28 212 (c) 
Eligibility • 27 212 
Fee, Conveyance 27 212 
Attested True Copy, Court Order 1 4(a) 
Authorizations, Clinic Readmittance 1 6 
Emergency Cases 8 43 
First Admissions 8 43 
Non-emergency Cases 8 43 
Readmissions 8 44 
Basal Metabolism 16 89 
Michigan Hospital Service , 22 102 (b) Page Para. 
Bedside Education, Act 158, Titles VII, VIII and X, Sections 20, 21 
22, 23 and 33 
Bedside Visits, Extension of Physicians-Surgeons 30 304 
Physicians-Surgeons 30 302 
Bequests, Disposition of, Act 158, Title X, Section 38 
Act 283, Section 3 
Billing, Ambulance (Act 158) 4 16 (b) 
Approved Forms 24 110 
Blood Donors 23-a 
Calendar Month 23 109 
Date of Discharge 23 108 (c) 
Date of Entrance 23 108 (c) 
Date to Submit 23 109 
Economic Investigation 26 201 
Economic Investigation, Mailing Instructions 26 202 
Forms, Furnished by Commission 24 110 
Hospital Services 22-a 
Individual Invoice 24 110 
Instructions 24 110 
Investigation, Form A-75R 26-a 
Limitation Rebilling 24 111 
Medical Investigation 26 201 
Medical Investigation, Mailing Instructions 26 202 
Michigan Hospital—Medical Service Certificates 21-a 
Nursing Services . 24 112 
Out-Patient 24-a 
Physicians Court Examination, Form A-75R 31-a 
Physicians-Surgeons Limitations 31 308 
Physicians-Surgeons Responsibility 31 308 
Procedure, Hospital Billing 24 110 
Professional Services 23-a 
Summary Invoice 24-25 110 
Time Limitation 23 108 (a) 
Without Court Order 23 108 (b) 
Blood Donors, Billing 23-a 
Michigan Hospital Service 22 102-103 
Rates 15 86 (b) 
Blood Calcium 16 89 
Blood Cholesterol 16 89 
Blood Count, complete, red, white, differential 16 89 
Blood, Necessary Information 21 100 
Blood Sugar 16 89 
Boarding Homes, Approval of, Act 158, Titles III & VIII, Sections 4-23 
Act 283, Section 10 
Braces and Appliances, Exception to Flat Rates 15 86 (b) 
Michigan Hospital Service 22 102-103 
Bus or Rail, Conveyance 11 54 
Tax Exempt v 11 54 (d) 
Calendar Month Billing 23 109 
Cancellation, Agreement, Renewal Court Order 2 7(b) 
Agreement to Repay 2 8 (5) 
Entrance Reports 12 72 (f) 
Casts, Billing Instructions 20 95 
Multiple 20 95 
Out-patient 16 89 
Schedule 20 95 
Casualty Insurance 21 101 
Cerebral Palsy, Advance Approval 7 41 (i) 
Restricted Case 7 41 (i) 
Certificate, Physician-Surgeon, Form MCCC-121 8-a 
Certification of Agreement by Judge of Probate 3 8 
Change of Hospital 10 49 
Change of Residence 3 9 
Child Welfare Expense Voucher, Form A-75R, Ambulance (Act 158) 4 16 (b) 
Conveyance 26-a 
Economic Investigation 26 201 
Investigation 28-a 
Judge of Probate Approval 26 201 (d) 
Limitations 26 201 (g) 
Mailing Instructions 26 202 
Medical Investigation 26-31 201-310 
Signatures 26 201 (e) 
Circumcision, Maximum Hospitalization 7 41 (f) 
Restricted Cases 7 41 (f) 
Classification, Change of 10 50 (a) 
Clinic Readmittance, Authorization 1 6 
Limitations 1 6 Page Para. 
Clinic Report, Form MCCC-A5-56 11-a 
Form MCCC-57 14-a 
Communicable Diseases, Itemization 9 45 
Rechargeable Periods 9 46 
Report of Isolation 13 77 
Tuberculosis ; .. %. ; .. ...... 9 47 
Consultation, Physicians-Surgeons 31 307 
Convalescent Homes, Approval of, Act 158, Titles III & VIII, Sections 4-23 
Act 283, Section 10 
Convalescent Home Care, Rates 15 88 (c) 
Convalescent, Rates 15 88 (b) 
Conveyance, Attendants’ Fee 27 212 
Attendants’ Payment 28 212 (c) 
Billing, Form A-75R 26-a 
Bus or Rail 11 54 (f) 
Cheapest Method 27 204 
Commission Conveyor 3 14 
Crippled Children Only 26 203 
Delayed . 4 IB (c) 
Delayed, Recharge to County (Act 283) 11 54 (f) 
Direct Route 27 209 
Emergency 3 14 
Emergency Purchases 27 207 
Excessive 27 206 
Hospital Discharge 11 54 (b) 
Hotel Accommodations 28 214 
Hourly Rate 27 211 
Meals 28 213 
Mileage Detail 28 215 
Mileage Rate 27 211 
Prorating Expense 28 216 
Rail-Bus 11 54 
Receipt 26-27 201 (b)-210 
Receipt, Form MCCC-C76 27-a 
Restrictions 3 14 
Single 27 206 
Supporting Documents 28 217 
Telegrams, Telephone Calls 29 219 
Correction Memorandum 24 111 
Form MCCC-101 25-a 
County Treasurer, Remittance 6 24 
Court Order, Attested True Copy 1 4(a) 
Effective Date (Act 283) 1 3 
Effective Period 1 4 
Emergency Cases 8 43 
Exemplification of Record 1 4(a) 
Form MCCC-123 ; 1-a 
Limited 1 5 
Newborns 14 82 (2) 
Non-emergency Cases 8 43 
Original Coverage 12 74 
Personal Signature of Judge of Probate 1 4(a) 
Renewal 1 7 
Renewal, Hospital Responsibility 20 96 
Crippled Child, Definition, Act 158, Title II, Section 2 
Residence, Act 158, Title VI, Section 15 
Cultures, Blood, Fluid or Pus 16 98 
Custodial Case, Definition, Act 158, Title IX, Section 25 
Definition (Act 283) 10 52 
Determination of 11 56 
Recharge, Act 158, Title X, Section 35 
Dangerous Communicable Diseases (See Communicable Diseases) 
Date of Application, Definition 7 40 (a) 
Death of Patient, Discharge Report 14 84 
Definition, Afflicted Child, Act 283, Section 2 
Application for State Aid 1 7 40 (a) 
Crippled Child, Act 158, Title II, Section 2 
Custodial Case, Act 158, Title IX, Section 25 
Custodial Case (Act 283) 10 52 
Emergency Case 10 48 (a) 
Supplementary Treatment : 13 78 (a) 
Delayed Conveyance, Recharge to County (Act 283) 11 54 (f) 
Delinquent Entrance Reports 12 72 (b) 
Exception 12 72 (e) 
Dental Care and Surgery, Advance Approval 7 41 (h) 
Restricted Cases 7 41 (h) Page Para. 
Deposits on Account, Application for State Aid 23 106 
Effective Date Court Order 23 106 
Delinquent Entrance Report 23 106 (b) 
Procedure 23 106 
Desensitization Solution 16 89 
Determination of Custodial Case 11 56 
Designation of Hospital, Act 158, Title VI, Section 16 
Act 283, Section 5 
Diabetic Kit, to Take Home 21 98 
Diagnosis, Established 14 83 (b) 
Discharge, Hospital, Notification 11 54(a) 
Discharge Report 14 83 
(Act 158) Form MCCC-57 13-a 
Date of Death 14 84 
Established Diagnosis 14 83 (b) 
Form MCCC-A5-56 11-a 
Reporting Period 14 83 
Donors, Blood 21 100 
Dressings, Out-patient 16 89 
To Take Home 21 98 
Economic Investigations, Approved 29 220 
Billing 26 201-202 
Dates 29 222 
Filing 29 220 
Form MCCC-27 3-a 
Hourly Rates 27-29 211-223 
Mileage 27-29 211-223 
Office Allowance 29 224 
Rejected 29 220 
Reports (Act 158-283) 1 2 
Education, Bedside, Act 158, Titles VII, VIII & X, 
Sections 20-21-22-23-33 
Effective Date, Court Order (Act 283) 1 3 
Effective Period of Court Order 1 4(a) 
Transfer Order 10 51 
Electrocardiogram 16 89 
Michigan Hospital Service 22 102 
Eligible Applicants, Act 158, Title III, Section 4; Act 283, Section 5 
Emancipated Persons (Act 283) 3 10 
Emergency Cases, Authorizations, First Admissions 8 43 
Authorizations, Readmissions 8 44 (a) 
Definition 10 48 
Hospital Responsibility 8 43 
Instructions to Parents 8 43 
Procedure 8 43 
Proof of 10 48 (b) 
Emergency Readmissions, Authority 8 44 (a) 
Procedure 8 44 (a) 
Without New Court Order 8 44 (a) 
Entrance Days, Recommended 27 205 
Entrance Reports, (Act 158) 12 71 (a) 
(Act 283) 12 71 (b) 
Cancellations 12 72 (f) 
Delinquent 12 72 (b) 
Delinquent Exceptions 12 72 (e) 
Form MCCC-A5-56 11-a 
Reporting Period 12 72 (a) 
Epispadias, Restricted Case 7 41 (e) 
Established Diagnosis 14 83 
Exemplification of Record, Court Order 1 4 (a) 
Exercises, Classification 16 90 
Schedule of Rates 17 90 
Expense Voucher (See Child Welfare Expense Voucher) 
Extension Requests (See Hospitals) 
Extras, Flat Rate 15 86 
Michigan Hospital Service, Full Rate Period 22 102 
Michigan Hospital Service, Partial Rate Period 22 103 
Out-patient 16-20 89-95 
First Admissions, Authorizations 8 43 
First Examination, Physicians-Surgeons 30 302 
Flat Per Diem Rates (See Rates) 
Forms 
6-R Request for Hospital Services 12-a 
8 Correction Memorandum 24 111 
13-A Statement of Account 5-a 
27 Agreement to Repay 2-a 
Economic Investigation 1-3-a 2 Page Para. 
Forms—Continued 
A5-56 Entrance, Discharge, Clinic Reports 11-a 
57 Clinic, Out-patient Report 14-a 
Discharge Report (Act 158) 13-a 
61 Assignment of Insurance Benefits 6-a 
A-75R Child Welfare Expense Voucher 26 201 (a) 
Conveyance 26-a 
Investigation Billing 28-a 
Physicians Billing, Court Examination 31-a 
C76 Conveyance Receipt 26, 27, 27-a 201-210 
94 Allotment Release 4-a 
100 Hospital Summary Invoice 24-25 110 
101 Correction Memorandum 25-a 
Individual Invoice 21-a, 22-a, 23-a, 24-a, 24, 30-a 110 
121 Physician-Surgeon Certificate 8-a 
123 Order of Conveyance 1-a 
124 Application for State Aid 7-a 
225 Cost In-patient Service 15 87 (a) 
227 General Public Ward Care & Summary of Income 15 87 (a) 
Formulae, Appropriation, Allocation 4-5 17 
Foster Home Care, Rates 15 88 (d) 
Gastric Analysis 16 89 
Gifts, Devises, Bequests, Disposition of, Act 158, Title X, Section 38 
Act 283, Section 3 
Glasses, Advanced Approval 7 41 (g) 
Exception to Flat Rates 15 86 (b) 
Michigan Hospital Service 22 102-103 
Gram Stain 16 89 
Guardians, Ad Litum 3 11 
Appointment of 3 10 
Heat Treatment, Classification 16 90 
Hernia, Restricted Case, Exceptions 7 41 (b) 
Hospitals, Approval of, Act 158, Titles III & VI, Sections 4-17 
Change of 10 49 (b) 
Designation of, Act 158, Title VI, Section 16 
Act 283, Section 5 
Discharge Conveyance 11 54(a) 
Discharge Notification 11 54(a) 
Invoice (See Billing) 
Location of (Act 158) 1 1 
Responsibility of, Accident Cases 12 75 
Responsibility, Insurance Cases 12 75 
Services, Billing 22-a 
Service Requests, Acute Periods 13 76 (b) 
Convalescent Periods 13 76 (b) 
Delinquent 13 76 (d) 
Delinquent Exceptions 13 76 (e) 
Form MCCC-6-R 12-a 
General Uses 13 76 (a) 
Nursing Services , 14 80 
Physicians’ Visits 13 79 
Pregnancy Cases 14 81 
Readmission Authorization 8 44 (a) 
Report of Isolation 13 77 
Reporting Period ; 13 76 (c) 
Supplementary Treatment 13 78 (a) 
Hospitalization Insurance 21 101 
Hotel Accommodations, Conveyance 28 214 
Hourly Rate, Conveyance 27 211 
Investigators 27-29 211-223 
Hydrotherapy, Classification 16 90 
Schedule of Rates 17 90 
Hypospadias, Restricted Case 7 41 (e) 
Incurable Mental Defectives 10 53 (a) 
Indemnity Insurance 21 101 
Individual Invoice 24 110 
Hospital Services 22-a 
Michigan Hospital Service 21-a 
Michigan Medical Service 21-a 
Out-patient 24-a 
Physicians-Surgeons Multiple Services 30-a 
Professional Services 23-a 
Instructions, Billing 24 110 
Insulin, Out-patient 16 89 
Insurance, Assignment of Benefits, Form MCCC-61 21-6a 101 
Cases, Hospital Responsibility 12 73 
Identification, Form MCCC-61 6-a Page Para. 
Investigation, Billing, Form A-75R 28-a 
Economic (See Economic Investigations) 
Medical, Probate Court 31 310 
Investigators, Approval 1 2 
Invoices, Hospital (See Billing) 
Judge of Probate, Approval Agreement to Repay 3 8 
Approval Expense Vouchers 26 201 (d) 
Personal Signature, Court Orders 1 4 
Liability Insurance 21 101 
Liability, State, Limitation, Act 158, Title X, Section 37 
Act 283, Section 19a 
Limitations, Age 11 55 
Application State Aid , 7 40 (b) 
Billing Time 23 108 (a) 
Of State Liability, Act 158, Title X, Section 37 
Act 283, Section 19a 
Physicians-Surgeons Fees 30 301 
Rebilling 24 111 
Limited Court Orders 1 5 
Liver and Iron Concentrate 16 89 
Liver Extract ..... 16 89 
Location of Hospital (Act 158) 1 1 
Mailing Instructions, Expense Vouchers 26 202 
Massage, Schedule of Rates 17 90 
Maximum Fees, Physicians-Surgeons 31 311 
Meals, Adults, Conveyance 28 213 
Children, Conveyance 28 213 
Diabetic 16 89 
Regular 16 89 
Medical Examination, Probate Court 31 310 
Memoranda, Correction 24-25-a 111 
Mental Illness, Incurable 10 53 (a) 
Michigan Hospital Service, Commission Extras 22 102 
Extended Period 22 104 
Full Rate Period 22 102 
Partial Rate Period 22 103 
Michigan Medical Service 22 102 
Mileage Detail, Conveyance 28 215 
Mileage, Economic Investigators 27-29 211-223 
Mileage Rate 27 211 
Monthly Billing 23 109 
Mouse Inoculations . 16 89 
Multiple Services, Physicians-Surgeons 30 305 
Billing 30-a 
Muscular Dystrophy, Advance Approval 7 41 (j) 
Restricted Case 7 41 (j) 
Non-Emergency Cases, Authorization 8 43 
Readmissions 8 44 (b) 
Neuro-Psychiatric Institute 10 53 (b) 
Newborns, Classification 14 82 (4) 
Court Order 14 82 (2) 
Effective as State Charge 14 82 (1) 
Normal 14 82 
N.P.N 16 89 
Nursing Services, Billing 23-a, 24 112 
Michigan Hospital Service 22 102-103 
Rates ...15 86 (b) 
Requests 14 80 
Requirements .... 14 80 
Office Allowance, Economic Investigation 29 224 
Old Age Assistance, Agreement Cancellation 2 8(5) 
Operating Room 16 89 
Optional Provisions, Agreement to Repay 2 8 
Orchidopexy, Restricted Case 7 41 (d) 
Order of Conveyance, Form MCCC-123 1-a 
Original Coverage, Court Orders 12 74 
Out-patient, Billing 24-a 
Extras, Itemization 16 89 
Forms 11-a, 14-a 
Rates 16 88 (e) 
Reports 12 72 (c) 
Reports, Grouping Visits 12 72 (d) 
Over-Payment, Refund 6 26 
Oxygen Therapy, Michigan Hospital Service 22 102-103 
Parents’ Payments 2 8 
Disposition of, Act 158, Title X, Section 32; Act 283, Section 17 
Optional Provisions 2 8 Page Para. 
Parents Payments—Continued 
Over-Payment, Refund 6 - 26 
To County Treasurer 6 25 
Pauper Aid, Payment by State Not, Act 158, Title X, Section 36 
Act 283, Section 18 
Payment for Services, Separate Warrants 23 107 
Payments by Parents (See Parents’ Payments) , 
Payments on Account (See Parents’ Payments) r 
Penalty Clause, Act 158, Title XI, Section 42; Act 283, Section 22 
Pension Recipients, Agreement Cancellation 2 8(5) 
Personal Signatures, Child Welfare Expense Vouchers 26 201 
Judge of Probate, Agreement to Repay 3 8 
Court Order 1 4(a) 
Physicians-Surgeons, Agreement with Patient 31 309 
Anaesthetists .30 303 
Bedside Visits 30 / , 302 
Requests 13 79 
Billing . 23-a 
Court Examination 31-a 
Period Limitations 31 308 
Multiple Services 30-a 
Responsibility 31 308 
Certificate, Emergency Cases 8 43 
Fee 31 310 
Form MCCC-121 8-a 
Consultation 31 307 
County Schedules (Act 283) 30 300 
Court Examinations, Billing 31-a 
Extension, Bedside Visits 30 304 
Fees, Exception to Flat Rates 15 86 (b) 
Michigan Hospital Service 22 102-103 
First Examinations 30 302 
Limitations 30 301 
Maximum Fees 31 311 
Medical Examinations, Probate Court 31 310 
Multiple Services 30 305 
Operative Procedures, After Care 31 311 
Out-patient Treatment 30 302 
Private Fees 31 309 
Services, Additional Calls 22 105 
Services, Basis, Court Order 22 105 
Special Examinations 30 304 
Surgical Fee Coverage 30 305 
Transfusion Limitations 31 306 
Physiotherapy, Classifications 16 90 
Michigan Hospital Service 22 102-103 
Out-patient 16 89 
Schedule of Rates 17 90 
Portion of Charges, Agreement to Repay 2 8(2) 
Pregnancy Cases, (Act 283) 7 42 
Extension of Hospitalization 14 81 
Maximum Period 14 81 
Prescriptions, Out-patient 16 89 
To Take Home 21 98 
Private Fees, Physician-Surgeon 31 309 
Professional Services, Billing 23-a 
Proof of Emergency 10 48 (b) 
Prorating Expense, Conveyance 28 216 
Proteins for Testing 16 89 
Provisions of Act Not Compulsory, Act 158, Title XI, Section 40 
Act 283, Section 21. 
Public Liability Insurance 21 101 
Purchases, Emergency, Conveyance 27 207 
Quota (See Allotment, Cases and Charges) 
Rail-Bus, Conveyance 11 54 
Rates, Acute 15 88 
Adjustments Due to Delinquent Reports 15 87 (b) 
Blood (donors) 15 86 (b) 
Classification of Hospitals 15 85 
Clinic 16 88 (a) 
Convalescent 15 88 
Convalescent Home 15 88 
Delinquent Semi-Annual Reports 15 87 (b) 
Exceptions to Flat Rates 15 86 (b) 
Flat Per Diem 15 86 (a) 
Flat Per Diem, Itemization 15 88 
Flat Per Diem, Notification 16 • 88 Page Para. 
Rates, acute—Continued 
Foster Home Care 15 88 
Hourly, Conveyors, Investigators 27 211 
Itemization of Extras 15 86 
Method of Determination 15 87 
Michigan Hospital Service, Partial Rate Period 22 103 
Mileage 27 211 
Nursing Services 15 86 (b) 
Out-patient Visits 16 88 (e) 
Semi-annual Reports 15 87 (a) 
Readmissions (See Authorizations) 
Rebilling, Limitations 24 111 
Receipt, Conveyance 26-27 201 (b),210 
Recharge to County, Communicable Diseases 9 45 
Custodial Care, Act 158, Title X, Section 35 
Delayed Conveyance (Act 283) 11 54 (f) 
Exceeding Case Allotments 4 15 (b) 
Excessive Hospitalization 4 15 
Hospital Cost Due to Delayed Conveyance 4 15 (c) 
Recommended Entrance Days 27 205 
Refund, Over-Payment 6 26 
Reinvestigation, Renewal Court Orders 1 7 
Release Reports (See Discharge Reports) 
Remittance, County Treasurer 6 24 
Renewal Court Orders, Agreement 1 7 
Agreement Cancellations 2 7 (b) 
Application 1 7 
Hospital Responsibility 20 96 
Reinvestigation 1 7 
Reports, Admission (Act 158) 12 71 (a) 
Admission (Act 283) 12 71 (b) 
Discharge 14 83 
Economic Investigation 1 2 
Entrance (Act 158) 12 71 (a) 
Entrance (Act 283) 12 71 (b) 
Out-patient 12 72 (c) 
Out-patient, Grouping Visits 12 72 (d) 
Request for Hospital Service (See Hospitals) 
Residence, Afflicted Child, Act 283, Sections 2 and 5 
Change of 3 9 
Crippled Child, Act 158, Title VI, Section 15 
In Another County 3 9 
Settlement in Another County 3 13 
Settlement Not Established 3 13 
Where Found 3 13 
Restricted Cases, Advance Approval 7 41 
Itemized 7 41 
Restrictions, Conveyance 3 14 
Schedules, Ambulance (Act 158) 4 16 
Appliances-Braces Section 7 
Casts 20 95 
Meals, Conveyance 28 213 
Michigan Hospital Service, Extras 22 103 
Out-patient Extras 16 89 
Physicians-Surgeons gecs 5 & 6 
X-ray 17-18-19 ' 94 
Service Requests (See Hospitals) 
Signatures, Acceptable, Agreement to Repay 2 8(4) 
Judge of Probate, Court Order 1 4(a) 
Special Examinations, Physicians-Surgeons 30 304 
State Aid Not Pauper Aid, Act 158, Title X, Section 36 
Act 283, Section 18 
State Liability, Limitation of, Act 158, Title X, Section 37 
Act 283, Section 19a 
Statements of Account 6 23 
Form MCCC-13A 5_a 
Sterilization 10 53 (c) 
Sulfonamides in Blood 16 89 
Summary of Hospital Income, Form MCCC-227 15 g7 /a) 
Summary Invoice, Hospital, Form MCCC-100 25 
Supplementary Treatment (Act 158) 5 20 
Approval 5 20 
Definition 13 78 (a) 
Requests .13 78 (b) 
Supporting Documents, Conveyance 28 217 
Surcharge to Counties, Act 158, Title X, Section 37 
Act 283, Section 19-a-2 Page Para. 
Surgeons’ Fees, Exception to Flat Rates 15 86 (b) 
Surgeons (See Physicians-Surgeons) 
Survivor Benefits, Agreement Cancellation 2 8(5) 
Tax Exemption Certificates 11 54(d) 
Telegrams, Acceptable Classifications 21 99 
Billing Instructions 21 99 
Conveyors 29 219 
Copies 21 99 
Exception to Flat Rates • 15 86 (b) 
Michigan Hospital Service 22 102-103 
Telephone Calls (See Telegrams) 
Terms and Conditions, Agreement to Repay 2 8(3) 
Tissue Examination, Michigan Hospital Service 22 102 
Tonsillectomies and Adenoidectomies, Extended Care 7 41 (a) 
Maximum Hospitalization 7 41 (a) 
Restricted Cases 7 41 (a) 
Transfer Order 10 50 (b) 
Authority for Issuance 10 49 
Change of Classification 10 50 (a) 
Change of Hospital 10 49 
Effective Period 10 51 
Transfusions, Blood (donors) 21 100 
Transfusion Limitations, Physicians-Surgeons 31 306 
Tuberculosis 9 47 
Urea Clearance 16 89 
Vaccine, Autogenus 16 89 
Autogenus, To Take Home 21 98 
Ward of County, Agreement Cancellation 3 8(5) 
Ward of State, Agreement Cancellation 3 8(5) 
Eligibility 3 12 
Warrants, Delivery to Hospitals 23 107 
Hospital Service 23 107 
Personal Service 23 107 
Professional Service 23 107 
Welfare Recipients, Agreement Cancellations 2 8 (5) 
X-rays, Billing Instructions 17 94 
Combination 17 , 93 
Michigan Hospital Service 22 102-103 
Maximum 22 102 
Miscellaneous 19 
Progress 17 92 
Schedule 17-18-19 94 
Therapy 19 
Out-patient 16 89 
References to Act 158 and Act 283 can be located in Section 9. 
Pages identified with an “a” are exhibits of forms. SECTION I—PROBATE COURT 
Location of Hospital 
Act 158 
1. It is recommended by the Commission that the Judge of Probate and 
the physician respectively have the child committed to one of the 
nearest or most accessible hospitals equipped to render the required 
service. 
Act 158, Title X, Section 31. 
Economic Investiga- 
tion Reports 
Act 158 
Act 283 
2. a. Parents, husband, guardians or kindred making application for 
medical care or surgical treatment for a child under Act 158 and 
Act 283 shall be subject to an economic investigation to determine 
their eligibility for state aid under these acts. 
Act 158, Title VI, Section 15. Act 283, Section 5. 
See page 3-a b. Economic investigations shall be made by representatives or 
agents approved by the Commission. 
Act 158, Title VI, Section 15. Act 283, Section 3. 
c. All economic investigations shall be submitted on Form MCCC-27, 
furnished by the Commission. 
Act 158, Title X, Section 32. Act 283, Section 3. 
Effective Date of 
Court Order 
Act 283 
3. a. The effective date of a Court Order shall be the entrance date to 
the hospital as a state case if application for hospitalization was 
made within 10 days from date of such entrance. 
Act 283, Sections 3 and 5. 
Effective Period of 
Court Order 
Act 158 
Act 283 
4. A Court Order should remain in effect for a maximum of 1 year from 
the effective date thereof. 
a. All copies of Court Orders must comply with one of the following 
stipulations: 
1. Bear personal signature of the Judge of Probate. 
See page i-a 2. Be attested as a true copy. 
3. Be accompanied by an exemplification of record. 
Act 158, Title III, Section J,\. Act 283, Section 3. 
Limited Court Orders 
Act 158 
Act 283 
5. If the Probate Judge should issue an order for a definite period of 
time, or for a specific service, such limitations shall be noted on the 
Court Order. 
Act 158, Title VI, Section 16. Act 283, Section 5. 
Authorization for 
Readmittance to 
Clinic 
Act 158 
Act 283 
6. Authorization for readmission for clinic service must be issued by 
the Probate Judge either upon the basis of each individual clinic 
visit or to cover a definite period of time as one, two, or three months, 
et cetera, not to exceed one year. 
Act 158, Title III, Section U. Act 283, Section 3. 
Renewal 
Court Orders 
Act 158 
Act 283 
7. Application for the renewal of Court Orders shall be subject to re- 
investigation and redetermination of ability to repay. 
a. Applicants for renewal of Court Orders whose financial status 
has improved should comply with the terms of the original agree- 
ment and the new agreement should be based on the applicants’ 
better ability to pay. 
1 ORDER OF CONVEYANCE (Form MCCC-123) 
Important; Correct name, application date, signature 
Probate Judge. 
REPORT—CONVEYANCE AND COURT ORDER 
M.C.C.C. Form 123—9-42—20M 
Crippled Child Act 158 P.A. 19S? 
Afflicted Child Act 283 P.A. 1939 
STATE OF MICHIGAN 
In the Probate Court, County of Roscommon 
To the Probate Court for said County: 
In the matter of J.UJ}® EI j Zabeth ■ a (Affliotad 
Surname First Name Middle Name * (Crippled 
[ Prudenvi I le 
child within meaning of statutes and a resident of-j city—vuu** Qounty 
I Township 
now residing with and under control of _J_QhQ-.SO.d__RQSe_.Hoyt Q«^Uai» 
That said child was born.... Aufl_US.t.7. .. .19.38...., that said child has/has not attended school. 
IMPORTANT 
[Name firfflet 
school Name of 
No .9 
District 
(To be reported on crippled children only) 
School 
District 
[Treasurer , School 
[Secretary of District - Roy ElSWOfth 
Address of Secretary or Treasurer 
I have investigated the residence and the financial condition of child and others liable for its care and set forth 
the results thereof in the attached report and agreement to repay. I therefore pray that Court consider the 
same and determine disposition thereof. 
Ge.Qr.fle .White.. County Agent May 8, I9M4 
Name of Investigator Title Date 
COURT ORDER At a session of said Court held at Probate office in the 
County of- Roscommon Date.... May .15 19m 
it, is }2rdered , , that said be conveyed to the Blodgett Memorial 
11 18 (Riccommended 8a u j Afflicted Ghtld Name ot Hospital 
approved by the Michigan Crippled Children Commission at Grand .Rapids 
(Address of Hospital) 
by paCSP-tS. for treatment to be paid by the State of Michigan. 
(Name of person acting as conveyor) 
Diagnosis B i J.a.t.e.r.ai.pe.a _e.auiQQy.ar.us 
To Be Entered by Court: 
Application Date — May 7 19. m 
Valid Date: Hay_.J0 IsMH 
(Court Order) 
Expiration Date: . May 10 .19 U5 
(12 months from valid date) 
Classification: * 
(Full or limited Court Order) 
Charge to Quota:_ ...May_ Act 158 
Month 
Monthly Repayment .5,00. 
Checked By: ’ 
M. C. C. C. Clerk 
This order shall be deemed valid not more than 
five days preceding the date on which application for 
State aid was made by parents, guardians, or kindred 
of patient. 
Dated this _ J.Sth... 
- day of— 
-May .19UU.. 
IP&rsLOQai.Sijjnature.) 
Judge of Probate 
County of Roscommon 
Distribution 
No. 1 Original to Court 
No. 2 Duplicate to Hospital 
No. 3 Triplicate to M.C.C.C. b. Applicants whose financial status has not improved and there 
appears to be no opportunity for meeting the terms of the agree- 
ment should be given consideration as to cancellation of this obli- 
gation to the state, for prior care as well as subsequent care. 
If the court concurs with the current investigation and the appli- 
cant addresses a letter to the Commission setting forth the facts 
as to his financial condition, the Commission will consider cancel- 
lation of the obligation and refer the matter to the State Admin- 
istrative Board for disposition. 
Act 158, Title III, Section U- Act 283, Section 3. 
Payments by Parents 
Act 158 
Act 283 
8. The Judge of Probate, or the Commission, through a duly authorized 
person or agency approved by the Commission, as the case may be, 
shall make an investigation into the financial resources of the parent, 
husband, guardian, kindred or other persons bound by law to main- 
tain the child, as to their ability to pay for the cost of medical and 
surgical treatment, and such determination shall give consideration 
to the following provisions of the agreement to repay. 
Act 158, Title VI, Section 15. Act 283, Section 5. 
Optional Provisions 1. Actual cost 
2. Portion of charges 
3. Terms and conditions 
4. Acceptable signatures 
5. Cancellation 
Interpretation 1. Actual Cost: Shall be construed to mean the total expenditure 
made by the Commission to hospital, nurses, physicians and sur- 
geons during the valid period of the Court Order. 
See pages 2-a and 3-a 2. Portion of Charges: Shall be construed to mean that portion of 
the actual cost that shall be paid during the valid period of the 
Court Order. (Applies to Act 158 only, Act 283 makes no provi- 
sion for repayment of a portion of charges). 
3. Terms and Conditions: The amount to be repaid monthly and the 
date when such payments are to begin. 
4. Acceptable Signatures: The Judge of Probate may, when the 
child is found by him to be emancipated, neglected, abandoned, or 
deserted, accept the signature of such child in lieu and stead of 
the parent, guardian or husband, (in cases under Act 283 only). 
5. Cancellation: When the resources are not sufficient to permit re- 
payment under provisions 1, 2, or 3 above, and the applicant 
qualifies within any of the following provisions: 
a. Parent, husband, guardian or kindred are unemployed, or un- 
employable due to age or physical or mental condition. 
b. Parent, husbandt guardian or kindred are recipients of welfare 
for reasons other than temporary unemployment. 
c. Parents, husband, guardian or kindred are recipients of social 
security benefits such as Aid to Dependent Children, Old Age 
Assistance, Aid to the Blind, Survivor Benefits, pensions, or 
similar forms of income. 
d. When the income of employed children residing within the 
home is not more than sufficient to meet their personal main- 
tenance in the payment of room, board, clothing, etc. 
2 AGREEMENT TO REPAY 
(Form MCCC-27) 
Instructions: Interpretation of methods 
for drafting agreements, refer to page 
2 or Manual for Investigators. 
Repayment in total, 
Act 283 
Under authority of Act 283 of the P.A. of 1939 
as amended by Act 225 of the P.A. of 1943 : 
(1) THE ACTUAL COST OF MEDICAL AND/OR SURGICAL TREATMENT, 
■Linder authority of Act 158 of the P.A. of 1&47-- 
-*» amended by Act 227 of thw P,Aro4 1943 i~" 
A1) (1) TUB ACTUAL COST (8) OR A PORTION OF THE ACTUAL COST (not to wwawd) 
$ of the total expenditure made by the State for medical and/or surgical treatment 
(3) $ ...5»00— monthly (wihout interest) until paid, payments to begin... May...! 19*44... 
-Under authority of Act 283 of tho P.A, of IQjUfc- 
daa=tmu‘H(li‘d by A>»t336 of tho P.A. of 1943ri 
tt) the ACTUAL COST OF MEDICAL AND/OR SURGICAL TREATMENT. 
Repayment in total, 
Act 158 
Under authority of Act 158 of the P.A. of 1937 
as amended by Act 227 of the P.A. of 1943; 
(2) (1) THE ACTUAL COST A PORTION OF THE ACTUAL COST (m4 to exceed^ 
of the total expenditure made by the State for medical and/or surgical treatment. 
(3) $....5.i.Q0 monthly (wihout interest) until paid, payments to begin May...!. 19.44 
Repayment of 
portion cost, 
Act 158 
Under authority of Act 158 of the P.A. of 1937 
as amended by Act 227 of the P.A. of 1943: 
-~m (1>- THE ACTUAL COST (2) A PORTION OF THE ACTUAL COST (not to exceed) 
$ 60.00 of the total expenditure made by the State for medical and/or surgical treatment. 
(3) $ 5-t.QQ monthly (wihout interest) until paid, payments to begin JMay._.J 19 44... 
-(3) (1) THE ACTUAL COOT (3) OB A PORTION OF TOE ACTUAL 000T (nut to 
--- ~gf'tin* total expenditure made by thw8tg,t,B''fonn«diPHt~gnd/or Burkina! treatment. 
(3)$ monthly (wifcwi< whereat) until paid, payments1 ttrfrpgin. 1&—■■■■= 
(Statute of Limitations is Expressly Waived) 
Date June! .wJW. 
(Ink Signature) (Ink Signature) 
Witness Parent, Husband. Guardian. Kindred 
Approved Cancelled X Rejected 
Date June-JU—1944 Clnk Signature) 
Judtte of Probate 
Cancellation of agreement. 
Acts 158-283 Interpretation 
(Cont’d.) 
e. When a case is a ward of the County or State. 
f. When it has been determined a child is neglected, abandoned, 
or deserted. 
In all instances the Judge of Probate shall submit to the Commission 
a copy of the investigation, and if there are no resources in accord- 
ance with the investigation, he shall certify to same in the space 
designated on the agreement to repay, (Form MCCC-27), and affix his 
signature. 
Act 158, Title X, Section 32, Title III, Section 1/. Act 283, Sections 3 and 17. 
9. The Court Order may remain effective to its expiration date, even 
though the parents, husband, guardians or kindred may change their 
residence to another county. 
10. The signature on the agreement to repay of a person deemed to be 
“emancipated” may be accepted by the Probate Judge. 
Act 283, Section 17. 
11. If neither parent, nor husband, is living and the child has no guardian 
the court shall appoint a guardian according to the statutes,* or a 
guardian ad litum, to sign such an agreement. 
Attorney General's opinion of May 6, 191/2. 
12. a. Crippled children of normal mentality who are wards of the state 
are eligible for necessary medical or surgical treatment. 
Act 158, Title II, Section 2. 
b. Afflicted children who are wards of the state other than those 
provided for under Act 138 of the P. A. of 1881 are eligible for 
necessary medical and surgical treatment. 
Attorney General’s opinion No. 21/611/ of December 15, 191/2. 
13. The Probate Court of the county in which the child is found shall 
issue the order, even though the parents, husband, or guardians of an 
afflicted child may have settlement in another county of the state of 
Michigan or have never established a settlement in any county of 
the state. 
Act 158, Title VI, Section 15. Act 283, Section 5. 
14. a. Crippled children from the Upper Peninsula shall not be conveyed 
to a hospital in the Lower Peninsula for services which are avail- 
able in the Upper Peninsula without the approval of the Director, 
or the District Medical Coordinator. 
b. Conveyance to the Lower Peninsula shall be by the Commission 
conveyor except in emergency cases when the Commission con- 
veyor is not available. 
Act 158, Title III, Section I/. 
Change of Residence 
Act 158 
Act 283 
Emancipated Persons 
Act 283 
Appointment of 
Guardians 
Act 158 
Act 283 
Ward of State 
Act 158 
Act 283 
Residence in 
Another County 
Act 158 
Act 283 
Conveyance 
Restrictions 
Act 158 
Act 283 
3  
Bom August 12 1,M_ 
IO PBOBATE COURT, COUNTY OF I no ha. 
Refer to Physl- 
Di.gnoois dsn's Csrtlflcsts 
In th. matter of Heien Marie-Smith |S" p!.d Slid -Aub. Fasl 
MICHIGAN CRIPPLED CHILDREN COMMISSION 
4BS HOLLISTER BUILDING. LANSING. MICHIGAN 
STATEMENT OF PARENTS—GUARDIANS—KINDRED—HUSBAND 
Name „ Name 
Father .„.JjjlUl SMith Age 33 Mother Mary.-- ikith Age ZL 
Name of Name of 
Guardian Age .Kindred or Hnaband Age 
Address, Street and No. or R.F.D. No LOBB St. -Joseph Street 
Post Office Address Lansing,..Michigan 
SI 
ECONOMIC REPORT (Form MCCC-27) 
Instructions: Interpretation of approved procedures, 
refer to Manual for Investigators. 
At above yrs. 
Address ....... mos. 
4®JtobartJHreet StJiohBt, Hichlnan yT*. ..Ifl... .moa. 
Father: Av. monthly wage $ 192,00 Av^annual wage $ 23CW.0Q... Badge No. 
Employer’s name and address Jkaes- Mamjfactur ioo CoMpany>130Q 3tr—tr Uw4ng - 
Mother: Av. monthly wage $ Hone Av^annual wage g Badge No 
Employer’s name and address 
Other members of family employed residing in home and income of each isXtt 
What can they contribute monthly for cost of care of above child! g 
Rent...X„ Ilome.X- Farm Monthly Rental gJifidHQ Are payments up to date X - 
Own... Home Parra Value g—: infract | Unpaid Balance g 
Income Property X— Farm Home Monthly Income g Annual Income g 
Itemize—Balance owed, date of accounts, status of payments,,, ZuiLfumiturfl, Store, $100.00, 
pgy.Mgntg $2.80 per month: Dr. Case. $78.00. oavMenta $2.80 oar mnnthy St. Imrasm 
ttQ5pj.lal^..$iBQ»(X)^..pa)[Ments..l5JiOQ..gBr-MootlL 
List amounts (individually) cash or loan values—If group hospital fill out form M.0.0.0. Ho. 61 in detail 
JAlhac..-.$XQDQ. flf); Mother - $800.00; Hi chi paw 
Hospi taJ. flenafi t Asaociatioo, - See-iC0CrAl -attAch«d.- - 
IMPORTANT GIVE COMPLETE DETAILS AS TO CAUSE, TIME. PLACE, PERSONS INVOLVED 
SSi4*"* Attach copy of REPORT 
as—. 
BEL- 
Ki- 
KSCS- 
Ilnve you agreed prior to this application for hospitalisation to make er have yon made private arrange- 
ments with any hospital er physician for care of the abeva child! X 
I# ao, with whom were private arrangements nude! 
Have you agreed prior to this application for hcapitalisation to make or have you made any payment towards 
the eoet of care to any hospital or pAysickm for the above child! X 
If ao, whom did you pay, day, date and the amount!—4rJLrj5t.120.00. .tQ.iiaivarai t)f..H(Splt8 i 
Witness (ftarunsal 1 IflaalUTttT 
(Give reaaona why this application should be 
accepted or rejected) 
KOI II: U r*IM I* la BNirilil >■ M data cf imMIm «W* 
r*<rmmcr dale >ai»r Hcapital a. part oTreport 
U Jads* «T I'ratata. 
AGREEMENT TO REPAY 
(Form MCCC-27) 
Instructions; Interpretation of methods 
for drafting agreements, refer to page 
2 or Manual for Investigators. 
8 children under 15 years of age. The Monthly expenses of this faeily 
average $106.80. I therefore recc—end they be given consideration for 
Stata aid, with tba agreement to repay indicating Monthly payMeet of 
13.00, for a total repaysent of $42.00. 
Date of Application ...ACfl.i...I 
(Signed) . (Persona I Sjpnaturt) 
Title 
To JUDGE OF PROBATE: Note the optional plana for repayment under Act 158 (2) and (I). If 
applicant is to re|«y under either Act 158 or Act 283, the agreement must be complete aa to t**.e ament 
at monthly repayment and date payments are to begin or be cancelled by your personal signature 
AGREEMENT TO UFAT 
We/I, being the parent, hnaband. guardian, or kindred of the above named child, request medical 
and/or surgical treatment for the aame. and the undersigned agrees to pay the State of Michigan, 
through the Crippled Children Commission, in accordance with the following terms and conditions; 
Cndce authority *i Aet 888 ef 4he P A *4 1989 
■a amended by Ami W* ef the P A e« 1010: 
Under authority of Aet 158 of the P.A. of 1937 
aa amended by Aet 227 of the P.A. of 1M3; 
(2) I <11 mm AINU •••■ (II) M A PORTION OF TBS ACTUAL OOWt (not to exceed) 
$.42.00 of the total expenditure made by the State for medical and/or aurgieal treatment. 
(8) |—3-?® monthly (•cikout interett) until paid, payments to begin 1»M- 
(HtatuU of limitation* u Brprwly Waived) 
Date AfttiLlQ, (FWaonn I Signatures) 
(ftiracma I Signature! 
Approved—X Cancelled Rejected 
to —AstiJ 12* ! Recharge Excessive 
Hospitalization 
Act 158 
Act 283 
15. Cost of hospitalization will be recharged to the county as follows: 
a. Excessive or unnecessary hospitalization due to neglect of county 
authorities. 
b. Exceeding case allotments. (In cases of true emergencies, or epi- 
demics, the Judge of Probate should negotiate promptly with the 
Director for release of additional allotments.) 
c. Failure to remove child from hospital within 48 hours from date 
of notification of discharge. (Exception—72 hours from date of 
discharge on Upper Peninsula patients, in Lower Peninsula hos- 
pitals.) 
Act 158, Title X, Section 37. Act 283, .Section 19 a-2. 
Ambulance and 
Invalid Coach 
Schedule 
Act 158 
16. a. The Commission accepts no responsibility for the payment of am- 
bulance services for other than crippled children and the charges 
shall not exceed the following schedule of rates, which are in- 
clusive of attendant’s fee. 
1. (a) Fees within cities in excess of 15,000 pop- 
ulation, inclusive of 8 mile zone $5.00 flat 
(b) Fees within cities or villages of a popu- 
lation of less than 15,000, inclusive of 8 
mile zone 3.00 flat 
2. Map mileage beyond the 8 mile zone, both ways .15 per mile 
3. Passenger cars (used for ambulance convey- 
ance) y2 above rates 
NOTE: Suppliers of ambulance or invalid coach service may add the 
flat fee to map mileage in billing for services. 
Lansing to Ann Arbor—(Map mileage) 62 miles 
Less zone mileage 8 miles 
One way 54 miles 
COMPUTATION: Total miles—108 mi. x .15 (rate per 
mile) 16.20 
Additional allowance (flat rate) 5.00 
Total $21.20 
Billing 
Example 
b. The billing must be made on Child Welfare Expense Voucher 
(Form A-75-R), available through the Commission, the Judge of 
Probate or county agent, and must be certified by a Judge of Pro- 
bate, or a representative of the Commission. 
Act 158, Title III, Section Jf, Title X, Section 31. 
Wayne County 
Ambulance 
Act 158 
Act 283 
c. Ambulance services for all crippled children, and Wayne County 
afflicted children hospitalized in Wayne County, must be author- 
ized in advance by the District Medical Coordinator. 
NOTE: For afflicted children from other counties, the coordinator may 
authorize ambulance service when desirable in order to facilitate service for 
the child and the Commission. 
Allocation of 
Appropriation 
Act 158 
Act 283 
Formulae 
17. The allotments for funds to counties are computed by formulae and 
converted into cases for the convenience of commitment by Judges 
of Probate and for methods of control by the Commission. 
a. The crippled children formula gives consideration of equal 
weight to these factors:—(a) Number of crippled children served 
in each county during the last sexennium (six-year average), (b) 
Number of crippled children registered in each county as of May 
31, of current year, (c) Average annual expenditure in each 
county during the last sexennium (six-year average). 
4 ALLOTMENT RELEASE (MCCC-94) 
Quarterly release, monthly allotment control. 
QUARTERLY CASE ALLOTMENT: ACT 283 
To: Probate Judge Ingham County 
The cases hereon are allotted to your county for the Second quarter 
in accord with the approved case allotment and control plan of the Commission. 
CASES OF COUNTY ALLOTMENT FOR 
COMMITMENT BY JUDGES OF PROBATE 
1. Cases uncommitted at the 
beginning of the month. 
2. Allotment of county cases 
for the month (75%). 
3. Additional cases released for 
commitment by Judge of Probate. 
4. Number of cases committed by 
Judges of Probate during month. 
5. Number of cases uncommitted at 
end of month. 
MONTH OF MONTH OF MONTH OF TOTAL 
July August September forwarded 
No 
i... 
None 
Forwarded 
CASES IN COUNTY RESERVE ALLOTMENT 
SUBJECT TO DIRECTOR’S RELEASE 
6. Cases unreleased at the 
beginning of the month (15%). 
7. Allotment of county reserve 
cases available for release 
8. Total number of reserve cases 
released by Director. 
9. Unreleascd county reserve cases 
at end of month. 
No 
Balance 
None 
Forwarded 
RELEASED THIS DATE: September ?5, I9I4I4 
SEE PARAGRAPH 17, page 4 
THROUGH PARAGRAPH 22, page 6 
MCCC-9U b. The afflicted children formula gives consideration of equal 
weight to three factors:—(a) Number of afflicted children served 
in each county during the last sexennium (six year average), (b) 
Population under 21 years of age (1940 census) in each county, 
(c) Average annual expenditure in each county during the last 
sexennium (six-year average). 
Release of 
Allotments 
Quarterly 
Act 158 
Act 283 
18. On or before the first day of the months of July, October, January 
and April of each fiscal year, notice of the allotments for the respec- 
tive counties are forwarded to the Judge of Probate for the ensuing 
three months period. 
a. The county allotment is subject to commitment by the Judge of 
Probate during the quarter. 
b. The county reserve is subject to commitment by the Judge of Pro- 
bate upon approval by the Director, upon notice of need. 
Allocated Cases 
Act 158 
Act 283 
For purposes of allotment charges, the commitment of any child 
under either act is counted only once during the fiscal year, re- 
gardless of the number of readmissions. 
Uncommitted 
Allotment 
All uncommitted county allotment at the end of each quarter is 
not available for commitment during the following quarter. All 
such unused balances are redistributed to counties in accordance 
with the approved plan. 
When released to counties as an addition to their allotment they 
are released under the classification of “c” cases. 
Reserves to Meet 
Extra Needs of 
County 
c. Whenever a county’s needs exceed that county’s allotment, a re- 
lease of additional cases may be made at the discretion of the 
Commission, providing there are uncommitted cases available for 
release, or in cases of epidemics. 
Act 158, Titles III and X, Sections 4 and 37. Act 283, Sections 3 and 19a-l. 
Cases not Chargeable 
Against Allotment 
Out-Patient 
Act 158 
Act 283 
19. Any case approved for out-patient (clinic) services exclusively, shall 
not be charged against allotment. 
NOTE: If a child is required to spend a night in the hospital for the ap- 
plication of casts, repairs of braces or other necessary causes, such stay, if 
it does not exceed one night, shall not be chargeable against allotment. 
Act 158, Title III, Section Jf. Act 283, Section 3. 
Supplementary 
Treatment 
Act 158 
20. Cases receiving care and treatment under Act 158 Court Orders, and 
requiring treatment classified under Act 283 will not require a new 
Court Order for such service, and such cases are not chargeable 
against Act 283 allotment. 
a. Approval for Act 283 service as supplementary to Act 158 must, 
however, be obtained from the Director of the Commission. 
Act 158, Title III, Section Title X, Section 37. 
5 STATEMENT OF ACCOUNT (Form MCCC-13-A) 
Moiled by Commission direct to parents, husbands, 
guardians, County Treasurers, and Judges of Probate, 
showing total encumbrance and credit on account. 
M. C. C. C. Form No. U-A 
STATEMENT OF ACCOUNT 
Statements are mailed the month following the 
entry of charges or credits and constitute your 
receipt for payments shown. Charges are 
shown as soon as approved for payment. 
Doe, John Jr. 
Patient’s Name 
Ingham 
County 
AGREEMENT TO REPAY 
$ 3*00 Monthly 
Acct. No.. 283. P. A 
Mr, John Doe sr. 
230 Garden St. 
Lansing 10 Michigan 
To assure proper credit. 
Return this heading with your remittance. 
Month of 
Billing Case No. Description of Service Charges | Credits Balance 
Balance Brought Forward. 
SPARROW HOSPITAL LANSING 
JUL 44 945666 2 18 44 TO 2 28 44 HOSP. CARE 35.00 
DR.FEE 50.00 85.00 
945666 3 I 44 TO 3 3 44 HOSP. CARE 10.50 
MICH,HOSP. SERVICE INS, IS.OOcr 80.50 
945666 4 3 44 PMT.PARENT 3.0OCR 77.50 
9*5666 5 6 44 PMT.PARENT 3.00cr 74.50 
To Parents and Guardians: Re: Current statement of account 
Repayment by you in accordance with agreement signed at the time of admittance of this child to the hospital is requested. WAYNE 
COUNTY Cases should make their payments to the Friend of the Court Wayne County Circuit Court as per its order, or to the 
Wayne County Juvenile Court, 1025 Forest Avenue, Detroit. Other than Wayne County payments shall be made to the office of 
the County Treasurer or mailed direct to the Commission at 458 Hollister Bldg., Lansing, Michigan. 
MICHIGAN CRIPPLED CHILDREN COMMISSION Special Cases 
Act 158 
Act 283 
21. Cases which qualify under the following classifications shall not be 
charged against allotments: 
a. Contagious (fully rechargeable) 
b. Eligible for hospital benefit insurance (total cost) 
c. Private arrangements made to pay the cost 
d. Non-resident (Act 283) 
e. Over twenty-one years of age 
f. Incorrectly classified 
g. Economic rejection 
If any part of the medical or surgical treatment under “a” and “b” 
above is paid by the state the case is chargeable against allotment. 
Act 158, Title III, Section 4- Act 283, Section 3. 
Allotment Charge 
Transfer from 
Act to Act 
22. When a case is admitted under Acts 283 and 158 and charged against 
allotment and later within the fiscal year conditions require a change 
of authority, or service, the allotment should be adjusted by cancel- 
ling the original allotment charge and taking credit for an additional 
case, charging the allotment under the act covering the final classi- 
fication or determination. 
Act 158, Title III, Section 4• Act 283, Section 3. 
Statements of 
Account 
Act 158 
Act 283 
23. The Commission will render for each child a statement of account of 
all expenditures made for medical and surgical treatment as the 
records of the Commission may disclose; one copy each will be directed 
to the person signing the agreement to repay, the Judge of Probate, 
and county treasurer. 
Act 158, Title III, Section 4- Act 283, Section 3. 
County Treasurer 
Report of Collections 
Act 158 
Act 283 
24. County treasurers shall remit to the Commission on the 15th of each 
month all collections from parents, husband, guardians, or kindred, 
made in accordance with the agreement to repay. 
Act 158, Title X, Section SO. Act 283, Section 11. 
Payments on Account 
Act 158 
Act 283 
25. Payments made by parents, husband, or guardians, in accordance 
with the agreement to repay shall be made to the treasurer of the 
county of residence. 
Act 158, Title III, Section 4, Title X, Section 32. Act 283, Sections 3 and 11. 
Over-Payment 
and Refund 
Act 158 
Act 283 
26. Over-payment on accounts for the cost of medical or surgical 
treatment will be refunded. Vouchers will be made payable to the 
source from which the original remittance was received. 
Act 158, Title III, Section 4. Act 283, Section 3. 
Acceptance Subject 
to Hospital Indemnity 
Casualty Insurance 
Act 158 
Act 283 
27. For the policy of the Commission as to acceptance, terms and condi- 
tions of applicants for state aid who are beneficiaries of hospital in- 
surance or indemnity contracts, or a possible beneficiary of a public 
liability, accident or casualty insurance adjustment, refer to para- 
graph 101, page 21. (See page 6-a.) 
6 ASSIGNMENT AND IDENTIFICATION 
HOSPITAL INSURANCE BENEFITS (Form MCCC-61) 
Duplicate copies required. Direct both copies to Commis- 
sion attached to Order of Conveyance (Court Order). 
Note; Instructions contained in margin of report. 
ASSIGNMENT RE: H OS P I T A L-S U R G I C A L BENEFITS 
A I hereby assign to the Crippled Children Commission, Lansing, Michigan, 
Indemnity as becomes payable to me under Certificate No. ’ Qy issued 
under Group No. G-5000 by the Michigan Hospital Benefit Asson. 
(Association or Company) 
I 300 Btih I B I do . Detroit for services furnished to 
(Address Street City) 
Helen Marie Smith beneficiary under the above Certificate, 
I Same of Patient) 
by reason of Court Order issued by Judge of Probate, County of I nohaih 
under authority of Act 158 P. A. of 1937 as amended by Act 227 P.A. of 
1913 or Act 283 P.A. of 1939 as amended by Act 225 P.A. of 1913. 
Dated this 28th day nf March 191 ** 
(Date Month) (Month) . 
Signature 
(Witness) (Insured-Subscriber) 
Relationship ~~~ 
(Bus band-P at her-Mot her-Guardian) 
IDENTIFICATION OF CERTIFICATE 
B HameJames Manufacturing Co. Address 1300 Ced?r, Lansing, Michigan 
(Smp layer) (Employer) 
Plan: Hard Semi-Private Other 
SURGICAL BENEFITS (Inc luded In Plan) Y e a X H o 
SPECIAL BENEFITS (Included In Plan) X-ray - jinnm 
(X-ray, Operating Room, Anaesthetic, Hursing Care, etc.) 
SCHEDULE OF BENEFITS ___?®__Fu 1 1 Days (Rate Per Day) $ 5 • 00 
SCHEDULE OF BENEFITS 9P.. . Part i a I Days (Rate Per Day) $ 2.25 
EFFECTIVE (or) RENEWAL DATE OF CERTIFICATE October, 19 
Benefits paid under the Certificate during current policy year, dates covered by 
payments and to whom paid None 
CjsLzJL 
(IWitness) (Insured-Subscriber)■ 
Date 19 Relationship 
/ ( Husband-father-Mother-Guardian) 
IHYSSTIOATORS: Complete Section B only for Michigan Hospi- 
tal Service Certificates - Sections A and 8 
for all other types of hospital insurance. 
MCCC-61-R/1/UU (Duplicate Copies) SECTION II—PROBATE AND HOSPITAL 
Definition 
Date of Application 
Act 158 
Act 283 
40. a. The date of application shall be construed to be the date Applica- 
tion for State Aid, (Form MCCC-124) was signed or the date 
application was made in person to the Judge of Probate by parent, 
husband, guardian or kindred. 
Time Limitation 
b. If a Court Order is to be effective as of date of admission, applica- 
tion must be made within 10 days from date of entrance to the 
hospital. 
Act 158, Title III, Sec. If. Act 283, Secs. 3 and 5. 
See page 7-a. 
Restricted Cases 
Advance Approval 
Act 158 
Act 283 
41. Advance approval must be obtained for the following (a through f) 
from the Director, Medical Coordinator, or Medical Filter Committee 
of the County Medical Society subject to review by the Commission: 
a. Tonsillectomy and adenoidectomy. 
1. Uncomplicated cases—1 day hospitalization (maximum). 
2. Complicated cases—2 days hospitalization. Extended care 
must be fully explained by letter or on Form MCCC 6-R, and 
approved. (See page 12-a). 
NOTE: Advance approval is not necessary in cases of T & A, 
complicated by chronic otitis media, mastoiditis, tubercular ade- 
nitis, rheumatic fever, endocarditis and chorea. 
b. Hernia (inguinal, femoral, umbilical) except strangulated. 
c. Chronic appendicitis, d. Orchidopexy. e. Hypospadias—epispadias. 
f. Circumcision—Maximum 1 day hospitalization. 
The following restricted cases are acceptable only upon the approval 
of the Director: 
g. Glasses. Requests for glasses shall be given consideration only 
when a child’s condition is of such a nature as to require hospital- 
ization for medical or surgical treatment of the eyes and glasses 
are a necessary part of the treatment following hospital care. 
Glasses for the treatment of strabismus and other conditions that 
can be cared for in a physician’s office are not acceptable. 
h. Dental care and surgery. 
Act 158, Title III, Sec. J{. Act 283, Sec. 3. 
i. Cerebral palsy. j. Muscular dystrophy. 
(i-j) Act 158,'Title VI, Sec. 15. 
Pregnancy Cases 
Act 283 
42. Only complicated pregnancies will be acceptable. 
COMPLICATED CASES INTERPRETED AS FOLLOWS: 
1. Medically complicated cases. 
2. Pregnancies in cases 16 years of age or under. 
3. Social complications (when the home conditions or environ- 
ment are such that home delivery is not feasible). Approval 
must be obtained from the Commission or its representative 
for hospitalization of such cases. 
Act 283, Sec. 3. 
NOTE: Except in emergency cases, application for state aid 
shall be made prior to date of confinement and in sufficient time 
so that medical, economic, and social conditions can he properly 
investigated. 
7 APPLICATION FOR STATE AID (Form MCCC-124) 
Temporary application taken on admission to hospital 
of emergency cases. 
(Note instructions to applicant). 
Date. A.p.ru.,1 1* 194.M... 
To; MICHIGAN CRIPPLED CHILDREN COMMISSION 
Lansing, Michigan Date of Birth L?..”?.™ 
i/we the ( pare.?t(s.M of. Kfi..f.fi.a...Ma r.i.fi....Sm.Lth a resident of. Lansln.iU....M JLc. hJ.g.a n 
\gunrdiaB(a)j Name of Child \aflhctedj City-Village 
in the County of. l.a.g.h.am , Michigan, hereby certify that I/we are without resources to provide proper hospital care and 
medical treatment for the above named child. 
I/we therefore apply for such State aid as is authorized by law, and agree to make a further application for such aid to the Probate Court of the above 
named county within five days from even date herewith. 
If after investigation it is determined that the undersigned is financially able to pay all or any part of the .charges for the care and treatment provided 
for the above named child, I/we agree to repay the State of Michigan in such amount and at such rate as shall be determined by the Probate Court and/or 
the Michigan Crippled Children Commission. 
Lansing <ri #f( “ 
Hospital Address... .m>1x/&4*/AA'; 
v-_ - M rOtr-Vttta. \ Street y V R.F.D. A 
Witness „>J 
Note: (Hospital shall advise applicant to make application to Probate Court within 5 days from date of admission of child to the hospital.) 
APPLICATION FOR STATE AID 
ACT 158 P. A. 1937—ACT 283 P. A. 1939 
As amended by Act 227-225 P. A. 1943 
MCCC-124—5M-—10-43 
Original MCCC No. 1 Copy 
Dupl. Judge Probate No. 2 Copy 
Hospital No. 3 Copy 
7-A First Admissions 
Authorizations 
Act 158 
Act 283 
43. Physicians, surgeons, supervisors, or other persons are without au- 
thority to commit the state for the payment for services under Act 
158 and Act 283. Hospitals are authorized to accept patients for ad- 
mission on one of the following authorities: 
Non-Emergencies a. Court Orders. 
b. Letters of authorization from the Director, 
Emergencies c. Letters of authorization from the Judge of Probate. (Such letters 
of authorization must be confirmed by Court Orders). 
d. Emergency cases admitted without authority stipulated above 
may be accepted subject to investigation, and the hospital shall 
be responsible for the following: 
1. To obtain the signature of the parents, husband, guardian, or 
kindred on Form MCCC-124, if state aid is required to meet 
the cost of medical and surgical treatment. (See page 7-a). 
2. Instruct the applicant to apply to the Judge of Probate in per- 
son within 5 days to complete the application. 
3. Complete Physician-Surgeon Certificate, (Form MCCC-121), in 
triplicate. (See page 8-a). 
IMPORTANT: Hospitals are urged for their own protection to 
submit the above forms to the Judge of Probate within 48 hours 
after entrance of the child. 
Act 158, Title III, Sec. 1,. Act 283, Sec. 3. 
NOTE: In counties where the medical and economic investigation 
is made in the office of the Medical Coordinator, the parent 
accompanied by the child shall bring the completed medical cer- 
tificate to the office of the District Medical Coordinator. 
In case the patient is unable to accompany the parent, the doctor 
shall so signify on the certificate. 
Emergency 
Re-admissions 
Without New 
Court Order 
Act 283 
44. a. Emergency cases may be readmitted for treatment of any accept- 
able condition during the valid term of a Court Order providing the 
hospital submits notification of emergency readmission on Form 
MCCC-A5-56, together with Hospital Service Request (Form 
MCCC 6-R) which shall serve, (See pages 11-a and 12-a). 
1. In lieu of a Physician-Surgeon Certificate. 
2. As authority to bill from date of entrance. 
3. As request for extension of hospital service. 
Non-Emergency 
Re-admissions 
Without New 
Court Order 
Act 158 
Act 283 
b. Non-emergency cases may be readmitted during the valid term 
of a Court Order. 
1. For treatment of the same condition by a letter of authoriza- 
tion from the Probate Judge. 
For in-patients file immediately, forms requested under 44-a. 
2. For treatment of conditions other than that for which the child 
was first hospitalized by a letter of authorization from the 
Probate Judge and a new physician’s certificate. 
NOTE: Acceptance of emergency or non-emergency readmis- 
sions without new Court Order shall he subject to reinvestigation 
of the economic status if it is known that the financial status of 
the parent, husband, guardian or kindred has changed. Act 158, 
Title III, Sec. 4. Act 283, Sec. 3. 
8 PHYSICIAN-SURGEON CERTIFICATE 
(Form.MCCC-121) 
Prepare in triplicate. 
Important: Personal signature of physician or surgeon. 
PHYSICIAN-SURGEON CERTIFICATE 
MEDICAL FILTER REPORT 
M.C.C.C. Form No. 121—10M—11-43 
Crippled Act f58 P. A. 1987 
Afflicted Act 283 P. A. 1939 
STATE OF MICHIGAN 
In the Probate Court, County of. 1.N.6HA.M. 
To Probate Court of said County: 
In the matter of _5.l5.Lth .JH.®J.®J1 hlSY-i 6 
Surname First Name Middle Name 
address. ......J_Q58 S t. . J O S e ph JLa.ILSJ.ILg 
Number Street — Road City — Village 
I, A, M, Richards., M. 0 , , do hereby certify that I am a permanent resident of 
Name of Physician 
Jtansi Mjch i Q3n and that I am a licensed practitioner of medicine in the State of 
City — Village 
Michigan. I did on LCAt day of .__.A_p_r_.LJ. 19 JJ.H. personally examine the 
said child, and further certify that said child, born ® 2-36 19 —is in my opinion a 
Date Birth (afflicted 
child whose condition can be remedied at . —— * S pa r r ow —.L®.P.-?-.Ln.fl. 
Hospital City 
and that said child can not be treated in his own home, and that said facts and circumstances upon which this 
opinion is based are as follows: 
•history and present findings: Acute pain in lower right abdomen, 
Fever, v ornj ting. 
•physical diagnosis: 
•COMPLICATIONS . 
MENTAL DIAGNOSIS: (These questions must be answered) if subnormal, give I. Q. 
LENGTH OF HOSPITALIZATION (Estimated days, months, or years) LQ_._d.aY_S 
ACUTE CARE X __. CONVALESCENT CUSTODIAL OUT-PATIENT .... . PROGNOSIS 
Curable or Incurable 
CRIPPLED CASES ONLY: BRACES ( ) ARTIFICIAL LIMBS ( ) ORTHOPEDIC SHOES ( ) CASTS. 
Number of 
PHYSIOTHERAPY OTHER APPLIANCES - 
How Often 
If crippled, state whether child will benefit by medical or surgical treatment; educationally or vocationally; 
TREATMENT: (Medical or Surgical) Su f fl ! C3 I 
EMERGENCY (X) URGENT ( ) PRIVATE CASE ( ). CASE ( ) 
DATE... Apr LL.2. 194 H (Signedf^^—~ »M. D. 
Address—Cfty, and Number \ 
•Use reverse side for additional Information x 
Telephone 
8-A Communicable 
Diseases 
Recharged to 
Counties 
Act 158 
Act 283 
45. All costs of care for crippled or afflicted children suffering from a 
dangerous communicable disease while in an approved hospital under 
Act 158 or Act 283, shall be paid by the state and recharged to the 
county from which the child was committed, as provided by the laws 
and regulations for the control of communicable diseases. 
Where local facilities are available hospitalization of children suffer- 
ing only from a communicable disease, whose care and treatment is 
provided for under the Communicable Disease Act, shall not be hos- 
pitalized under Act 283 and Act 158. 
Act 158, Title III, Sec. Jt. Act 283, Secs. 3 and 15. 
The following diseases are designated by the Department of Public 
Health as dangerous communicable diseases: 
Chancroid 
Cholera 
Diphtheria 
Diphtheria carriers 
Diarrhea of newborn 
Erysipelas 
Gonorrhea 
Granuloma inguinale 
Leprosy 
Lymphogranuloma venereum 
Malaria 
Measles 
Meningococcic meningitis 
Paratyphoid A 
Paratyphoid B 
Pertussis 
Plague 
Poliomyelitis 
Psittacosis 
Scarlet Fever 
Smallpox 
Strentococcic sore throat (acute) 
Syphilis 
Tuberculosis 
Typhoid 
Typhoid cholecystitis 
Typhus 
Yellow Fever 
Period of 
Minimum Recharge 
Act 158 
Act 283 
46. The minimum period rechargeable to the county shall be as follows: 
Diphtheria During the period of contagion 
Syphilis Until recovery is complete 
Measles Minimum of 7 days and until recovery 
Meningococcic meningitis Minimum of 14 days from onset 
and until recovery 
Pertussis 3 weeks after development 
Poliomyelitis Minimum of 14 days 
Scarlet fever Minimum of 14 days 
Smallpox Until skin is clear 
Tuberculosis 
Act 158 
Act 283 
47. a. When cases have been committed under Act 158 or Act 283 and 
are found to be complicated by tuberculosis (all types except bone 
and joint) they are to be transferred to Act 93 of the P.A. of 1937. 
b. When such cases are not in approved tuberculosis hospitals they 
are to be recharged to the county from the date that the diag- 
nosis of tuberculosis is established until such time as the case 
may be transferred to an approved hospital or sanatorium under 
the Tuberculosis Act. 
c. It is to be understood that under ordinary circumstances cases of 
suspected tuberculosis should be committed under Act 93 for 
diagnosis rather than committed under these acts. 
d. Cases of TB bone and joint may be accepted if in the opinion of 
the Commission the facilities for treatment under Act 158 are 
better adapted to the particular needs of the case than those 
available under Act 93. 
Act 158, Title III, Sec. If. Act 283, Secs. 9 and 15. 
9 Definition 
Emergency Case 
Act 158 
Act 283 
48. a. Emergency cases are considered to be those resulting from acci- 
dents or conditions so acute as to require immediate hospitaliza- 
tion. 
b. The Commission reserves the right in all cases of an emergency 
admittance of crippled or afflicted children to require proof of 
need for emergency care and treatment before approving hospital 
billings for payment of such services. 
Act 158, Title III, Sec. 4. Act 283, Sec. 3. 
Proof of 
Emergency 
Change of Hospital 
Act 158 
Act 283 
49. Cases coming within the classification of either act under which the 
original court order is issued, provided such order is in effect, may be 
transferred to another approved hospital without the issuance of a 
new court order. The transfer order may be issued by the Commis- 
sion or Judge of Probate. Copies of such transfer order shall be di- 
rected to the hospital, the Commission, and the Judge of Probate. 
Act 158, Title VI, Sec. 16. Act 283, Sec. 6. 
Change of 
Classification 
Act 158 
Act 283 
50. a. In the event the original Court Order classifies a case as afflicted 
and the confirming diagnosis shows it to be crippled, or vice versa, 
the Commission shall request an amended order from Judges of 
Probate. 
Hospital or 
Clinic Transfer 
b. Transfer to another approved hospital or clinic may be made with- 
out renewal of effective Court Order, by a Transfer Order (Form 
MCCC 26-R) issued by the Director or the Medical Coordinator. 
Act 158, Title VI, Sec. 16. 
Transfer of Case c. The Commission may issue transfer orders to some other ap- 
proved hospital better adapted to the child’s needs. 
Act 158, Title VI, Sec. 16. Act 283, Secs. 6 and 9. 
Effective Period 
of Transfer 
Act 158 
Act 283 
51. A transfer order shall not be effective until approved by the Commis- 
sion or for a period beyond the expiration date of the original Court 
Order. 
Act 158, Title III, Sec. 4. Act 283, Sec. 3. 
Definition of 
Custodial Case 
Act 283 
52. These are cases of normal mentality whose physical condition is 
such that further hospitalization is not indicated but under existing 
circumstances necessary care can not be rendered in the child’s own 
home. 
Act 283, Sec. 3. 
NOTE: The superintendents of hospitals shall report such cases 
to the Commission promptly. 
Incurable 
Mental Illness 
or Defect 
Act 158 
Act 283 
53. a. Any child suffering only from an incurable mental illness or de- 
fect shall be retained in the hospital only for such period as may 
be necessary to discharge him to his home or to the jurisdiction 
of some other act. 
Act 158, Title III, Sec. 4- Act 283, Sec. 9. 
Neuro-Psychiatric 
Institute 
b. The State Neuro-Psychiatric Institute shall not be approved for 
the purposes of these acts. 
Act 158, Title III, Sec. Jt. Act 283, Sec. 7. 
Sterilization c. Sterilization of mental defectives shall not be approved as this is 
provided under Act 281 of the P.A. of 1929. 
Act 158, Title III, Sec. 4. Act 283, Sec. 7. 
10 Hospital 
Discharge 
Conveyance 
Act 158 
Act 283 
54. a. Upon discharge the hospital shall immediately notify by telegram 
the Judge of Probate, authorized conveyor, parent, husband, guar- 
dian or kindred. 
b. Judges of Probate may authorize conveyance by bus or rail if the 
condition of the child permits such methods of travel. Parents or 
guardians may be included in these arrangements. 
c. If release is delayed beyond the provisions of paragraph 15, page 
4, hospitals are authorized to purchase transportation. 
d. The purchase of bus or rail transportation shall be tax exempt. 
(Tax Exemption Certificates are furnished by the Commission). 
e. Billing for transportation shall be on Expense Voucher (Form 
A-75-R), accompanied by the tax exemption certificate, approved 
by the hospital or Judge of Probate, unless other procedures have 
been approved by the Commission. 
Act 158, Title X, Secs. 31 and 35; Title III, Sec. If. 
f. All costs of bus and rail transportation incident to delayed con- 
veyance of afflicted children following discharge from the hos- 
pital shall be billed as in “e” above and recharged to the county 
from which the child was admitted. 
Act 283, Secs. 16 and 19 a-2. 
Age Limitation 
Act 158 
Act 283 
55. The Commission assumes no responsibility for care of individuals 
beyond their twenty-first birthday. 
Act 158, Title II, Sec. 2. Act 283, Sec. 2. 
Determination of 
Custodial Case 
Act 158 
Act 283 
56. A case may be determined to be custodial upon the recommendation 
of the Director of the Commission after review of the case history 
and the mental and physical diagnosis of the child. 
• Act 158, Title III, Secs. 4 and 5. Act 283, Sec. 3. 
11 ENTRANCE-DISCHARGE-CLIN1C REPORTS, ACT 283 
(Form MCCC-A5-56) 
Note: Mailing instructions printed on form. 
Entrance Report (Sections 1 and 2) Within 10 calendar 
days. 
M.C.C.C.—*»-M—«M—T-U) 
HOSPITAL ENTRANCE REPORT 
Tbit entrance report effective for reporting cate* under 
Act 198, P. A. of 1937 and Act 988 P. A. of 1939. 
Act No 
Name He ten Mar i e Smith 
Child 
Address 1058 St, Joseph St,, Lansing 
City-V ill&ge-Township 
County I.n.flham 
n Issuing Court Order .. 
Name Parents _.._.?.r.X 
A Father- . , - _ Mother 
o pp?m£itis 
Admitting M. D. Attending Lj*. lA 
Anticipated days care.__.IO. Hosjted Insurance Case..)?. Michigan Benefit ASSOC . 
Date HospTtai....N.°. E. W. SparrowIfespUat _ 
Name 
In-Patient 
Out-patient 
Date Admitted )i.*..J..;;.HAL LQ...A.M P.M. 
Date Discharged 
Date Released 
Date of Birth. 
Date Court Order ~~ 
Date Last Visit.“. ?_ -X. 
State Private 
Hospital: Mail No. 2 copy to Judge of Probate within 
5 days or to Medical District Office if so instructed. 
....Lan.s.i.afl.,...JMLi.cli.i.iaa 
Address 
Discharge Report (Section 3) Within 7 calendar days. 
M.C.C.C.—Aft-M—(«M—■4-44) 
HOSPITAL DISCHARGE REPORT 
This discharge report effective for reporting eases under 
4 Act 183 P. iLoflVlt. 
Act No 283. 
Name..._ JfeJ<SD._Mar.i.9...SllsJ.th.. 
Child 
Address Joseph. .St..,..JLan.$J.Dfl 
City* Village-Township 
County Inoham 
Issuing Court Order 
Name Parents.— OUl —..Mary 
Father Mother 
Diagnosis Appendicitis. 
Admitting A*..JML...Ri.cJiards, .M....D., Attending .A.—H.-Fir-th^-M—0. 
Physician Physician 
Anticipated days care._..J..Q Hospital Insurance Case....X Mlch.ioan .Hoapi.tai-Benefit- Assoc. 
Date April II. I9W Ho^pTtai....N.°. E. W. 
In-Patienl 
Date Admitted J.O.-.-A.M P.M. 
Date Discharged....Urrifl-MU Expired 
Date Released 
Date of Birth .8-12.-36. 
Date Court Order..UrrSt4l?4 
Date Last Visit X 
State Private 
Out-patient [ 
Hospital: Insert dates of discharge and release and 
mail No. 3 copy to M.C.C.C. within T days or to Medical 
District Office if so instructed. 
Unsj ng, Hi ch iflan.. 
Address 
Clinic Report (Section 1) On or before 15th of month. 
M.C.C.C.— 
HOSPITAL ENTRANCE REPORT 
In-Patient 
Out-patient 
This entrance report effective (or reporting cases under 
Act IBB. P. ▲. of 19ST and Act 983 P. A. of 1939. 
Act No .?®3 
Name...- Mary._E.Lizabe.th-J.Qn.es 
Child 
Address 
City-Village-Township 
County I .n oh am 
Issuing Court Order 
Name Parents John Mary 
Father Mother 
Diagnosis D.iabetes...Me.l.l.j..t.us 
Admitting A»...Mr..,Richards. Attending A-...M.*...JR.i.Qh.ard.s*..Mt...Dj 
Physician Physician 
Anticipated days care....O.f.r.-.PHospital Insurance Case N.Q 
a • /vs i Yes No Name of Company 
Date ApnJ„.Sj..J8W Et„ W,...SparrjCM..JHQspXtai 
L Name 
Date Admitted.. H/8r.l.2.-22/l& A.M P.M. 
Date Discharged 
Date Released 
Date of Birth -.. .8-1.2-36 
Date Court Order....l -i. 
Date Last Visit 3-i5rm x 
State Private 
Hospital: Mail No. 1 copy to M.C.C.C. within B 
days or to Medical District Office if so instructed. 
JLan&Lna,. Mich i gan- 
Address 
11-A SECTION III—HOSPITAL 
Approved Hospitals 
Act 158 
Act 283 
70. Hospitals which fulfill the requirements as set forth in the stand- 
ards of the Michigan Crippled Children Commission as adopted 
June 3, 1942, or as they may be revised thereafter pursuant to 
the provisions of this act may be approved. 
Entrance Reports 
Act 158 
71. a. In-patients—Form MCCC A-5-56 
Out-patients—Form MCCC-57 
Act 158, Title VI, Section IS. 
Act 283 b. In-patients—Form MCCC A-5-56 
Out-patients—Form MCCC A-5-56 or 57. 
(See pages 11-a, 13-a and 14-a). 
Act 283, Section 8. 
Entrance Reports 
Act 158 
Act 283 
72. a. Hospitals shall be responsible for reporting to the Commission 
the admittance of in-patients, or transfer patients within 10 cal- 
endar days of admission on Form MCCC A-5-56. 
Act 158, Title VI, Section 18. Act 283, Section 8. 
Delinquent Reports b. Delinquent reports shall become effective 10 calendar days retro- 
active from the date the report is received by the Commission or 
its representative. 
Out-Patient 
Reports 
c. Out-patient reports, Forms MCCC-57, or A-5-56 received on or be- 
fore the 15th of the month subsequent to the month of service will 
be acceptable for payment. 
Grouping 
Out-Patient 
Visits 
d. Clinic and out-patient visits of one individual may be grouped by 
dates of service covering calendar month periods on one clinic re- 
port, if visits are for the same condition. 
Physicians 
and Nurses 
e. The regulations under “b” above shall not apply to physicians’ and 
surgeons’ and nursing services. 
Cancellation f. When entrance report (Form MCCC A-5-56) has been submitted 
and it is later determined that the case is not eligible for state 
aid, hospitals are requested to cancel THE ORIGINAL EN- 
TRANCE REPORT IMMEDIATELY by submitting Section 3 of 
the report indicating disposition thereon. 
Act 158, Title III, Section If. Act 283, Section 3. 
Insurance Cases 
Act 158 
Act 283 
73. Superintendents of hospitals are expected to notify the Commission 
of the entrance of all cases under Act 158 and Act 283 who are bene- 
ficiaries of Michigan Hospital Service Certificate, indemnity con- 
tracts, public liability or casualty insurance, and report such informa- 
tion on entrance report (Form MCCC A-5-56) in the space provided, 
giving such information as will properly identify the certificate con- 
tract or liability insurance coverage. 
Act 158, Title VI, Section 18. Act 283, Section 8. 
Original Coverage 
Court Order 
Act 158 
Act 283 
74. A Court Order is authority for the original acute care, (10 days 
afflicted and 15 days crippled), provided need for acute care is justi- 
fied. 
Act 158, Title VI, Section 17. Act 283, Section 3. 
Accident Cases 
Act 158 
Act 283 
75. In all cases resulting from an accident, the entrance report shall in- 
dicate cause of injury. 
Act 158, Title III, Section 4. Act 283, Section 3. 
12 HOSPITAL SERVICE REQUEST (Form MCCC-6-R) 
Note: Limitations for filing, 
A most careful analysis of the various uses of this report 
is recommended to all the representatives of hospitals 
and clinics. 
Form U.C.C.C. 6-B—10M Sets—2 « 
Original—White—Nf.C.C.C. 
Duplicate—Blue—M.C.C.C. 
Triplicate—Yellow—Hospital 
REQUEST FOR HOSPITAL SERVICES 
Act IN r. 1. ol 19*7—Act 2U P. A. of 19*9 
Michigan Crippled Children Commission 
Lansing, Michigan 
Patient’s Record 
County of 
SC 7./I2M 
Expiration date 
Joan Hale 
Name of Patient 
6/15/29 
Birth date 
3876 Willow 
Addreae No. Street—R.F.D. 
city/village Lansing, Michigan 
SERVICE REQUESTED 
Act No. 283 
Acute Care 
Convalescent 
Supplementary 
Appliances 
Special Services .... 
Special Drugs 
Special Fees 
Foster Home Care .... 
Other 
INSTRUCTIONS TO HOSPITALS : 
Submit duplicate requests for hospital 
services on this form for Crippled and 
Afflicted children within five days follow- 
ing initial acute period, 15 days—Act 158, 
10 days—Act 283, or expiration of last 
service approval. Approval of service shall 
be subject to Rules and Regulations of the 
Commission. 
Stl E-W. Sparrow Date .5/1.8 
Address Ea.Ds.jng. 
Date Admitted 
Extension Requested; 
From 5/20/UU 5/30/U4 
Parent's Name 
Paul and Martha Hale 
Rate of $ 3.25 per 
Day 
Week 
PHYSICIAN’S STATEMENT 
Diagnosis: Meningitis (meningococcic),... ear abscess 
fa^fto date?17 °f MuleJx.JJ.Luo.t.jJ._5y.l5/W 
Type of Operation: 
Prognosis and Need 
for further care: 
Special Service 
give details on 
cost of — Drugs 
and Appliances 
REMARKS: 
_ Date of operation May 5 ...1M A. 
As soon as abscess stops draining child can be discharged. Estimated period 
of further care 10 days. Prognosis good. 
Give date of onset if contagions Apr i l ? 194 A 
Miss Jennie Mick, special nurse 5 nights - 8 hours: U/10. II. 12. 13. IH/UH. 
$7.00 per night. Blood transfusion 5/l/UU, 500 cc Type 3, donor Joe Boyce, 
(professi ona I donor), 327 N. DTv is Ton St.,' tans i ng.' Receipt WI TT ' accompany 
bi 111ng. 
Permission is requested to bill for doctor's calls on U/27. 5/1, 3f 12, 15. 18AM 
Service requested 
by: I 
Personal Signature) M. n. ...(Personal Signature).. 
(Personal Signature) Superintendent of Hospital 
This space reserved for Michigan Crippled Children Commission : 
12-A Requests for 
Hospital Services 
Act 158 
Act 283 
76. Request for Hospital Service, (Form MCCC 6-R) shall be used for 
acute and convalescent care, supplementary treatment, appliances, 
special services, special fees and foster home care and must be person- 
ally signed by the superintendent and the physician. 
Extension 
Acute and 
Convalescent 
Periods 
a. When a period of care is required beyond the acute allowance of 
10 days for afflicted and 15 days for crippled, (unless otherwise 
stipulated) the hospital shall request extension of services indicat- 
ing the necessity of further care. 
Periods of 
Extension 
b. Crippled (acute, maximum) 15 days 
Afflicted (acute, maximum) 10 days 
Crippled (convalescent, maximum) 30 days 
Afflicted (convalescent, maximum) 30 days 
Time Limit 
For Filing 
c. Requests shall be submitted to the Commission or its representa- 
tive, within seven calendar days following the initial acute period, 
or expiration of the last service approval. 
Penalty 
Delinquent 
Extensions 
d. Requests delinquent more than seven calendar days when received 
by the Commission, or its representative, will be effective from 
date received and not retroactive to expiration date of last ap- 
proval, providing continued care justifies approval. 
Exception e. The penalty under “d” above shall not apply to physicians’, sur- 
geons’ and nursing services. 
Change of 
Condition 
f. If the condition for which an afflicted child is hospitalized is such 
that a crippling condition does exist or will result such informa- 
tion should be included on Form MCCC 6-R. 
Act 158, Title III, Section If, Title VI, Section 18. Act 283, Sections 3 and 8. 
Notice of 
Recharge 
Period 
Act 158 
Act 283 
77, Hospitals shall notify the Commission of the period of isolation for 
any child afflicted with a contagious condition. Such informa- 
tion shall appear on Form MCCC 6-R. 
Act 158, Title III, Section If. Act 283, Sections 9 and 15. 
Supplementary 
Treatment 
In-Patient 
Act 158 
78. a. When a crippled child is receiving in-patient treatment under the 
care of an approved orthopedic or plastic surgeon, and develops a 
condition which would classify under the Afflicted Children’s Act, 
the treatment of which is not within the scope of the orthopedic 
or plastic surgeon, such treatment shall be rendered as supple- 
mentary treatment under the existing Court Order under Act 158. 
b. Such service shall be requested on Form MCCC 6-R, and approved 
by the Commission, or its representative. 
Out-Patient c. If the crippled child is receiving treatment in the Out-patient De- 
partment only, the above does not apply. See procedure under 
paragraph 44, page 8. 
Act 158, Title III, Section If, Act 283, Section 3. 
Extension 
Physician’s Visits 
Act 158 
Act 283 
79. Requests for physician’s bedside visits beyond the maximum (15 
calls) must be submitted on Hospital Service Request, (Form MCCC 
6-R), indicating necessity of further calls, and signed by the nhvsi- 
cian. 
Act 158, Title III, Section If, Act 283, Section 3. 
13 ACT 158 (Crippled) 
HOSPITAL DISCHARGE REPORTS (Form MCCC-57) 
Triplicate copies required within 7 calendar days. Sur- 
geon's report must be complete as to service rendered, 
findings, and recommendations for future care. 
Important: Date to return. 
HOSPITAL 
DISCHARGE REPORT 
ACT No ,158 
FOR COMMISSION USE ONLY 
(1-6) Ser. No 
(7-10) Co. Res 
(11-14) Date S 
(19-21) Diag 
(22-24) Inst 
Mail All Copies of This.Report To: 
Michigan Crippled Children Commission 
458 Hollister Bldg., Lansing, Michigan 
(unless otherwise instructed) 
Doe, John .7/6/27 
(Name of Patient) (Birth Date) 
IQ(.!. First .AY.e.-,.,.. Port^.Huron,. Mi ch Fort Huron St. Clair 
(Present Address) (Town) (Township) (County) 
Doe, John - father 
(Name of Parent or Guardian) 
PATIENT DISCHARGED TO: Home B; Convalescent-home □; Foster Home □; 
As above _ _ ' 
(Address) 
diagnosis:Bilateral talipes equino varus; post-operative on left. 
° ADMITTED: B./IQ/HQ 
D DISCHARGED: 6/28/UO 
D to" return : 2months 
DATE OF ONSET: Bi rth -- - 
PART AFFECTED: feet js patient vocationally handicapped? Yes □; No K1 
operation or treatment given: (Dates) 6/ J2/U0 Left Achi I lastendon ...lengthen ing and.. .triple- - 
arthrodesis -....wedges...in , cast , to correct, adduction and. equinus. 6/21/U0 removed part of 
stitches.- appl ied long . leg. cast. 
prognosis:,..- Good with continued treatment 
DESCRIPTION OF APPLIANCES, SHOE MODIFICATION, ETC., PRESCRIBED: Continue US6 Of Club foot $h06 OR 
right. ...: to be worn at night, Yes □; No O 
RECOMMENDATIONS FOR AFTERCARE: (dressings, medications, rest period—frequency and length of time) 
Non-weight bearing on cast; cast care - observe for pressure areas or skin irritation. 
Exercises as below for right foot. 
REMARKS: 
6/IU/U0 post-operative triple arthrodesis of left foot shewn by x-ray; abnormally 
high position of navicular with reference to astragalus. Right foot remains in good 
position with no equinus but in mild varus position. 
PHYSICAL-THKKAPY FREQUENCY LIST EXERCISES AND INSTRUCTIONS 
Hydrotherapy ..... — ....— —.... 
Coordination — 
Hea I , 
MuMuge X IQ min. b, j.d. Light stroking from ankle to knee and toes to ankle. 
Muscle teat.— - — 
Muscle training „ — — 
Muscle .tretching X 20 times b. i.d, Discontinue stretching of right tendon Achilles. Stretch foot.. 
Exercises: Active X 20 times b.,i.d (r ght) in up and out position. Have child turn foot up and 
Passive - out as .far as possible. _ 
Posture exercises —........~... 
Standing instruction ..... 
Walking „ « : 
SCHOOL: Physical disability requires: orthopaedic school room facilities □ physical-therapy at school □ home teaching Q 53 
Patient will be under local care of Dr Ms... A. .. Johnson Por t. Hur on,... Mi eh igan 
(Name of Family Physician) (Address) 
Signed J.9!!!?.?. §P&d G f M« D. Hospital B.I.SLO.K...HOS p 1121.1 Date .61. 30/M0. 
(Orthopedic Surgeon) 
M .C.C.C.-C’57—20M—4-43 
White—M.C.C.C. 
Canary—M .C.C.C. 
Canary—M .C.C.C. 
13-A Special Nursing 
Services 
Act 158 
Act 283 
80. Approval for special nursing service shall be subject to the following 
requirements: 
1. Registered nurse. 
2. Devote full time to patient (unless otherwise approved by the 
Commission). 
3. Billing of services at local rates. 
4. Hospitals shall furnish board without charge to the Commission 
or nurse. 
5. Billing shall show name, dates, and hours of service. Method of 
billing, see paragraph 112, page 24. (See page 23-a). 
Act 158, Title III, Section 4, Act 283, Section 3. 
Pregnancy Cases 
Act 283 
81. The maximum period for normal pregnancy cases is 10 days, unless 
complications arise, in which instance, extension of care must be re- 
quested on Form MCCC 6-R, and be approved by the Commission or 
its representative. 
Act 283, Section 3. 
Newborns 
Act 158 
Act 283 
82. Care of newborns is included in the per diem flat rate for the care of 
the mother during the maximum period or for any extension thereof. 
1. Conditions which require extension of care of newborns beyond 
the maximum period or extension thereof for the mother will be 
accepted as of the DATE OF DISCHARGE OF THE MOTHER at 
the approved acute or convalescent rate for the hospital effective 
as of the date of service, based upon the type of service necessary. 
Newborns 
Court Order 
2. Hospitals shall be responsible for making application for Court 
Order for newborns to the Judge of Probate if the period of care 
extends beyond the date of discharge of the mother. 
Procedure 
Reporting 
Newborns 
Change of 
Classification 
3. Hospitals shall report on Form MCCC A-5-56 newborns remain- 
ing beyond the discharge of the mother. 
4. If a child at birth has a crippling condition and the child remains 
in the hospital beyond the period of care approved for the mother, 
a Court Order should be requested under Act 158. Otherwise, it 
should be made out under Act 283. 
Act 158, Title III, Section 4. Act 283, Section 3. 
Discharge Reports 
Act 158 
Act 283 
83. a. Hospitals shall be responsible for. forwarding discharge reports 
within 7 calendar days after discharge of the patient, furnishing 
full information as to service rendered, findings, recommendations 
of examining surgeon, as regards further treatment and return 
date, as requested on the following forms: 
For Crippled Children, MCCC-57 (In triplicate) 
For Afflicted Children, MCCC A-5-56 (Section 3). 
(See page 11-a). 
Established 
Diagnosis 
b. The established diagnosis should appear on the discharge report. 
Act 158, Title VI, Section 18. Act 283, Section 8. 
Discharge Due 
to Death 
Act 158 
Act 283 
84. The death of a patient shall be recorded on the discharge report and 
the date that respirations ceased shall be inserted as the date of dis- 
charge. 
Act 158, Title VI, Section 18. Act 283, Section 8. 
14 OUT-PATIENT (CLINIC) REPORT (Form MCCC-57) 
Triplicate copies required on or before the 15th of month 
subsequent to month of service. 
Important: Report must be complete as to service ren- 
dered, x-rays, casts, shoes purchased, and modifications 
or other appliances,ordered on the recommendation of 
the surgeon, and physical therapy instructions to parents. 
CLINIC 
REPORT 
FOR COMMISSION USE ONLY 
(1-6) Scr. No 
(7-10) Co. Res 
(11-14) Date S 
(19-21) Diag. 
(22-24) Inst 
Mail All Copies of This Report To: 
Michigan Crippled Children Commission 
458 Hollister Bldg., [.arising, Michigan 
(unless otherwise instructed) 
ACT No I®® 
Jones, John LeRpy 3/22/Ul 
(Namf of Patient) (Birth Date) 
R. HQ, Bad Axe Sheridan Huron 
(Present Addreaa) (Town) (Township) (County) 
Jones, Ronald - Father 
(Name of Parent or Guardian) 
PATIENT DISCHARGED TO: Home 53; Convalescent-home □; Foster Home □; 
D ADMITTED: 1.9/1.®/?®., 
D DISCHARGED: I0/I6/H2 
D'toEreturni 3 months 
(Add reals) 
diagnosis: Bi lateral talipes equino varus 
DATE OF ONSET: Bi rth 
PART AFFECTED: Peet Is patient vocationally handicapped? Yes □; No £ 
operation or treatment given: (Dates) 3/26/Hl to 6/20/U2 series of wedged plaster casts 
with feet in dorsal flexion and eversion. 
prognosis: Good with continued treatment. 
description of appliances, shoe modification, etc., prescribed: To wear club foot shoes with 3/16" 
lifts on outer borders, soles and heels. to be worn at night. Yes S3; No □ 
RECOMMENDATIONS FOR AFTERCARE; (dressings, medications, rest period—frequency and length of time) 
Public Health Nurse or Crippled Chi Idren's worker to check shoes in 6 weeks for 
wear and maintenance of corrected position; to supervise exercises listed below. 
REMARKS: . . . , A . 
On examination feet show good correction. They are free and flexible and over- 
correct well passively. There is no equinus present, but are still held in mild 
varus position. 
PHYSICAL-THERAPY FREQUENCY LIST EXERCISES AND INSTRUCTIONS 
(Physical Therapist) 
Hydrotherapy. Stretching: Grasp chi ld's foot above...ankle with left hand. 
Coordination a rI ace pa I pd of right hand under arch of chi Id's foot; turn 
Hem foot up and put as far as possible. Maintain pressure for 
Maaaase a. mi nuteand re I ease g r ad u311 y Repeat 20 times. 
Muscle lest 
Muscle training v - 
Muaciestretching X »-6 tiscs d«y Exercises: Child to turn right and left foot up and out. 
Exercises: Aeti.. 5 sin. each tiwe Repeat 20 tSmess Co-operation may be obtained by placing 
Passive an object above and to the side of the foot...for the child 
Posture exercise* to touch with outer border of his foot, thus obtaining the 
Standing instruction ......... 
des i red motion acti ye Iy. Knee and hip mot ion should be pre- 
Wsikinn vented during exercise. 
SCHOOL: Physical disability requires: orthopaedic school room facilities □ physical-therapy at school Q home teaching ® No modilication of program [JS 
Patient will be under local care of Dr Bad AxS 
(Name of Family Physician) (Address) 
Signed T* Hospital BI .ank..MOSP.LtaJ Date 10/177)42 
(Orthopedic Surgeon) 
M .C.C.C.-C’S7—20M—4-43 
White— M.C.C.C. 
Canary— 
Canary—M .C.C.C. 
14-A Rate Classifications 
for Hospitals 
Act 158 
Act 283 
85. For purposes of determining Commission hospital rates, considera- 
tion is given to the classification of hospitals as follows: 
a. A.C.S. (Approved by American College of Surgeons) 
b. Non-A.C.S. (All other hospitals) 
Flat Rate 
All Inclusive 
Act 158 
Act 283 
Exceptions to 
Flat Rates 
86. a. All approved hospitals shall be paid a FLAT PER DIEM RATE 
for care during the acute and convalescent periods, which shall 
include all services and materials supplied by the hospital. 
b. The following are approved in addition to the flat rate allowances: 
Braces, appliances Schedule 
Nursing care (special) Local Community Rate, R.N. 
Telephone, telegrams See paragraph 99, page 21 
Blood (donors) $5.00-100cc 
Glasses (cost—plus 10%) $7.50 maximum 
Physicians’-Surgeons’ Fees Schedule 
Act 158, Title X, Section 30. Act 283, Section 13. 
Method of 
Determination of 
Flat Rates 
Act 158 
Act 283 
87. a. The flat rates to be paid to hospitals for acute and convalescent 
care shall be determined semi-annually and effective April 1st and 
October 1st, of each year. The factors considered in making the 
determination are as follows: 
1. Cost of in-patient service per patient day, Form MCCC 225. 
2. Rates charged to general public for ward care inclusive of 
extras, Form MCCC 227, paragraph 30. 
3. Summary of income on Form MCCC-227, from counties as the 
result of contractual agreements with public agencies for the 
care of afflicted adult patients who have been discharged from 
the hospital, inclusive of extras, for the preceding six months 
periods ending January 1st and July 1st. 
Adjustments due 
to Delinquent 
Reports 
b. The above reports shall be filed with the Commission on or before 
March 15th and September 15th, of each year, otherwise billings 
for hospital services shall be allowed at the following rates if not 
in excess of the flat rates determined for the preceding 6 months 
periods: 
Acute Periods—A.C.S. Hospitals $4.75 
Non-A.C.S. Hospitals 3.75 
Convalescent Periods—A.C.S. Hospitals 2.50 
Non-A.C.S. Hospitals 2.50 
Approved Rates 
Act 158 
Act 283 
88. a. Acute Periods 
(1) A.C.S. Hospitals (Maximum) $6.25 per diem 
(2) Non-A.C.S. Hospitals (Maximum) 5.25 per diem 
b. Convalescent Periods 
A.C.S.—Non-A.C.S. Hospitals (Maximum) 3.75 per diem 
c. Convalescent Home Care (Maximum) 3.75 per diem 
d. Foster—Boarding Home Care By Negotiation 
NOTE: The maximum rates will he subject to adjustment and 
allowed at whichever rate is lower in accordance with an analy- 
sis of Forms MCCC 225 and 221 as required under 1, 2 and 3, 
Paragraph 87. 
15 Notification of hospitals per diem flat rate will be directed to each 
approved hospital indicating the effective date. 
Act 158, Title X, Section SO. Act 283, Section IS. 
Act 158 
Act 283 
See page ll>-a and 
paragraph 72 
e. Out-Patient Visits 
Reported on Form MCCC-57 (158 and 283) $1.00 per visit 
(Report must be complete as to service rendered, findings, and 
recommendations of examining physician as regards further 
treatment and return date.) 
Act 283 (only) 
See page 11-a 
Reported on Form MCCC A-5-56 (283) 50 per visit 
Act 158, Title IX, Section 30, Title III, Sec. Jt. Act 283, Sections 3, 10, 13. 
OUT-PATIENT EXTRAS 
(Paragraphs 89 through 95). 
Out-Patient 
Extras 
Act 158 
Act 283 
89. Anaesthetic (applying dressings, casts or wires) $2.00 
Autogenus vaccine 5.00 
Basal metabolism 2.50 
Blood calcium 2.00 
Blood Cholesterol 2.00 
Blood, fluid or pus culture 2.00 
Blood sugar 3.00 
Casts Paragraph 95, page 20 
Complete blood count 1.50 
Red, white, and differential, each .50 
Desensitization solution 6.00 
Dressings, small 25 
large 50 
Electrocardiogram 3.50 
Gastric analysis 2.00 
Gram stain 50 
Insulin see Paragraph 98, page 21 
Liver extract, Liver and Iron concentrate (Not to exceed 7 days 
supply at list cost plus 10%) 
Meals, diabetic (Limited to two) ea. .75 
Meals, regular (Limited to two) ea. .50 
Mouse inoculation 2.00 
N.P.N 2.00 
Operating Room 5.00 
Prescriptions (not to exceed) 1.50 
Physiotherapy Paragraph 90, pages 16 and 17 
Proteins for testing (50 or more tests, not to exceed) 3.00 
Sulfonamides in blood 3.00 
Urea clearance 3.00 
X-rays Paragraph 94, pages 17, 18 and 19 
Physiotherapy 
Hydrotherapy 
Act 158 
Act 283 
90. Includes: Hot packs, Kenny treatment, whirlpool, contrast bath, pool, 
Hubbard tank, other (specify) 
Heat Includes: Infra red, diathermy, paraffin, other (specify) 
Exercises Includes: Active and passive exercises, posture work, coordination, 
muscle reeducation, relaxation work, stretching, balance work, walk- 
ing instruction, muscle testing, other (specify) 
NOTE: Charges allowed on a basis of time spent and modality used. 
16 Schedule 
NO BILLING WILL BE ALLOWED FOR ANY CHILD UNLESS 
THE TECHNICIAN HAS GIVEN THE TREATMENT. 
Periods of Treatment 
(Minutes) 
1 
Meat 
2 
Hydro- 
therapy 
3 
Mas- 
sage 
4 
Exer- 
cises 
Total 
Any (2) 
1 to 4 
Total 
Any (3) 
1 to 4 
(A) 15 to 30 
.30 
.40 
.40 
.40 
.60 
.80 
(B) 30 to 45 
.50 
.60 
.70 
.80 
.90 
1.00 
(C) 45 to 60 
.70 
.80 
1.00 
1.20 
1.30 
1.50 
(D) 60 min. (or over).. 
maximum per diem 
.90 
1.00 
1.25 
1.60 
1.80 
2.00 
The above fees are inclusive of reports 
on Form MCCC-57 
Variable periods of treatment—including combinations of classifications 
of treatments may be billed at the combined rates. 
Example: 
A—(1) and (2) 60 
B— (3) 70 
$1.30 
X-RAY SCHEDULE 
X-Ray 
Act 158 
Act 283 
91. The following schedule applies to Out-patient Department services 
only. If patient is eligible under Michigan Hospital Service and Mich- 
igan Medical Service certificates, refer to paragraph 102, page 22. 
Progress 
X-rays 
Act 158 
Act 283 
92. Progress x-rays shall be allowed at the fee stipulated (Code No. 100) 
for a 30 day period following the initial x-ray. At the end of the 30 
day period another x-ray will be allowed at the full rate. 
Combination 
X-rays 
Act 158 
Act 283 
See page 2U-a 
93. Any combination of x-rays taken on the same plate shall be charged 
at the rate for the next highest group. Hospital billing must indicate 
the views taken on one plate. Example: No. 103 and No. 222 charged 
as No. 300, or No. 105 AP and lateral views charged as No. 200. No. 
105 right and left on same plate charged as No. 200. 
BILLING INSTRUCTIONS—Use Code Number of Service 
Group 1 
Nos. 100-110 
Rate $2.00 
Code No. 
94. 100 Special Examinations, all progress examinations within 30 days, 
(Identify, itemize) 
101 Fingers (one or both hands) 
102 Wrist (one) 
103 Forearm (one) 
104 Toes (one or both feet) 
105 Ankle (one) 
106 Lower leg (one) 
107 Larynx and trachea 
108 Thymus in children 
109 General Abdomen 
110 Preliminary examination for suspected ocular foreign body. 
17 Group 2 
Nos. 200-241 
Rate $2.75 
200 Special examinations, combined examinations (Identify, itemize) 
221 Elbow (one or both) 
222 Humerus 
223 Shoulder (one) 
224 Knee (one or both) 
225 Femur 
226 Hip joint (one) 
227 Regular chest 
228 Chest bones 
229 Bedside chest 
230 Cardiac orthodiagram only 
231 KUB 
232 Pyelogram (Retrograde) 
233 Cervical, thoracic or sacral spine (any one) 
234 Regular sinuses 
235 Barium enema 
236 Examination of esophagus only 
237 Injection of sinus tract 
238 Uterogram—tubal potency test 
239 Measurement obstetrical conjugate 
240 Fluoroscopic examinations 
241 Mandible 
Group 3 
Nos. 300-369 
Rate $4.50 
300 Special examinations, combined examinations, (Itemize) 
350 Obstetrical conjugate 
351 Both shoulders 
352 Both hip joints 
353 Stereo of pelvis 
354 Complete study of long bones 
355 Teleo of spine 
356 Special study of 5th lumbar vertebra 
357 Regular skull 
358 Study of optic foramina 
359 Regular mastoid examination 
360 Pyelogram (intravenous) 
361 Cystogram 
362 Chest with iodized oil injection 
363 Regular chest stereo (patient in bed) 
364 Complete study of chest 
365 Complete cardiac study 
366 Upper GI examination 
367 Cholecystogram 
368 Biplane Fluoroscopic Examination 
369 Routine spine 
Group 4 
Nos. 400-491 
Rate $6.50 
400 Special examinations (Identify, itemize) 
481 Complete spine study (Routine spine plus cervical cholecysto- 
gram, upper G. I. examination. All requested in advance) 
482 Complete GI series (Colon) 
483 Pneumoperitoneum 
484 Foreign body localization in chest 
485 Pregnant uterus pelvic measurements 
(Complete pelvic measurements) 
486 Anteriogram 
487 Encephalogram 
488 Ventriculogram 
489 Iodized oil in spinal canal 
490 Sweet localization foreign body in eye 
491 Smith-Peterson examination 
18 Group 5 
No. 500 
Rate $8.00 
500 Special examinations, combined examination, (Identify, itemize) 
X-ray Therapy 
Act 158 
Act 283 
222 X-ray Treatments 
Superficial No. 80 
1000 R or less $2.50 
1001 R—3000 R 4.00 
3001 R—5000 R 6.00 
5001 R—7000 R 8.00 
7001 R—More 10.00 
X-ray Treatments 
Deep Therapy No. 81 1.25 
X-ray Treatments No. 82 
Radium capsules, gamma plaques, applicators and 
platinum needles 
Per 100 MGHS 10 
Minimum charge 2.50 
X-ray Treatment No. 83 
Radium plaques 
Beta Radiation—1st Field. 4.00 
Beta Radiation—Add. field 80 
X-ray Desiccation No. 85 
Y2 hour or less. 5.00 
Y> hour to 1 hour. 10.00 
Over 1 hour 15.00 
X-ray Treatment No. 86 
Radon Seeds—1 mm and under 2.00 
2 mm and under 3.50 
X-ray Treatment No. 88—Radium Professional Fee 
Ultraviolet, children (.50 per treatment) 3.00 
Ultraviolet, local and general 1.00 
No additional charge for dressing 
Ultraviolet, water cooled 1.50 
No additional charge for dressing 
Heliotherapy, each 50 
6 General 3.00 
Helium therapy per hour 1.25 
Miscellaneous 
X-Rays 
Screen reading $ .50 
Complete dental x-ray 2.25 
Yz dental x-ray of mouth 1.15 
Single x-ray 50 
Bilateral x-ray of jaw 5x7 : , 1.50 
Occlusal x-ray 75 
Right wing x-ray 75 
19 Casts and 
Materials 
Use of Fracture 
Room 
Act 158 
Act 283 
Billing Instructions 
Use Code Number 
of Service 
95. Charges for casts shall not exceed the following rates: 
Code No. 
601 Arm, elbow $5.00 
602 Arm, long unilateral 5.00 
603 Arm, long bilateral .' 7.50 
604 Arm, short unilateral 5.00 
605 Arm, short bilateral 7.50 
606 Back Mold 5.00 
607 Body Long 7.50 
608 Body Short 5.00 
609 Club foot, unilateral 3.00 
610 Club foot, bilateral 5.00 
613 Finger 1,00 
614 Foot, unilateral 3.00 
615 Foot, bilateral 5.00 
616 Hand 2.00 
617 Heel 2.50 
618 Hip spica, long unilateral 5.00 
619 Hip spica, long bilateral 7.50 
620 Hip spica, short unilateral 5.00 
621 Hip spica, short bilateral 7.50 
622 Leg, short unilateral 5.00 
623 Leg, short bilateral 7.50 
624 Leg, long unilateral 5.00 
625 Leg, long bilateral 7.50 
626 Leg, short to be used with Boehler Iron, unilateral 5.00 
627 Leg, short to be used with Boehler Iron, bilateral 7.50 
637 Neck 2.50 
628 Shoulder spica, unilateral 5.00 
629 Shoulder spica, bilateral...» 7.50 
635 Thumb spica 1.00 
636 Torso and hip 5.00 
632 Wrist, cock up 2.50 
The charges for other types of casts shall be fixed by negotia- 
tion with the Commission. 
In cases of multiple casts, the most costly will be allowed at the 
scheduled rate and each additional at 50% of this schedule. 
Renewal 
Court Order 
Hospital 
Responsibility 
Act 158 
Act 283 
96. It shall be the responsibility of the hospitals to notify the parents, 
husbands, guardians or kindred AT LEAST TWO WEEKS IN AD- 
VANCE IF CHILD IS AN IN-PATIENT, that there is a necessity 
of renewing the Court Order before the expiration date, and a new 
physician’s certificate is not required. 
Act 158, Title III, Section 4. Act 283, Section 3. 
Appendicitis 
Act 283 
97. a. The determination of acute appendicitis and the necessity for 
immediate hospitalization as an emergency case shall be confirmed 
by such examinations as are generally accepted for such determi- 
nation, and if deemed necessary, by a consultation. 
b. In all cases of appendectomy, the Director may require a patho- 
logical report by a recognized pathologist as a part of the billing 
to the Commission for such services. 
Act 158, Title III, Section 4. Act 28S, Section 3. 
20 To Take Home 
at Discharge 
Act 158 
Act 283 
98. Autogenus vaccine $5.00 
Diabetic Kit 5.00 
2 insulin syringes, 2 needles 
5 day treatment of insulin 
2 test tubes, 1 test tube holder 
4 ounces Benedict solution 
Dressings, not to exceed 1.50 
Prescriptions, not to exceed 1.50 
Act 158, Title X, Section 30. Act 283, Section 13. 
Telegrams 
Telephone 
Calls 
Act 158 
Act 283 
99. Hospitals may bill the Commission for: 
1. Telegrams when copies are submitted with billing. 
2. Telephone calls when necessity is explained on individual service 
invoice. 
Telegrams and telephone calls shall be limited to Judge of Probate, 
parents, husbands, guardians, conveyor or Commission and permitted 
for the following reasons: 
a. Advising date of discharge 
b. Requesting permission for surgery 
c. Approvals for surgery 
d. Advising date respirations ceased 
Act 158, Title III, Section 4• Act 283, Section 3. 
100. A sincere effort should be made to secure blood from relatives, or 
friends, in which case no allowance is made for blood. 
The following information should be furnished: 
1. Relation of donor to patient 
2. Number of transfusions 
3. Number of cc of blood administered each time 
4. Name and address of donor 
5. Dates of transfusions 
A receipt front the donor shall be attached to the billing. Billings 
shall identify the name of the donor. Act 158, Title III, Section 
4. Act 283, Section 3. 
Purchase of Blood 
Act 158 
Act 283 
Indemnity 
Public Liability 
Casualty and 
Accident Contracts 
Act 158 
Act 283 
101. a. Hospitals shall be responsible for making a prompt determination 
of the acceptance of any case subject to hospital indemnity con- 
tract or possibly a beneficiary of a public liability and accident or 
casualty insurance adjustment, within the statutory provisions 
of Act 158 or Act 283 if the Commission is to give consideration 
for the acceptance of the case as eligible for state aid. 
Responsibility for 
Settlement 
b. If the Commission accepts a case under section “a”, it shall as- 
sume the responsibility for effecting any and all adjustments with 
parents, husbands, guardians, associations, or companies under- 
writing the contracts insofar as the cost of care for the hospital- 
ization of the child. 
Payment of 
State Rates 
c. If accepted as a state case, hospital, physician’s and other services 
are limited to the approved fee and rate schedule of the Commis- 
sion effective as of the dates of service. 
(Authority Attorney General’s Opinion No. 0524 dated July 6, 1943 and No. 
01559 dated February 14, 1944) 
21 INDIVIDUAL INVOICE (Form MCCC-101) 
Michigan Hospital and Medical Certificate 
Approved procedure for applying benefits and approved 
extras as accrue to the subscriber patient during the full 
and partial rate periods. 
Serial No. M.C.C.C. Surname First Name Secon Name 
Smith Henry James 
Act No. County Patient’s \ddress 
158 Kent U02 S. Edison, Grand Rapids 
Hospital Name and Location Father’s Name 
John 
Hospital Name & Address Mother-.Name 
Mary 
Date Last Visit Date Admitted Date Discharged Date Birth 
New 5/1/44 Remaining 6/17/33 
Physician's Name Diagnosis 
Dr. C. H. Snyder Poliomyelitis 
M.C.C.C. No. 101—7-10-42—25M Sets 
Hospital 
Voucher No. 
28 
Month of Service 
May 
Audit VENDOR LEAVE BLANK 
Stamp 
Application of fees for 
FULL and PARTIAL RATE 
PERIODS for approved 
extras to Michigan Hos- 
pital Service Certificate. 
TYPE OF DATE OF NO. DAYS CARE DAY TOTAL 
SERVICE SERVICE DESCRIPTION , RATE CHARGES 
O.P.D. Acute Conv. 
HOSPITAI 
5/1 - 5/22 Daily care (Full rate period) M.H.l). No Charge 
5/22-6/1 Daily care (Partial rate period) 10 1.625 16.25 
X-RAY 
5/1 AW #225 (Full rate period) 2.75 
5/25AW #352 ($U.50) Half rate period 2.25 
# 
appliances 5/31/44 Brace (According to schedule) 
Shoes (According to schedule) 
treatments 5/21/44 A 1 -4 -60<t (Full rate period) qq 
5/23,25, 
27, 29, 
31 /U4 A 1-4 (5 & .50 - Half rate period - $1.53) 1.50 
Insert Total 
MISCELLANEOUS 
physician 5/1-5/16 Calls: I @ 3.00 
14 § 2.00 31..00 
INSERT 
GRAND 
Of the Above Total $ is to be charged to the County TOTAL 
INSTRUCTIONS TO HOSPITALS DISTRIBUTION 
1. Prepare (4) copies Form 101 1. Yellow—M.C.C.C. 
2. Retain 4th Copy (Green) 2. Pink—M.C.C.C. 
3. Transmit remainder to Michigan Crippled 3. Blue—M.C.C.C. 
Children Commission with Form No. 100. 4. Green—Hospital 
21-A Policy 
Michigan Hospital 
and Medical Service 
Certificates 
Act 158 
Act 283 
102, a. During the first twenty-one (21) days of benefits of a certificate 
year, the Commission accepts no responsibility for payment of 
any service which is ’provided by a certificate of the Michigan 
Hospital or Medical Service. 
b. Exceptions: The Commission will approve services which are not 
included in the certificates during the full rate period, as follows: 
Approved Extras 
Full Rate Period 
(1) Basal metabolism examination $2.50 
(2) Electrocardiogram 3.50 
(3) Tissue examination 2.50 
(4) Animal inoculations 2.00 
(5) X-rays (Limited to $15.00 during 12 mo. period) Schedule 
(6) Braces and appliances Schedule 
(7) Telephone and telegrams Paragraph 99, Page 21 
(8) Glasses—(invoice plus 10%) $7.50 maximum 
(9) Nursing care Local R.N. Rate 
(10) Blood transfusion (donor) 100 cc $5.00 
(11) Physicians’ and Surgeons’ fees Schedule 
(12) Oxygen therapy Tank cost 
(13) Physiotherapy Schedule 
Partial Rate 
Period 
Act 158 
Act 283 
103. a. Effective with the twenty-second (22nd) day, and inclusive of 
the one hundred eleventh (111th) day, the Commission will pay 
ONE HALF OF ITS ESTABLISHED RATE FOR HOSPITAL 
SERVICES effective as of the date of service. 
b. The following are approved extras during the (partial rate period) 
WHEN THEY ARE NOT INCLUDED in Michigan Hospital or 
Medical Certificates, payable as follows: 
Full Rate Half Rate 
Schedule Schedule 
a. Braces, appliances x 
b. Telephone, telegrams x 
c. Glasses x 
d. Nursing care (special) x 
e. Blood transfusion (donors) x 
f. Physicians’ and Surgeons’ fees x 
g. Daily care x 
h. X-rays (Included in maximum) x 
i. Oxygen therapy x 
j. Physiotherapy x 
Approved Extras 
Partial Rate Period 
Extended Period 
Act 158 
Act 283 
104. If approved services shall be extended during a certificate year to a 
subscriber patient in excess of the period of full and partial benefits, 
the Commission will accept during the extended period billing for 
such approved services as are provided in the manual and effective 
as of the date of such services. 
Physicians’ and 
Surgeons’ Services 
105. a. Recognition cannot be given to physicians’ and surgeons’ fees for 
services rendered prior to the effective date of the Court Order. 
b. Billing for physicians’ bedside visits will be given consideration 
based on the effective date of the Court Order covering the unused 
portion of the original 15 calls. 
c. Additional physicians’ calls beyond the original 15 should be re- 
quested on Form MCCC 6-R indicating need and number of addi- 
tional calls. (See page 12-a). 
22 INDIVIDUAL INVOICE (Form MCCC-101) 
(Hospital Services) 
Approved procedure for billing hospital service at the ap- 
proved flat per diem rate, effective as of date of service. 
Serial No. M.C.C.C. Surname First Name Secon Name 
Smith Hugh James 
Act No. County Patient’s Address 
283 Allegan 336 Penn Street, Allegan 
Hospital Name and Location Father’s Name 
Hospital Name & Address 
Ella 
Dote Last Visit Date Admitted Date Discharged Date Birth 
New 5/2/44 5/17/44 5/5/35 _ 
Physician's Name Diagnosis 
Dr. Shepard I Ruptured Appendix 
ILC.C.C. No. 101—7-10-42—25M Sets 
Hospital 
Voucher No. 
25 
Month of Service 
May 
Audit VENDOR LEAVE BLANK 
Stamp 
Hospital Approved 
Flat Per Diem Rates 
TYPE OF DATE OF NO. DAYS CARE DAY TOTAL 
SERVICE SERVICE DESCRIPTION RATE CHARGES 
O.P.D. Acute Conv. 
HOSPITAL 
5/2-5/12 Daily Care 10 6.25 62.50 
5/12-5/17 Daily Care 5 3.25 16.25 
78?75~ 
X-RAY 
APPLIANCES 
TREATMENTS 
MISCELLANEOUS 
physician 5/2/44 #1307 Dr. Shepard 50.00 
5/2/144 #419 Dr. DePree 5.00 
"133.75 
Of the Above Total $ is to be charged to the County 
INSTRUCTIONS TO HOSPITALS 
1. Prepare (4) copies Form 101 
2. Retain 4th Copy (Green) 
3. Transmit remainder to Michigan Crippled 
Children Commission with Form No. 100. 
DISTRIBUTION 
1. Yellow—M.C.C.C. 
2. Pink—M.C.C.C. 
3. Blue—M.C.C.C. 
4. Green—Hospital 
22-A Deposits 
Court Order 
Effective 
Date Admission 
106. a. If a Court Order is effective from the date of admission, and 
acceptable and the hospital has complied with statutory regula- 
tions relative to admission reports, deposits made by parents or 
others at the time of admission or subsequent thereto shall be 
applied to the cost of services to be paid by the Commission at 
the approved schedule of rates. 
Deposits 
Entrance 
Report 
Delinquent 
b. If a Court Order is effective from the date of admission, and the 
entrance report is delinquent under the statutory limitations, the 
regulation governing delinquency shall be enforced and the total 
deposit shall be applied at the same rate per diem which would 
have been approved were there no delinquency. Unused balances 
shall be applied against the period of service accepted by the 
Commission. 
Deposits 
Application 
Delinquent 
c. If an entrance report has been submitted within the statutory 
limitations, and a deposit made at the time of admission, or sub- 
sequent thereto, but the date of application is not within the stat- 
utory limitations, the following shall apply: 
Case will be accepted in accordance with statutory limitations and 
deposits applied against the period of care which is not acceptable 
due to the delinquent application at the same rate per diem as 
would have been approved were there no delinquency. Unused 
balances shall be applied against the period of service accepted by 
the Commission. 
Procedure 1. The admission notice must bear the actual date of entrance as a 
private case. 
2. Submit an itemized statement of all charges, amounts and dates 
of deposits. 
3. If patient entered hospital subject to hospital insurance, complete 
identification of contract must be provided. 
4. Indicate the anticipated additional hospitalization required. 
Act 158, Title III, Section If. Act 283, Section 3. 
Separate 
Warrants 
Act 158 
Act 283 
107. Compensation for physicians, surgeons, nurses, blood donors, and 
hospitals rendering service under these acts shall be paid by the 
Auditor General on separate warrants, drawn to their order and de- 
livered to the hospital. 
Act 158, Title X, Section 31. Act 283, Section 1 'f. 
108. a. Payment shall be refused on any billings rendered sixty days or 
more after discharge of patient from the hospital. 
Act 158, Title X, Section 30. Act 283, Section 1A. 
b. Submission of hospital invoice for services is not contingent on 
the receipt by the hospital of delayed Court Orders. 
Act 158, Title III, Section }. Act 283, Section 3. 
c. The hospital may bill for the date of entrance but not for the date 
of release. 
Act 158, Title X, Section 30. Act 283, Section 13. 
Hospital 
Invoice 
Limitations 
Act 158 
Act 283 
Calendar 
Month 
Billings 
Act 158 
Act 283 
109. All services rendered during a calendar month shall be billed on or 
before the 10th of the subsequent month. 
NOTE: To avoid errors and deferred audits do not forward individual in- 
voices without summary invoice attached. Act 158, Title III, Section Jf. 
Act 283, Section 3. 
23 INDIVIDUAL INVOICE (Form MCCC-101) 
(Professional Services) 
Approved procedure for billing hospital services, phy- 
sician-surgeon fees, nursing and blood donor services. 
Serial No. M.C.C.C. Surname First Name Secon Name 
Hal I Ruth Janet 
Act No. County Patient’s Address 
283 Kent 218 Bridge St., N.W., Grand Rapids 
Hospital Name and Location Father’s Name 
Joseph 
Hospital Name and Address Mother Name 
Mary 
Date Last Visit Date Admitted Date Discharged Date Birth 
New 5/3/U4 Remaining 10/3/3U 
Physician’s Name Diagnosis 
A.R. Johnson, M.D. Rheumatic fever with chorea 
M.C.C.C. No. 101—7-10-42—25M Seta 
Hospital 
Voucher No. 
25 
Month of Service 
May 
Audit VENDOR LEAVE BLANK 
Stamp 
Hospital Approved 
Flat Per Diem Rate 
TYPE OF DATE OF NO. DAYS CARE \ DAY TOTAL 
SERVICE SERVICE DESCRIPTION \RATE CHARGES 
O.P.D. Acute Conv. \ 
hospital 5/3-5/13 Daily care 10 6.25 62.50 
5/13-6/1 Daily care 19 3.25 61.75 
X-RAY 
If the donor is to be 
paid direct, please list 
his name under caption 
appliances of "Professional Services" 
on invoice and under the 
caption of "Phys ic ian" on 
summary. Otherwise in- 
clude in hospital total 
as shown below. 
TREATMENTS 
MISCELLANEOUS 5/UAW j 500 cc blood (receipt attached) ll' 2b.00 
(John Doe, donor) [i|9~25 
Professional 
5/3-5/S 12 hour duty, 5 days 9 7.00 
Lorraine Day (Special Permission) 35.00 
5/1-5/16 Cal Is: 1 9 3.00 
IU 9 2.00 3L00 _ 
Of the Above Total $ is to be charged to the County I 215.25 
DISTRIBUTION 
1. Yellow—M.C.C.C. 
2. Pink—M.C.C.C. 
3. Blue—M.C.C.C. 
4. Green—Hospital 
INSTRUCTIONS TO HOSPITALS 
1. Prepare (4) copies Form 101 
2. Retain 4th Copy (Green) 
3. Transmit remainder to Michigan Crippled 
Children Commission with Form No. 100. 
23-A Approved 
Billing 
Forms 
Act 158 
Act 283 
110. The Commission will furnish to all approved hospitals the individual 
hospital invoice forms, and hospital summary invoices. 
Form 
MCCC-101 
See pages 21-a, 22-a, 
23-a, 24-a 
Individual service invoice Form MCCC-101, is used for billing all 
approved services, for each case. (See paragraph 86, page 15). 
Monthly Hospital Summary Invoice (Form MCCC-100), is used as a 
summary of the individual cases billed for the preceding calendar 
month, summarizing the total service charges, and shall be attached 
to the individual invoices of patients included in the summary. Such 
summary shall be certified by the superintendent of the hospital. 
Form 
MCCC-100 
See page 25 
Et al 
Instructions 
Form MCCC-100 
SUMMARY OF 
PAYEES 
(1) If more than one payee appears on the sum- 
mary invoice, list the individual payees includ- 
ing the hospital, at the bottom of the invoice 
in accordance with the following provisions. 
SPACING (2) Double space each item of SUMMARY ONLY. 
If space does not permit, use extra set of forms. 
TOTALS (3) Carry summary amounts to “total amount” 
column. 
ET AL (4) a. If summary of payees includes name of hos- 
pital and one or more doctors, insert “et al” 
after name of hospital in the space desig- 
nated “name and address of vendor”. 
b. If summary of payees lists more than one 
doctor, et cetera, but not the hospital, insert 
the name of the first doctor above the name 
of hospital in space designated and follow 
same with “et al” 
NON- 
ET AL 
c. If only the hospital is to receive a payment, 
place name of hospital in the space desig- 
nated. (Et al will not be used). 
d. If only one doctor or nurse is to be paid, 
insert his, or her, name only above name of 
hospital in the space designated. (Et al will 
not be used). 
Act 158, Title X, Section 30. Act 283, Sections 3 
and 13. 
Correction 
Memoranda and 
Rebilling 
Act 158 
Act 283 
See page 25-a 
111. Hospitals will be advised of all corrections and deletions in billings 
by Correction Memorandum (Form MCCC-8), or on the return of the 
blue copy of Form MCCC-101. 
NOTE: All correction memorandum and returnedi hilling should be exam- 
ined for rebilling instructions and thoroughly checked against hospital 
and court records to determine eligibility of rebilling. 
Limitation 
Rebilling 
If acceptable for rebilling all rebillings must be submitted within 90 
days of date of receipt of notification of original deletion. 
Act 158, Title III, Section Act 283, Section 3. 
Nursing 
Services 
Act 158 
Act 283 
112. a. Nursing services shall be billed in the same manner as physicians’ 
and surgeons’ fees, giving the name of the nurse, hours of em- 
ployment, and rate of pay. 
b. To facilitate prompt payment of nursing services billing may be 
submitted covering 10 day periods by submitting special sum- 
maries accompanied by individual invoices. 
NOTE: Incorporate no other services than the above on special 
summaries of nursing services. Act 158, Title III, Section If. Act 
283, Section 3. 
24 INDIVIDUAL INVOICE (Form MCCC-101) 
(Out-Patient Services) 
Approved procedure for billing Out-Patient (clinic) 
services, x-rays and physician's fees. 
M.C.C.C. No. 101—11-16-42—25M Seta 
Serial No. M.C.C.C. Surname First Name Second Name Hospital 
Voucher No. 
Hendricks George Phillip 25 
Act No. County Patient’s Address Month of Service 
'5® 108 Cherry St., S.W,, Grand Rapids May 
Hospital Name and Location Father’s Name Audit VENDOR LEAVE BLANK 
Stamp 
Herman 
Hospital Name and Add reSS I Mother’s Name 
Ste I la 
Date Last Visit Date Admitted Date Discharged Date Birth 
5/IU/UU 5/iU/UU 7/10/38 
Physician’s Name Diagnosis 
Dr. Hodgen Fracture of wrist 
TYPE OF DATE OF NO. DAYS CARE DAY TOTAL 
SERVICE SERVICE DESCRIPTION RATE CHARGES 
O.P.D. Acute Conv. 
HOSPITAL 
5/IU/UH Out-patient service (MCCC-57) I 1.00 1.00 
x-hay 5/lU/MH #200 (#102 and #103) 2.75 
3.75 
appliances (Procedure for Billing Braces 
and Appliances, See Page II 
of the Appliance Schedule) 
TREATMENTS 
MISCELLANEOUS 
physician 5/IUAW Check-up examination - Dr. Hodgen 1.50 
~~572lT~ 
INSTRUCTIONS TO HOSPITALS 
1. Prepare (4) copies Form 101 
2. Retain 4th Copy (Green) 
3. Transmit remainder to Michigan Crippled 
Children Commission with Form No. 100 
DISTRIBUTION 
1. Yellow—M.C.C.C. 
2. Pink—M.C.C.C. 
3. Blue—M.C.C.C. 
4. Green—Hospital 
24-A HOSPITAL SUMMARY INVOICE (Form MCCC-100) 
Attach to individual invoice vouchers for preceding calen- 
dar month. 
Important: To observe the arrangement, serial number 
and spacing of final summary of hospital and physicians' 
services, refer to paragraph 110, page 24 for use of term 
"Et Al". 
MCCC-Form No. 100—10M Sets—9-2-42 
HOSPITAL LEAVE BLANK 
Voucher No. 
Warrant No. 
Warrant Dote. 
State of Michigan 
AUDITOR GENERAL’S DEPT. 
Accounting Division 
1— White—-Auditor General 
2— Pink—Accounting Division 
3— Goldenrod—Remittance 
4— -Yellow Department 
5— Blue— Department 
6— Green—Hospital 
Hospital Summary Invoice 
Purch. Order No... N.P.O. 
Account No. . 
OR 
Hospital Inv. No. 
in.oice D.to.J_.«neA 1944 
May ,,.44 
INSTRUCTIONS TO HOSPITAL 
1. Prepare six copies of this standard 
form. 
2. Hospital superintendent must sign 
certification. 
S. Retain sixth copy (green) and trans- 
mit remainder to the Michigan 
Crippled Children’s Commission 
with the individual invoices. 
Hospital Name and Address 
This space for name and address of hospital 
HOSPITAL CERTIFICATION 
I hereby certify that the items listed below are proper charges against the 
State of Micldgan. 
(Fen and ink signature required) 
Superintendent or Authorised Representative must sign In Ink 
Object Code Amount 
Total 
HOSPITAL LEAVE BLANK 
It Is hereby certified that the services represented on this voucher were 
authorised, that the amount is correct and is hereby approved for payment. 
Head of Unit or Authorised Agent 
Compt'd Coded 
Audited Cheeked 
DISTRIBUTION Total LEAVE 
Name of County Name of Doctor Name of Patient Amount BLANK 
Hoapital Physician 
Allegan Dr. Shepard Smith, Hugh James 78.75 50.00 
Dr. DePree Smith, Hugh James 5.00 133.75 
Ionia Dr. Shepard Irish, Bertha 12.50 7.00 19.50 
Dr. Johnson Lewis, James 62.50 23.00 85.50 
Dr. Shepard MacDonald, Mary 171.50 50.00 
Dr. DePree MacDonald, Mary 5.00 226.50 
“246750 85700 331750“ 
Kent Dr. Johnson Hall, Ruth Janet 149.25 31.00 
L. Day, R.N. Hall, Ruth Janet 35.00 215.25 
Dr. Hodgen Hendricks, George 3.75 1.50 5.25 
"753700 67750 2207Bo 
Name of Hospital 478.25 
Dr. Shepard 107.00 
Dr. DePree 10.00 
Dr. Johnson 54.00 
Loraine Day, R. N. 35.00 
Dr. Hodgen 1-50 
totals 478.25 207.50 685.75 AudhCU* 
25 INDIVIDUAL INVOICE (Form MCCC-101) 
(Correction Memorandum) 
Hospitals will be advised of all corrections made in bill- 
ings by return of blue copy stamped "Correction Mem- 
orandum". 
Important; Review carefully upon receipt. 
M.C.C.C. No. 101—7-10-42—25M Seta 
Serial No. M.C.C.C. Surname First Name Secou Name Hospital 
Voucher No. 
Johnson Harold Jr. IH 
Act No. County Patient’s Address Month of Service 
283 Kent 282H Wi I low St., Grand Rapids, Mich. Mav 
Hospital Name and Location Father’s Name Audit VENDOR LEAVE BLANK 
Stamp 
Hospital Name & Address e°r^e 
Mother’s Name 
Hary 
Date Last Visit Date Admitted Date Discharged Date Birth 
12/6/U2 5/5/UU 5/25/UU IQ/8/U2 
Physician’s Name Diagnosis 
Dr. M. McDougalI Pneumonia 
TYPE OF* DATE OF NO. DAYS CARE I DAY TOTAL 
SERVICE SERVICE DESCRIPTION , RATE CHARGES 
O.P.D. Acute I Conv. 
HOSPITAL 
X-RAY 
APPLIANCES 
TREATMENTS 
MISCELLANEOUS 
PHYSICIAN 
Of the Above Total I la to be charged to the County 
INSTRUCTIONS TO HOSPITALS 
1. Prepare (4) copies Form 101 
2. Retain 4th Copy (Green) 
3. Transmit remainder to Michigan Crippled 
Children Commission with Form No. 100. 
DISTRIBUTION 
1. Yellow—M.C.C.C. 
2. Pink—M.C.C.C. 
3. Blue—M.C.C.C. 
4. Green—Hospital 
25-A SECTION IV—CONVEYORS AND INVESTIGATORS 
PREPARATION EXPENSE VOUCHER 
GENERAL INSTRUCTIONS 
Introduction 200. It is necessary that the Commission verify all fees and expense 
vouchers submitted covering the economic investigation, medical ex- 
amination of afflicted and crippled children and the conveyance of 
crippled children. 
The same care should be exercised in incurring expense against the 
State that a prudent person would exercise if traveling on personal 
business. 
With a desire to pass expense vouchers for payment at the earliest 
possible moment, the Commission hereby submits a comprehensive 
summary of the necessary procedure to be followed by conveyors 
and investigators. 
Act 158, Title III, Sec. Jf. Act 158, Title X, Secs. 29 and 31. Act 283, Sec. 12, 
Preparation 
Expense Voucher 
201. a. All vouchers for investigation, both medical and economic, and 
conveyor’s expense of transporting crippled children to and from 
hospitals, shall be submitted on Child Welfare Expense Vouchers 
(Form A-75R.) (See page 26-a). 
Conveyance 
Receipt 
b. Conveyors shall fill out and attach Child Conveyance Receipt 
(Form MCCC-C-76), in duplicate, to Form A-75-R. (See page 
27-a). 
c. Correct spelling of name and address of each patient shall be 
shown. 
Purpose and 
Approval 
d. Each voucher must state purpose of the expense and be approved 
by the Judge of Probate, or some person designated by the Com- 
mission. 
Signatures e. The white copy of the voucher must be signed in ink by both the 
person rendering service and the authorizing official. 
Periods Covered f. Vouchers must be submitted at least once a month, and contain 
charges for no longer a period than a calendar month. 
Limitations g. In no instance will vouchers be given consideration submitted in 
excess of sixty (60) days after the expense was incurred. 
h. SUBMIT ALL FIVE (5) COPIES OF YOUR EXPENSE VOUCH- 
ER FOR AUDIT. 
i. It is preferred that all vouchers be typewritten, although those 
prepared in ink are acceptable. 
j. Upon the audit of your expense voucher, if any change or correc- 
tions are necessary the green copy will be returned with a cor- 
rection memorandum attached, indicating the changes. 
Mailing 
Instructions 
202. a. All vouchers submitted by county agents shall be sent to the Mich- 
igan Social Welfare Commission, 230 North Grand Avenue, Lan- 
sing 4, Michigan. 
b. Vouchers of all others shall be mailed directly to the Crippled 
Children Commission, 458 Hollister Building, Lansing 4, Michigan. 
Act 158, Title III, Sec. ). Act 283, Sec. 3. 
Conveyance 
Act 158 
203. The Commission accepts no responsibility for the payment of con- 
veyance for other than crippled children with active Court Orders. 
Act 283, Sec. 16. 
26 CHILD WELFARE EXPENSE VOUCHER (Form A-75-R) 
(Conveyance) 
Important: Note individual itemization of expenses, ex- 
planation in detail of mileage and proration of total 
expense. 
Private Other 
NAME AND ADDRESS Comp,„..tl»= Automobile Hotel Jgg—- 
Dat* City* Town, or Township Description of Work Done Age Meals Room eelpts and Total Portion 
(Attach Describe in of Charges 
Hours Amount Miles Amount Receipts) Description 
JUne Column) 
15 John Jackson, Crippled To and from University Hospital 15 1.70 
& 123 Washington Avenue 
16 Harrison, Michigan 
June Miller, Crippled To University Hospital 4 Mo .25 
R.R. No. 2, Harrison, Mich. Mother acted as attendant 2.60 2.00 
Frank White, Afflicted To University Hospital 14 .45 
R.R. No. I, Harrison, Mich. 
Henry Jones - Afflicted From University Hospital 60 .65 
123 Main Street Adult 
Harrison, Michigan 
Conveyor 14 12.25 2.60 2.00 
From my home 2 miles in Harrison to pick up John Jackson. 2 
June Miller and Mother, norlh M-27 3 miles; east 2 miles and retirn. 10 
Frank White - west on M-61, 4 miles and return to Harrison 8 
Harr ison to Clare 15 
Clare to Ann Arbor 141 
Vicinity mileage in Ann Arbor 4 
Return trio Clare to Harrison 156 
Returned Henry Jones, Mrs. Miller and John Jackson 
to their home and returned 1o my home 14 
MEALS Jackson Miller White Jones Conveyor Mr ;. Mi 1 er 
15 Lunch .40 .2! .45 .65 .65 
Dinner .55 .85 .80 
16 Breakfast .30 .50 .50 
Lunch .45 .65 .60 .65 
PR0RATI0N: Down 2 crippled children and I mother, Mrs. Miller 3l 5/7 State 
Back I crippled child and I mother, Mrs. Miller 2' 
Down I afflicted child j 1 2/7 Countv 
Back I afflicted adult 1/ 
5/7 of $45.50 : 132.50 - State's share 7 Total Service* 
2/7 of $45.50 = 1 13.00 - County share acrv.ce. 
totau 14 12.25 350 21.00 8.25 4.00 45.50 13.00 
DETAIL OF CHILD WELFARE EXPENSE VOUCHER 
26-A 204. Travel shall be made via rail, automobile or bus, depending upon 
which is the cheapest method after consideration of the time con- 
sumed in traveling. 
Act 158, Title III, Sec. I,. 
Entrance Days 205. Other than emergency cases requiring immediate hospitalization, con- 
veyance should be arranged so that the entrance can be effected not 
later than Thursday of each week, thereby avoiding charges for days 
of unnecessary hospital care over week-ends, when hospital staffs are 
operating at a minimum. 
S.ngle Conveyance 206. The necessity for periodical trips with only one child shall be ex- 
plained. Unless an emergency is clearly shown, the Commission re- 
serves the right to delete charges for trips considered excessive. A 
full load shall be conveyed whenever possible. 
Emergency 
Purchases 
207. Emergency purchases for needs of children while enroute may be 
purchased but must be reported on the expense vouchers and 
supported by a receipt from the vendor. 
Act 158, Title III, Sec. If. 
Rail-Bus 
Conveyance 
208. Refer to paragraph 54, page 11. 
Most Direct 
Route 
209. All travel by privately owned automobiles must be by the most direct 
and usually traveled route. 
Conveyance Receipt 
See pages 26-a and 27-a 
210. The Form MCCC-C-76 must accompany Form A-75R to show delivery 
1 to hospitals of all individuals conveyed thereto. The names of both 
afflicted and crippled children, and adults if any, shall be shown. 
This form must be signed by the conveyor, the attendant, if any, the 
Judge of Probate or other authorizing official, by a representative 
of the hospital, whose signature must be known to the Commission. 
Act 158, Title III, Sec. If. Standardized Travel Regulations approved by the 
State Administrative Board. 
Hour Mileage 
Rate 
211. Personal Service STVaC per hour 
Maximum (per day) $7.00 
Act 220, P. A. 1943. 
Mileage Refer to Serial Letter No. 96 
(Standard Travel Regulations, State Administrative Board) Act 158, Title III 
Section If. 
Allowance for more than S hours in any one day shall be at the discretion 
of the Commission. 
Attendant’s Fee 212. Personal Service 37Y2C per hour 
Maximum (per day) $3.00 
a. Attendants, other than members of the patient’s family, will be 
paid at approved rates for personal services. 
b. Whenever possible parents shall act as attendants of their chil- 
dren in which instance no allowance is made for personal service. 
Meals and hotel expense may be paid at approved rates. 
27 CHILD CONVEYANCE RECEIPT (Form MCCC-C-76) 
Approved report of conveyance. 
Important: Note signatures of Judge of Probate, hospital 
superintendent, conveyor and attendant, and itemization 
of time. 
GOING FROM: ’ TO: ,...AC!.*LA!1!?P.C. RETURNING TO: 
Time of Departures 9«.Q0 A.M. or f.M. Waiting Time at H.QSpJ. .tci) Time of Departures A.M. or P.TVt, 
Time of Arrival; .?.?.PQ AiM. or P.M. Time of Arrival .A.AC or P.M. 
Elapsed Time.— 5 Hours Hours Elapsed Time 6 Hours 
CRIPPLED CHILDREN TO HOSPITAL CRIPPLED CHILDREN FROM HOSPITAL 
Date Name Age Date Name Age 
5/15 John Jackson 15 vrs.5/16 John Jackson 15 vrs 
5/15 June Mi I ler and Mother U No. 5/16 Mrs. Miller (Mother of June) 
COUNTY CASES TO HOSPITAL COUNTY CASES FROM HOSPITAL 
5/15 Frank Wh i te IU vrs.5/16 Henrv Jones 60 yrs 
It is hereby the children named were conveyed to and received belows 
fejEw 
f y' Signature of Attendant / / Superintendent of Hospital or Institution 
University Hospital Ann Arbor 
Name of Hospital or Institution Location of Hospital or Institution 
NOTEi—A separate receipt must be obtained from each hospital, institution or other delivery point, and for each trip. 
to F°rm A-75-R 
MICHIGAN CRIPPLED CHILDREN COMMISSION 
458 HOLLISTER BUILDING —LANSING, MICHIGAN 
CHILD CONVEYANCE RECEIPT 
STATE OF MICHIGAN 
Form MCCC—C76—3000 Set*—6-42 
27-A c. The conveyor may pay the attendant direct for personal service, 
meals and hotel expense, and bill the incurred cost of these items 
as his personal expense by certifying same on Form A-75R. 
Act 288 of the P. A. of 1939. 
Meals 
Conveyors 
Attendants 
Patients 
213. Breakfast will be allowed if absence from the home commences prior 
to 7 a. m. and extends beyond 10 a. m. 
Lunch or noon meal will be allowed when absence commences prior to 
11 a. m. and extends beyond 2 p. m. 
Dinner or supper will be allowed when absence commences prior to 
4 p. m. and extends beyond 7 p. m. 
Meals for each child, conveyor and attendant shall be shown opposite 
his name on expense voucher. Time and place of securing meals shall 
be indicated. 
Adults—Breakfast $ ,50 
Lunch 75 
Dinner 1.00 
Children—Breakfast 40 
Lunch 50 
Dinner 75 
Meals may be divided as best suited. 
Hot«l 214. Hotel accommodations, (Maximum) $3.00 
Milease 215. All point to point mileage shall be shown sufficiently in detail that it 
may be readily checked by comparison with State and County High- 
way maps for travel between points shown thereon. 
NOTE: In detailing the trip, points should be so named that they can be identified 
either on the State or County Maps supplied by State and County Highway Com- 
missions. Highway numbers shall be shown whenever possible. For proper 
method of billing vicinity mileage refer to page 26-a. Act 158, Title III, Sec. U. 
Standardized Travel Regulations approved by the State Administrative Board. 
Prorating Expenses 216. If the voucher covers conveying of both State and County patients, 
the name and address of each patient shall be shown even though all 
are not State charges. 
The method of prorating shall be on a total expense basis including 
all costs of conveyance with the exception of the attendant’s fee which 
will be charged to the State or the County as the case may be. 
NOTE: The parent acting as an attendant is included as an individual in 
the prorating of expense. Act 158, Title III, Sec. Jf. Act 283, Sec. 3. 
Supporting 
Documents 
217. Receipts must be attached for the following: 
Hotel bills 
State ferry 
Bus fare 
Railroad and Pullman charges 
Miscellaneous expenses 
Emergency purchases 
Standardized Travel Regulations approved by the State Administrative Board. 
Hospital Discharge 
Limitations 
218. Refer to Paragraph 15, page 4, Paragraph 54, page 11. 
28 CHILD WELFARE EXPENSE VOUCHER (Form A-75-R) 
(Economic Investigation) 
Important: Correct name and address of child, date of 
investigation. Total each entry. 
Private Other 
Compensation Automobile Hotel Expenses 
NAME AND ADDRESS or (Attach Re- County 
Date City* Town* or Township Description of Work Done Age Meals Room ceipts and Total Portion 
(Attach Describe in of Charges 
Hours Amount Miles Amount Receipts) Description 
Column) 
Ju ly 
15 Jbhn Smith Investigation of crippled child 5 2 1.75 2 .12 1.87 
102 S. Main Street 
Gladstone, Michigan 
18 Mamie Fields Investigation of afflicted 4 3 2.63 6 .36 2.99 
R. R. #1 chi Id (3 mi les from city I imits 
Gladstone, Michigan and return same way) 
20 Loraine Green Investigation of afflicted 6 2 1.75 IU .84 2.59 
R. R. #2 child (south 4 miles, west 3 
Gladstone, Michigan miles on #41, return same way) 
20 Frank Jones Investigation of crippled child 10 4 3.50 27 1.62 5.12 
R. R. #1 (north on #54 10 miles, east 
Gladstone, Michigan on #515 3 miles, south i mile, 
return the same way) 
TOTALS II 9.63 49 2.94 |~~~ |'"" ' | | 12.57 
DETAIL OF CHILD WELFARE EXPENSE VOUCHER 
28-A Telegrams 
Telephone 
Calls 
219. Conveyors may bill the Commission for: 
1. Telegrams—when copies are submitted with the voucher. 
2. Telephone calls when necessity is explained on the voucher. 
Telegrams and telephone calls shall be limited to Judges of Probate, 
hospitals, parents, husbands or guardians, or the Commission, and 
permitted for the following reasons: 
a. Collect telegrams from hospitals. 
b. Notification to parents of return of child to hospital. 
c. All emergencies. 
Act 158, Title III, Sec. 
Investigators 
Act 158 
Act 283 
220. In all instances whether accepted or rejected the original economic 
investigation, Form MCCC-27, signed by the investigator and the 
Judge of Probate must be on file in the office of the Commission be- 
fore expense vouchers, Form A-75R, can be given consideration for 
services of conducting the investigation. 
Billing 
Attendant’s Fees 
221. Refer to paragraph 212. Billing procedure and proration see page 
26-a. 
Date must 
Agree 
222, Dates of investigation as shown on the expense voucher must agree 
with the date of investigation as shown on Form MCCC-27, 
Rates 223. Persons or representatives making economic investigations are paid 
on an hourly basis for personal services plus necessary mileage. Refer 
paragraph 211. 
Act 220, P. A. of 191,3. 
Office 
Allowance 
224. A maximum allowance of Vi day per month for office time for prep- 
aration of expense vouchers, correspondence with arid reports re- 
quested by the Commission, will be given consideration. 
NOTE: Any additional charges for office time must he fully explained on 
the expense voucher and will be allowed at the discretion of the Com- 
mission. 
29 SECTION V—PHYSICIANS' AND SURGEONS' FEES 
Act 158, Title III, Sec. 4, Title VI, Sec. 19, Title X, Secs. 29, 30. Act 283, Secs. 
3, 13, 14. 
Ccunty Schedules 
Act 283 
300. The fee schedule in operation for medical and surgical care of adults 
in any particular county shall be the fee schedule for afflicted chil- 
dren under Act 283, in that county when such fees do not exceed the 
fee schedule of the Commission. 
Limitations 
Act 158 
Act 283 
301. The above stipulations and the following schedules of fees are not 
applicable to services of medical or surgical assistants, resident phy- 
sicians or interns. 
Bedside & O.P.D. 
Non-Operative 
Treatment and 
Extension 
Act 283 
302. First Examination (bedside) $3.00 
Subsequent services (bedside, per day) $2.00 
Maximum visits (bedside), (not to exceed one per day) 15 
Treatment in out-patient department (per day). .. 1.50 
Act 158 First complete O.P.D. examination 5.00 
Subsequent clinic examination 2.00 
First examination (bedside) 3.00 
Subsequent services (bedside), per day 2.00 
Maximum visits (not to exceed one per day) 15 
Anaesthetists’ 
Services 
Act 158 
Act 283 
303. When anaesthetics are administered by other than salaried employees 
of the hospital, billing shall be in the name of the physician perform- 
ing the service. 
Extensions for 
Bedside Visits 
Act 158 
Act 283 
304. Extension for bedside visits beyond the maximum (15 calls) must 
be requested on Hospital Service Request (Form MCCC 6-R), indi- 
cating necessity of further calls, signed by the physician. 
Special 
Examinations 
Fees for special examinations, unusual conditions or maladies not 
listed shall be determined by the Director upon negotiation. (See 
page 12-a). 
Multiple 
Services 
Act 158 
Act 283 
305. a. Fractures: In cases of multiple services, the fee for the major or 
most complicated fracture shall prevail; for each additional frac- 
ture twenty per cent (20%) of the scheduled fee shall prevail. 
b. Operations: In case of multiple operations or within 15 days of 
the original operation the fee for the major or most complicated 
condition shall prevail; for each additional operation twenty per 
cent (20%) of the scheduled fee shall prevail. (See page 30-a). 
c. Fee for bedside services not allowed to surgeon for thirty (30) 
days subsequent to surgery. 
d. When the services of a surgeon who is not the attending physi- 
cian are required, the attending physician will be allowed fees for 
bedside care in accordance with the schedule of fees prior to 
operative date, and the surgeon will be allowed the surgical fee, 
to include after care for a thirty (30) day period. 
30 INDIVIDUAL INVOICE (Form 101) 
(Physician-Surgeon Multiple Services) 
Approved procedure for billing multiple services of phy- 
sician and/or surgeon. 
Note identification of service by code number. 
Serial No. M.C.C.C. Surname First Name Second Name 
Brown Lawrence B. 
Act No. County Patient’s Address 
283 Ingham 716 Homer Street 
Hospital Name and Location Father’s Name 
Hospital Name & Address Brown 
Mother's Name 
Martha Brown 
Date Last Viait Date Admitted Date Discharged Dale Birth 
5/27/44 Remaining 7/20/35 
Physician's Name Diagnosis 
Joseph Soles, M. D. Fracture rt. femur, fibula & tibia 
M.C.C.C. No. 101—11-16-42—25M Sets 
Hospital 
Voucher No. | g 
Month of Service 
May 
Audit VENDOR LEAVE BLANK 
Stamp 
SERVICE SERVICE DESCRIPTION NO. DAYS CARE ChakgES 
O.P.D. Acute Conv, 
HOSPITAL 
5/27-6/1 m Daily Care 5 6.25 31.25 
X-RAY 
APPLIANCES 
TREATMENTS 
MISCELLANEOUS 
physician 5/27 AW Code 1006 45.00 
" 1008 (20% of $10.00) 2.00 
" 1041 (204 of $25.00) 5.00 
■ 419 Dr. R. I. Post __5*QQ_ 
88.25 
Of the Above Total $ .is to be charged to the County 
.. 
INSTRUCTIONS TO HOSPITALS 
1. Prepare (4) copies Form 101 
2. Retain 4th Copy (Green) 
3. Transmit remainder to Michigan Crippled 
Children Commission with Form No. 100 
DISTRIBUTION 
1. Yellow—M.C.C.C. 
2. Pink—M.C.C.C. 
3. Blue—M.C.C.C. 
4. Green—Hospital 
30-A Blood 
Transfusions 
Act 158 
Act 283 
306. The direct blood transfusion fee includes all medical services on the 
day of the transfusion. In operative cases the cost of the first three 
(3) transfusions shall be included in the regular fees for operative 
treatment. 
Consultation 
Act 158 
Act 283 
307. The Commission will accept billing for services of only one physician 
on each case except when consultation service is required and ap- 
proved by the Director or his representative. 
Physicians’ 
Billings 
Act 158 
Act 283 
308. It is the responsibility of the physician to see that the hospital bills 
the Commission properly for his services. It is desirable that bills 
be submitted by the physician to the hospital before the end of the 
calendar month. 
Billings delayed over sixty (60) days after the discharge of the patient 
from the hospital will not be accepted for payment. 
Private Fees 
Act 158 
Act 283 
309. In cases, where the surgical or medical fee of the Commission is not 
accepted, physicians must make previous arrangements in writing 
with the patient, and a notification of the fact that such arrange- 
ments have been made sent to the Commission so that both patient 
and the Commission are informed that the Commission medical fees 
are not to be accepted. 
Examination for 
Determination 
of Medical need 
Act 158 
Act 283 
See page 8-a. 
See page 31-a 
310. Medical examination made and reported on Form MCCC-121. .$1.50 
Physicians should bill the Commission for medical examinations 
made for Probate Court within sixty (60) days following examination 
on expense voucher Form A-75R which must be signed by- the 
Judge of Probate. 
NOTE: This fee will not be allowed when the patient is treated in the 
hospital by the same physician who examines the child for the Probate 
Court. 
Limitation of 
Maximum Fees 
Act 158 
Act 283 
311. a. Two hundred dollars ($200.00) shall be the maximum paid for 
medical and surgical fee to any one doctor for any one patient 
in a twelve (12) month period. 
b. Professional fees shall not exceed seventy-five dollars ($75.00) 
for major surgery. 
c. Fees for operative procedures and setting of fractures shall in- 
clude all fees for bedside care for a thirty (30) day period follow- 
ing such service. 
NOTE: For proper procedure hilling physicians', surgeons', nurses' and 
blood donor fees, see pages 21-a, 22-a, 23-a and 21fa- CHILD WELFARE EXPENSE VOUCHER (Form A-75-R) 
(Medical Examination) 
Important: Correct name and address of child, and date 
of examination. 
Private Other 
Compensation Automobile Hotel Expense* 
gtfJSFJSSS, >—-w-»- —■ (£~ — H 
Hours Amount Miles Amount Receipts) Description 
Column) 
July 
15 John Smith Medical investigation for 5 1 
102 S. Main Street Probate Court. Crippled child, 
Gladstone, Michigan 
20 Henry Brown Medical investigation for 8 1*50 
R. R. #1 Probate Court. Crippled child 
Gladstone, Michigan 
\ 
22 Mary VanDyke Medical investigation for 10 1-50 
67 Walnut Street Probate Court. Afflicted 
Gladstone, Michigan child. 
TOTALS 1 U.50 i 
DETAIL OF CHILD WELFARE EXPENSE VOUCHER 
31-A PHYSICIANS’ - SURGEONS FEE SCHEDULE 
Act 283 
Effective Cbtober 1, 1943 
BILLING INSTRUCTIONS 
Use Code Number of Service 
CODE 
NUMBER 
1280 
ABSCESS, Superficial 
$3.00 
1278 
Oral 
7.50 
1483 
Tons iliar 
10.00 
1274 
Deep 
10.00 
1276 
Ischeorectal 
10.00 
1477 
Pharyngeal . . . 
12.50 
1279 
Prostatic 
25.00 
1281 
Subphr enic 
75.00 
1271 
Brain 
75.00 
1277 
Liver 
60.00 
1378 
Abdominal tumor 
50.00 
1478 
Accessory nasal sinuses, irrigation 
of 
3.00 
1302 
ADENECTOMY, cervical, inguinal, etc. 
(minor) 
10.00 
1303 
(radical) 
35.00 
402 
Adenoidectoray 
5.00 
419 
Anaesthetic 
5.00 
1301 
Anal Fissure 
20.00 
1304 
ANASTOMOSIS, Intestinal 
75.00 
1305 
Ur etero-intestina1 
75.00 
1306 
ANKLE, Exc i s i on o f j o int 
35.00 
1227 
Dislocation 
25.00 
1469 
ANTRUM, Intranasal, drainage of 
15.00 
1470 
Radical, operation of 
45.00 
1307 
Appendectomy 
50 .00 
1284 
Aspiration of chest 
5.00 
1308 
Biopsy, only 
5.00 
1271 
BRAIN, Abscess 
75.00 
1379 
Tumor 
75.00 
1309 
BREAST, Resection of (simple) 
35.00 
1310 
Resection of (radical) 
75.00 
1489 
BRONCHOSCOPY. Diagnostic 
25.00 
1451 
Foreign Body 
50.00 
1491 
Therapeutic (bronchiectasis) 
5.00 
1285 
BUNIONECTOMY (single) 
35.00 
1286 
(double) 
■ 
50.00 
0413 
Caesarean section 
• 
75.00 
1272 
CARBUNCLE.Incision 
5.00 
272 & 419 
Multiple incisions with ( 
general anaes 
thet ic) 
10.00 CODE 
NUMBER 
1311 
Cariospasm, dilatation for 
. 
• 
12.50 
1001 
1002 
1101 
1102 
1201 
1202 
1203 
CARPAL BONE, Fracture (one simple) 
(each additional) 
(one, compound) 
(each additional) 
Fresh dislocations 
(one, reduction and cast) 
(each additional) 
(open reduction, one or more) 
7.50 
2.50 
10.00 
5.00 
15.00 
2.50 
15.00 
1415 
1416 
CATARACT, Needling ..... 
Operation ..... 
25.00 
50.00 
1273 
1395 
1417 
1313 
1314 
1315 
Cellulitis, incision and drainage 
Cervical rib, removal of ... 
Chalazion 
Cholecystectomy ..... 
Cholecystotomy ..... 
Choledochotomy ..... 
12.50 
60.00 
5.00 
60.00 
50.00 
50.00 
403 
1316 
CIRCUMCISION ..... 
Newborn ..... 
7.50 
5.00 
1362 
Cisterna puncture, inclusive local anaesthetic 
and obtaining fluid 
• 
25.00 
1003 
1103 
1204 
1205 
CLAVICLE. Fracture (simple) .... 
(compound) 
Fresh dislocation (either end) 
(open reduction arthrodesis) 
15 00 
25.00 
10.00 
30.00 
1004 
1104 
COCCYX (simple) ..... 
(compound) ..... 
10.00 
20.00 
1317 
1318 
Colostomy ..... 
Colporrhaphy ..... 
50.00 
35.00 
411 
411 
CONSULTATION ..... 
Orthopedic ..... 
3.00 
5.00 
1418 
1435 
CORNEAL ULCER, Cauterization of 
Extensive peripheral, cauterization of 
5.00 
10.00 
1294 
Cryptorchidectomy ..... 
• 
35.00 
1382 
1381 
1397 
1290 
CYST. Superficial, removal of . . 
Deep, removal of 
Pilonidal, excision of 
Thyroglossal 
5.00 
12.50 
10.00 
50.00 
1319 
0418 
1390 
1419 
1205 
Cystotomy, Suprapubic .... 
Cystoscopy . . 
Dilatation and curettage, uteri 
Ectropion 
Elbow, fresh dislocation .... 
35.00 
7.50 
25.00 
25.00 
20.00 
1288 
1287 
EMPYEMA, Incision and drainage 
Including rib resection 
25.00 
50.00 CODE 
MMBER 
486 
Encephalogram .... 
15.00 
1317 
Enterostomy .... 
, , 
50.00 
1420 
Entropion 
• • ’ 
25.00 
1421 
Enucleation of eye 
. , 
50.00 
1320 
Epididymectomy .... 
. • • 
20.00 
1321 
Esophagoscopy .... 
• 
20.00 
1322 
Esophagus, dilatation by means of bougies or sounds 
12.50 
1479 
Ethmoid sinus, radical 
, . 
35.00 
1324 
Fecal fistula, abdominal 
50.00 
1323 
Femoral artery, ligation of 
• 
35.00 
100 5 
FEMUR, Fracture, Simple reduction and a 
pplicat ion of 
cast 
35.00 
1006 
Skeletal traction and 
fixation 
45.00 
1105 
Reduction, debridement, suture and 
or traction (compound) 
cast 
60.00 
1007 
Open reduction 
, , 
5C.C0 
1048 
Removal of plate 
, # 
25.00 
1049 
Removal of Smith-Peterson nail 
• 
25.00 
1008 
FIBULA, Fracture, Simple reduction and 
cast (simp 1e) 
10.00 
1107 
(compound) 
15.00 
1009 
Open reduction 
• 
• 
35.00 
1253 
FINGERS, Amputation (one) 
12.50 
1254 
(each additional) 
5.00 
1207 
Dislocations (one) 
5.00 
1208 
(each additional) 
2.50 
1010 
Fracture (one, simple) 
7.50 
1011 
(each additional) 
2.50 
1109 
(one compound) 
12.50 
1110 
(each additional) 
5.00 
1141 
Open reduction (one) 
25 00 
1327 
FISTULA-IN-ANO 
25.00 
1325 
Rectovaginal .... 
45.00 
1326 
Vesicovaginal .... 
45.00 
1324 
Fecal (abdominal) 
50.00 
1255 
Foot, amputation 
35.00 
1252 
Forearm, amputation 
35.00 
1422 
FOREIGN BODY, Removal from conjunctiva 
(dissection) 
7.50 
1423 
(magnet) 
5.00 
1424 
Removal from cornea (dissection) 
12.50 
1426 
(magnet) 
10.00 
1425 
(superf icial) 
5.00 
1451 
Removal from ear 
• 
3.00 
1480 
FRONTAL SINUS, Intranasal, drainage of 
25.00 
14 81 
Radical 
• 
50.00 
1329 
FULGURATION OF TUMOR, Superficial 
5.00 
13 28 
Bladder, trachea 
or esophagus 
(minor) 
15.00 
1330 
Gastrectomy (partial) 
60.00 
1331 
Gastroenterostomy 
60.00 
1427 
Grattage of lids for trachoma 
3.00 
1256 
Hand, amputation 
35.00 
1332 
Hemmorrhoidectomy 
20.00 
1333 
Herniotomy 
50.00 
1209 
Hip, dislocation 
30.00 CODE 
NUMBER 
1428 
Hordeolum 
. 
. 
3.00 
1012 
1111 
1013 
1014 
1143 
HUMERUS, Reduction and application of cast 
Reduction, debridement suture and cast 
or traction, open 
Traction suspension or skeletal fixation 
Open reduction 
Removal of plate .... 
, 
. 
25.00 
50.00 
35.00 
50.00 
15.00 
1336 
1337 
HYDROCELE, Aspirat ion of 
Operation 
• 
. 
3.00 
20.00 
406 
HYPOSPADIAS 
Each stage 
Maximum 
• 
♦ 
• 
35.00 
70.00 
1338 
1339 
1349 
1471 
1398 
1429 
1276 
1210 
1430 
1431 
1340 
1341 
1472 
422 
Hysterectomy, abdominal or vaginal (inclusive 
adnexa if 
Ingrown toenail, excision of 
Intestinal obstruction 
Intubation 
Intussusception 
Iridectomy 
Ischiorectal abscess, incision and drainage 
Knee, dislocation 
Lacrymal duct, dilatation of 
Lacrymal sac. excision of 
Laminectomy 
Laparotomy, exploratory 
Laryngectomy 
Laryngoscopy 
removal of 
indicated) 
60.00 
5.00 
50.00 
15.00 
50.00 
35.00 
10.00 
25.00 
5.00 
25.00 
60.00 
50.00 
50.00 
5.00 
1473 
1474 
LARYNX, Cauterization of 
Tumor, removal of 
5.00 
50.00 
1458 
1257 
1342 
1277 
1363 
1015 
1113 
Lateral sinus, drainage of 
Leg, amputation 
Litholapaxy 
Liver abscess 
Lumbar puncture, inclusive local anaesthetic 
and obtaining fluid 
MALAR BONE, Fracture (simple) 
(compound) 
5 0.00 
50.00 
35.00 
60.00 
5.00 
12.50 
20.00 
1452 
1454 
MASTOID, Acute, single 
Acute, double 
50.00 
75.00 
1211 
1016 
1017 
MAXILLA, Inferior; Dislocation 
Fracture, (wiring if necessary) 
Superior, Fracture, (wiring if necessary) 
\ 
7 50 
35.00 
35. 00 
134 3 
Meckel's Diverticulum, excision of 
50.00 
1212 
1213 
1018 
1019 
1115 
1116 
METACARPAL BONE, Dislocation (one) 
(each additional) 
Fracture, (one, simple) 
(each additional) 
(one, compound) 
(each additional) 
• 
7.50 
2.50 
7.50 
2.50 
12.50 
5.00 CODE 
NUMBER 
1214 
METATARSAL BONE.. Dislocation (one) .... 
7.50 
1215 
(each additional) 
2.50 
1020 
Fracture, (one. simple) 
7.50 
1021 
(each additional) 
2.50 
1117 
(one, compound) 
10.00 
1118 
(each additional) 
5.00 
1216 
NASAL BONES, Dislocation ...... 
5.00 
1022 
Fracture, (simple) 
10.00 
1119 
(compound) ..... 
15.00 
1475 
Nasal polypus, removal of ..... 
10.00 
1476 
Nasal septum, submucous resection of ... 
25.00 
1344 
Nephrectomy ...... 
75.00 
1399 
Nephrotomy ...... 
50.00 
1345 
Nephropexy - 
50.00 
1346 
Nerve, suture of ...... 
50.00 
1348 
Neuroma, resection of . . ... 
35.00 
414 
OBSTETRICAL 
Normal, including delivery and all hospital care, 
both ante partum and post partum 
25.00 
413 
Caesarean section ...... 
75.00 
1396 
Oophorectomy ...... 
50.00 
1278 
Oral abscess (not to include dental or peridental) 
7.50 
4 05 
Orchidooexy ...... 
35.00 
1350 
Orchidectomy ...... 
25.00 
1291 
Os calcis . . . . . ■ 
25.00 
14 5 5 
Ossiculectomy ..... 
35.00 
1351 
Osteomyelitis (chronic excluded under Afflicted Act) 
3 5.00 
1352 
Papilloma of bladder ...... 
35.00 
1456 
PARACENTESIS. Ear ...... 
5.00 
1358 
Abdomen or thorax ..... 
7.50 
135S 
Pericardium ..... 
10.00 
1436 
Eye ..... 
5.00 
1217 
PATELLA, Dislocation ...... 
10.00 
1023 
Fracture. Reduction with simple dressing (simple) 
15.00 
1024 
Open reduction suture (simple) 
30.00 
1120 
Simple suture and plaster 
dressing, (compound) 
30.00 
1121 
Debridement, open reduction and 
plaster dressing (compound) 
50 00 
1218 
PELVIS, Dislocation ...... 
35.00 
1025 
Fracture, Uncomplicated with or without 
plaster cast (simple) 
25.00 
1026 
Complicated with visceral injury (simple) 
5 0.00 
1122 
With external compounding debridement 
reduction and suture (compound) 
75.00 
1123 
With sutured viscera (compound) 
75.00 
1353 
Perineum, repair of 
35.00 
1477 
Pharyngeal abscess ...... 
12.50 
1354 
Phrenictomy ...... 
25.00 
1355 
Pneumolysis ...... 
50.00 
1356 
PNEUMOTHORAX, Artificial, First induction 
12.50 
1357 
Refills1’ 
5.00 CODE 
NUMBER 
1457 
1475 
POLYPUS, Ear, removal of . 
Nasal, removal of . 
12.50 
10.00 
1027 
Pott's fracture . 
25.00 
423 
424 
PROCTOSCOPY . 
With sigmoidoscope . 
3.00 
5.00 
1361 
Prolapse of rectum, abdominal fixation of 
50.00 
1388 
1292 
PROLAPSE UTERI . 
Inclusive perineal repair 
50.00 
75.00 
1279 
1432 
1433 
Prostatic abscess, incision and drainage 
Pterygium . 
Ptosis, skin and tarsal resection 
25.00 
20.00 
35.00 
1362 
1363 
PUNCTURE, Cisterna, inclusive local anaesthetic 
and obtaining fluid 
Lumbar . ... . 
• 
25.00 
5.00 
232 
360 
426 
PYELOGRAM (x-ray code) . ... . 
With intravenous (x-ray code) 
With cystoscopy and catheterization of ureter 
• 
5 00 
10.00 
15.00 
1364 
Pyloroplasty . 
• 
60.00 
1028 
1029 
1124 
1030 
1125 
RADIUS OR ULNA, or both 
Fracture, Including Colies' fracture, reduction 
and plaster dressing (simple) 
Shaft (simple) . . . . 
Suture reduction and plaster dressing 
Open reduction (simple) 
(compound) 
(compound) 
25.00 
30.00 
30.00 
35.00 
50.00 
1364 
1414 
1361 
Rammstedt's operation . 
Refractions . 
Rectum, orolapse - abdominal fixation 
• 
60.00 
5.00 
50.00 
1219 
1031 
1032 
1126 
1127 
1275 
0008 
RIB 
Dislocation . ... . 
Fracture (one, simple) . 
(each additional) . . . . 
(one, compound) . 
(each additional) . 
Resection . . ... 
Removal cervical rib . ... . 
* 
5.00 
7.50 
2.50 
12.50 
5.00 
25 .00 
60.00 
1033 
1128 
SACRUM, Fracture, Simple . ... . 
. Compound. . 
• 
25.00 
35.00 
1365 
Salpingectomy . , 
• 
50.00 
1034 
1129 
SCAPULA 
Fracture (simple) . ... . 
(compound) . ... . 
• 
20.00 
25.00 
1312 
1366 
1220 
Semilunar cartilage, removal from joint 
Seguestrum, removal of .... 
Shoulder, dislocation . ... . 
• 
50.00 
35.00 
20.00 CODE 
NUMBER 
1478 
1482 
1479 
1480 
1481 
1458 
SINUS 
Accessory nasal, drainage 
Sphenoid, drainage 
Ethmoid, radical 
Frontal, Intranasal . 
Radical 
Lateral 
3.00 
25.00 
35.00 
25.00 
50.00 
50.00 
1035 
1130 
1036 
1036 
SKULL FRACTURE, No complications (simple) 
(compound) 
With complications 
Operations 
30.00 
50.00 
50.00 
50.00 
1482 
1368 
Sphenoid sinus drainage of ... 
Splenectomy 
25.00 
75.00 
1140 
1142 
STEINMAN PIN Insert 
Removal 
50.00 
10.00 
1037 
1131 
STERNUM 
Fracture (simple) 
(compound) 
20.00 
25.00 
1434 
1369 
1293 
1281 
1347 
Strabismus, operation for 
Stricture of rectum 
Submucous resection 
Subphrenic abscess 
Supraorbital nerve, injection of 
50.00 
25.00 
25.00 
75.00 
5.00 
1370 
1371 
SYMPATHECTOMY, Cervical 
Periarterial 
50.00 
35.00 
1221 
1222 
1038 
1040 
1039 
1132 
1134 
1133 
TARSAL BONE, 
Dislocation (one) ..... 
(each additional) .... 
Fracture (one, simple) .... 
(each additional) .... 
Complicated, requiring operation (simple) 
(one, compound) 
(each additional) .... 
Open operation .... 
7.50 
2.50 
7.50 
2.50 
15.00 
12.50 
5.00 
25.00 
1372 
1373 
TENORRHAPHY, (one) 
(one additional) 
20.00 
5.00 
1374 
1258 
1375 
1223 
1376 
1377 
Tenotomy .... 
Thigh, amputation .... 
Thoracoplasty, each stage .... 
Thumb, dislocation .... 
Thyroid artery, ligation of ... 
Thyroidectomy .... 
12.50 
75.00 
50.00 
7.50 
25.00 
60.00 
1041 
1042 
1135 
1136 
114 3 
TIBIA 
Fracture, .Reduction with plaster dressing (simple) 
Traction suspension or skeletal fixation (simple) 
Reduction debridement suture and cast or 
traction (compound) .... 
Open operation ..... 
Removal of plate ..... 
25.00 
30.00 
30.00 
50 . 00 
15.00 CODE 
NUMBER 
1259 
1260 
1224 
1225 
1044 
1045 
1137 
1138 
TOE Amputation (one) 
(each additional) 
Dislocation (one) 
(each additional) 
Fracture (one., simple) 
(each additional) 
(one, compound) 
(each additional) 
12.50 
5.00 
5.00 
2.50 
7.50 
2.50 
10.00 
5.00 
1483 
401 
1484 
1485 
407 
Tonsillar abscess 
Tonsillectomy 
Tonsillectomy and adenoidectomy 
Tracheotomy 
Transfusion, direct 
10.00 
10.00 
15.00 
25.00 
5.00 
1401 
1402 
1403 
TRAUMATIC WOUNDS 
Incised 
Lacerated 
Punctured 
• 
• 
7.50 
10.00 
7.50 
1381 
1382 
1378 
1379 
1380 
1474 
TUMOR 
Tumor or cyst of skin, Deep, removal of 
Superficial 
Abdominal, Removal of .... 
Brain ..... 
Gastrointestinal tract. Resection of, including 
intestinal anastomosis 
Larynx, Removal of ..... 
12.50 
5.00 
50.00 
75.00 
75.00 
50.00 
1486 
Turbinate bone, galvano-cauterization of 
10.00 
1487 
1488 
TURBINECTOMY 
Double 
. 
10.00 
15.00 
1383 
1418 
1435 
ULCER, Gastric or duodenal 
Corneal, Cauterization of 
Extensive peripheral, cauterization of 
• 
60.00 
5.00 
10.00 
1251 
1384 
1385 
Upper arm, amputation 
Ureteral stone, removal of 
Urethral stricture, dilatation of 
35.00 
50.00 
3.00 
1386 
1387 
URETHROTOMY, External 
Internal 
20.00 
12.5 0 
1389 
Uterine displacement, abdominal 
20.00 
1390 
1388 
UTERUS, Dilatation and curettage of 
Prolapse, including perineal repair 
25.00 
50.00 
1391 
Vericocele 
• 
20.00 
1392 
1393 
VARICOSE VEINS Injection treatment, each injection 
Ligation saphenous 
3.00 
5.00 
1226 
VERTEBRA, Dislocation, one or more, reduction 
and plaster dressing 
* , 
• 
35.00 
1227 
Traction 
. 
50.00 CODE 
NUMBER 
1046 
104 7 
VERTEBRA (Continued) 
Fracture, Simple compression, reduction with 
application of cast (simple) 
Complicated .... 
35.00 
50.00 
1139 
One or more (compound) 
. 
, 
50.00 
1201 
Wrist dislocation 
• 
• 
• 
15.00 
501 
APPLICATION 
ARM Elbow 
OF CASTS 
7.50 
502 
Long Unilateral 
7.50 
503 
Bilateral 
10.00 
504 
Shari Unilateral 
7.50 
505 
Bilateral 
10.00 
506 
Back Mould 
12.50 
507 
BODY Long 
20.00 
508 
Short 
15.00 
509 
CLUB FOOT, Unilateral 
7.50 
5.10 
Bilateral 
10.00 
513 
Finger 
1.50 
514 
FOOT Unilateral 
5.00 
515 
Bilateral 
10.00 
516 
Hand 
5.00 
517 
Heel . . 
2.50 
518 
HIP SPICA, Long, Unilateral 
7.50 
519 
Bilateral 
10.00 
520 
Short Unilateral 
7.50 
5 21 
Bilateral 
10.00 
524 
LEG Long, Unilateral 
7 . 50 
525 
Bilateral 
12.50 
522 
Short, Unilateral 
7.50 
523 
Bilateral 
12,50 
526 
Short, to be used with Boehler 
Iron, Unilateral 
7.50 
527 
537 
Neck 
B i lateral 
12,50 
3.00 
528 
SHOULDER SPICA Unilateral 
10.00 
529 
Bilateral 
15 .00 
535 
Thumb spica 
1.50 
536 
Torso and hip 
538 
Wrist, cock up 
• • • 
10 00 
2.50 
The charges for other types of casts shall be fixed by negotiation 
with the Director. In cases of multiple casts, the most costly will 
be allowed at the scheduled rate and each additional at 50% of this 
schedule. 
NOTE No allowance will be made for physician’s services for appli- 
cation of casts for 15 days immediately following an operative 
procedure FEE SCHEDULE 
ORTHOPEDIC, PLASTIC, NEURO-SURGERY 
Effective May 1, 1944 
BILLING INSTRUCTIONS 
Use Code Number of Service 
CODE 
NUMBER 
42 
ABSCESS 
Paravertebral,, incision and drainage of 
50.00 
217 
Psoas, aspiration of 
25 „00 
Orthopedic 
37 
Psoas, incision and drainage of 
5 0.00 
Surgery 
Act 158 
25 
AMPUTATIONS 
Arm„ transcondylar, lower third . . • 
50.00 
26 
Carpo-metacarpa 1 joint 
35.00 
27 
For earm ..... 
* 
35.00 
28 
Fingers . . . . . 
9 
12.50 
86 
Foot ..... 
0 
35.00 
48 
Hip, disarticulation at hip joint 
75.00 
29 
Humerus ..... 
, 
50.00 
87 
Leg ..... 
* 
50.00 
30 
Metacarpus ..... 
35.00 
31 
Phalanges ..... 
12.50 
49 
Shoulder girdle .... 
D 
75.00 
89 
Thigh ...... 
a 
50.00 
88 
Toes ..... 
• 
12.50 
218 
ARTHRODESIS 
Astragalo-scaphoid fusion 
50.00 
32 
Elbow joint . . 
* 
75.00 
83 
Foot0 triple arthrodesis 
U 
65.00 
62 ' 
Foot and ankle, panastragaloid 
75.00 
58 
Hip ..... 
Q 
75.00 
51 
Knee ..... 
w 
75.00 
50 
Sacro iliac ..... 
75.00 
2 
Shoulder ..... 
75.00 
90 
Tibio-tarsal arthrodesis 
65.00 
3 
Wrist 
" 
75.00 
10 8 
ARTHROPLASTY 
Elbow ..... 
75.00 
109 
//ip ..... 
75.00 
110 
Knee ..... 
75.00 
111 
Metacarpal or metatarsal . . 
c 
50.00 
112 
Shoulder ..... 
- 
75.00 
64 
ARTHRORHESIS (Bone block operations) 
Ankle joint 
50.00 
54 
Elbow joint 
u 
50.00 
79 
Hip joint (shelving operation) 
* 
75.00 
59 
Knee joint 
50.00 
134 
Shoulder ..... 
• 
50.00 
5 
ARTHROTOMY 
For drainage ..... 
50.00 
91 
For repair . 
• 
75.00 
52 
Astragalectomy ..... 
75.00 Orthopedic 
Surgery 
Act 158 
CODE 
NUMBER 
6 
BONE GRAFT 
Inlay graft , . . . . 
75.00 
126 
Onlay graft 
75.00 
55 
Bone lengthening ...... 
75.00 
56 
Bone shortening ..... 
75.00 
57 
BONE TUMOR, EXCISION OF 
Long bones or pelvis .... 
75.00 
7 
Small bones .... 
50.00 
92 
BUNIONECTOMY 
Excision of exostosis. 
Single 
35.00 
93 
Double 
50.00 
94 
Reconstruction, 
Single 
50.00 
95 
Double ..... 
75.00 
33 
CAPSULQRRHAPHY 
Hands or feet ..... 
50.00 
34 
Large joints ..... 
75.00 
8 
CERVICAL RIB, removal of ... 
60.00 
40 
Resection of scalenus anticus muscle 
60.00 
9 
Club hand, reconstruction operation 
75.00 
215 
CLUB FEET 
Manipulation and casts bilateral 
10.00 
216 
unilateral 
7.50 
214' 
Application of Dennis Brown splint (feet) 
5.00 
61 
63 
(Not to exceed $50.00 for 3 months’ treatment) 
Multiple operative procedures for 
60.00 
202 
Ogston s operation (feet) 
60.00 
69 
Epiphyseal arrest, single 
60.00 
169 
double 
75.00 
41 
Laminectomy ..... 
75.00 
60 
Manipulative procedures of 
Dislocated hip with application of cast 
50.00 
10 
Muscle advancement of 
Flexor muscle from median epicondyle 
50.00 
120 
(For Volkmann s contracture) 
MUSCLE STRIPPING 
Campbell’s operation .... 
60.00 
65 
101 
Iliums (Soutter’s operation for 
flexion contracture of hip) 
Os Calais (Steindler’s operation) 
50.00 
50.00 
11 
Scapula (in Sprengel’s deformity) 
75 .00 
21 
OBSTETRICAL PARALYSIS OPERATIONS FOR 
Kleinberg’s operation 
50.00 
133 
Osteotomies 
50.00 
21 
Sever’s operation .... 
50.00 
106 
Tendon transplants .... 
50.00 Orthopedic 
CODE 
Surgery 
Act 158 
NUMBER 
OPEN REDUCTIONS FOR UNUNITED FRACTURES 
15 
Both bones of forearm 
o « 
y 
75.00 
67 
Femur 
« « 
y 
75.00 
38 
Humerus 
y 
75.00 
128 
Tibia 
u „ 
, 
75.00 
68 
Others 
OSTEOMYELITIS, CHRONIC 
60.00 
208 
Incision and drainage 
V | . 
y 
50.00 
77 
Osteotomy 
• V 
y 
75.00 
107 
Saucerization 
y . 
y 
75.00 
84 
Sequestrectomy„ simple 
OSTEOTOMY 
50.00 
71 
Femur 
w w 
75.00 
17 
Forearm 
• y 
50.00 
75 
Hip, intertrochanteric 
, , 
75.00 
76 
Hip, intra-articular 
w 
75.00 
53 
Hip, Lorenz-Bayer bifurcation 
75.00 
5 3 
Hip, Shantz 
u «. 
75.00 
80 
Hipf Subtrochanteric 
u » 
75.00 
19 
Humerus 
y y 
60.00 
70 
Knee, tibia and fibula 
y y 
60.00 
35 
Metacar pals of 
„ • 
40.00 
96 
Metatarsals of 
• y 
y 
40.00 
97 
Os Calcis 
o «. 
y 
50.00 
98 
Radial, MadelungJs 
u . 
y 
60.00 
99 
Supramalleolar 
• 
50.00 
73 
Tarsus and metatarsus, multiple 
• 
60.00 
10 
Palmar fasciotomy for Dupuytren s 
contracture 
50.00 
RECURRENT DISLOCATIONS. SURGICAL 
PROCEDURES 
FOR 
210 
Metacarpal phalangeaI joint 
* 
50.00 
211 
Pate11 a 0 
„ y 
y 
75.00 
212 
Shoulder 
y M 
75.00 
213 
Temporomandibular joint 
u 
75.00 
16 
Other joints 
“ 
• 
5 0.00 
43 
Removal of coccyx .- 
50.00 
209 
Removal of Steinman pin 
RESECTIONS 
w o 
• 
10,00 
18 
Elbow joint 
y y 
y 
75.00 
39 
Head of radius 
y 
y 
60.00 
129 
Hip 
y y 
y 
75.00 
78 
Knee 
u « 
y 
75.00 
127 
Metatarsal heads 
« « 
y 
60.00 
20 
Shoulder joint 
y , 
« 
75.00 
36 
Wrist 
. 
. • 
75.00 
81 
Shelf operation, hip 
SLIPPED FEMORAL EPIPHYSIS 
. 
• 
75.00 
203 
Open reduction 
. 
. 
75.00 
219 
Closed reduction 
• 
50.00 
44' 
Spinal fusion 
y , 
y 
75.00 Or fc hoped ic 
Sur ger y 
Act 158 
COM: 
NUMBER 
103 
150 
Stripping of internal malleolus (Ober‘s) 
SYNOVECTOMY 
In arthritis of knee 
50 00 
75 00 
151 
In osteochondromatosis 
• 
- 
75.00 
206 
Tendon lengthening 
40,00 
207 
shortening 
• 
• 
40.00 
121 
TENODESIS 
Ankle joint 
5 0.00 
122 
Paralytic calcaneus 
« 
5 0 00 
123 
Paraiytic equinus 
O 
50.00 
124 
Paralytic van us 
* 
ft 
50 00 
125 
1Vrsst 
• 
- 
50,00 
113 
TENOTOMY 
Subcutaneous 
30 00 
114 
Open 
ft 
50 00 
115 
Hamstring tendons 
ft 
50 00 
116 
Iliopsoas contracture 
o 
ft 
50 00 
23 
Sternocleidomastoid (in torticollis) 
« 
60 00 
113 
Tae flexors and extensors 
« 
- 
40 00 
105 
Tenoplasty 
° 
• 
50.00 
130 
TRANSPLANTS of biceps femoris 
75 00 
131 
other muscles 
ft 
50 00 
132 
tendons 
• 
- 
50 00 
Ne ur o 
Surgery 
160 
NERVE RESECTION 
Median nerve 
50 00 
162 
Obturator nerve 
0 
ft 
50 00 
164 
Posterior tibial nerve 
9 
ft 
50,00 
163 
Sciatic nerve 
0 
ft 
5 0 00 
161 
Ulnar nerve 
• 
• 
50 00 
173 
NERVE SUTURE 
Brachial plexus 
75 00 
171 
Median nerve 
50.00 
170 
Musculospiral 
• 
- 
50 00 
175 
SCIATIC NERVE 
external popliteal (peroneal) 
50 00 
176 
internal popliteal (tibial) 
50 00 
172 
174 
Ulnar nerve 
Other 
- 
O 
50 00 
50 00 
181 
RAMISECTIONS 
I: spastic paralysis 
75.00 
182 
Sympathetic cervical 
O 
75 00 
183 
Sympathetic, chronic arthritis 
ft 
75 00 
184 
Sympathetic lumbar 
• 
- 
75 00 
46 
SPINA BIFIDA, CLOSURE OF 
W , th meningocele 
75 00 
146 
Without meningocele 
50 00 
4 o 
Sympa hectomy . 
0 
75 00 Plas t ic 
CODE 
NUMBER 
303 
Cheiloplasty 
50.00 
Surgery 
301 
Palatorrhaphy 
. * • 
. , 
75,00 
307 
Rhinoplasty 
, „ , 
, , 
75.00 
302 
Repair of deforming contractures (old). 
ma j or 
75.00 
308 
Repair of deforming contractures (old). 
minor 
50.00 
304 
Skin grafting for old 
burns, major 
, 
75.00 
309 
Skin grafting for old 
burns, minor 
• 
50.00 
Measuring and 
421 
Non-operative case 
10.00 
Fitting of 
Appliance 
Post-operative case 
• 
• 
No Charge 
Application 
of Casts 
Refer to PHYSICIANS'- 
SURGEONS' FEE SCHEDULE, Act 
283. 
Act 158 CRIPPLED CHILDREN'S ACT 
No. 158 of the Public Acts of 1937 
As Amended By 
Act 227 of the Public Acts of 1943 and 
Act 187 of the Public Acts of 1945 and 
Act 227 of the Public Acts of and 
Act 248 of the Public Acts of 1947 
Bill 
Powers 
Duties 
1 AIT ACT to declare the policy of the state of Michigan with 
2 reference to crippled children; to provide for the appoint- 
3 ment of, and to prescribe the powers and duties of the 
4 Michigan crippled children commission; to provide for the 
5 registration, examination, diagnosis, treatment, follow-up 
6 supervision, convalescent and custodial care and education 
7 of crippled children; to provide for the establishment, 
8 maintenance and conduct of hospital schools for convalescent 
9 crippled children; and to provide for, and regulate the 
10 making of appropriations to carry out the purposes of this 
11 act; and to repeal all acts and parts of acts inconsistent 
12 with the provisions of this act. 
THE PEOPLE OP THE STATE OF MICHIGAN ENACT: 
TITLE I. POLICY OF STATE 
Policy of 
State 
Location 
Care 
Treatment 
1 Section 1, Policy of state. It is hereby declared to be the 
2 public policy of the state to develop, extend, and improve, 
3 especially in rural areas, services for locating children who 
4 are suffering from conditions which lead to crippling and for 
5 providing medical, surgical, corrective, and other services 
6 and care, including after care and custodial care when nec- 
7 essary, and facilities for diagnosis, hospitalization, and 
8 special education for crippled children as herein provided; 
9 and to prevent, insofar as possible, such crippling conditions, 
10 Such policy being based not only on humanitarian but on econ- 
11 omic considerations, it shall be carried out not only for the 
12 purpose of providing medical and physical care for crippled 
13 children, but for the purpose of making them self-sustaining 
14 in whole or in part, rather than charges on the public for 
15 support. 
TITLE II. DEFINITION OF CRIPPLED CHILD. 
Definition 1 Sec. 2. Definition. For the purposes of this act a crippled 
2 child is hereby defined to he one under twenty-one years of 
3 age, married or unmarried, whose activity is or may become 
4 so far restricted by defect or deformity of bones or muscles, 
5 or the impairment of function thereof, as to reduce his or 
6 her normal capacity for education and self-support. TITLE III. MICHIGAN CRIPPLED CHILDREN COMMISSION 
Commission 
Appointment 
Term 
1 Sec. 3. Commission; appointment, term vacancies. The^e 
2 shall be appointed by the governor, by and with the advice 
3 and consent of the senate, a commission composed of five 
members, to be known as the Michigan crippled children com- 
5 mission, hereinafter referred to as the commission. Two of 
6 such members shall be appointed to serve for a period of one 
7 year, two for two years and one for a period of three years, 
8 and each year thereafter there shall be appointed two members 
9 or one member, as the case may be, to serve for the full term 
10 of three years or until their successors are appointed and 
11 qualified. All vacancies shall be filled by appointment by 
12 the governor. Each member of the commission shall take and 
13 subscribe to the oath of office required by law. Such members 
shall serve without compensation, but shall be entitled to 
15 their actual traveling expenses. Such commission shall be a 
16 body corporate and may contract and be contracted with, sue 
17 and be sued, and do all things necessary to perform the duties 
18 required and to execute the powers vested in the commission by 
19 law. 
Powers, Duties, 
Rules and Regu- 
lations , 
Officers, 
Approval of 
Hospitals, 
Clinics, 
Fees and Rates, 
Payments 
1 Sec, b, Specific powers and duties. The commission shall 
2 have power (l) to administer a urogram of services for child- 
3 ren who are crippled or who are suffering from conditions 
4 which lead to crippling, and to supervise the administration 
5 of those services included in the program which are not ad- 
6 ministered directly by it; (2) to make rules governing its 
7 procedure; (3) to select a chairman and a vice chairman who 
8 shall serve without compensation, for the term of one year, 
9 and to employ a director who shall be a regularly qualified 
10 and licensed physician of the state of Michigan, a secretary 
11 and any other personnel necessary for the carrying out of the 
12 urovisions of this act, and other necessary and properly 
13 qualified office and fielc! employes, who shall serve during 
14 the pleasure of the commission, and receive necessary traveling 
15 expenses and salaries to be fixed by the commission; and (4) to 
16 make and enforce rules and regulations concerning employes 
17 serving the commission, the approval of hospitals, convalescent 
18 homes and orthopedic centers, the conduct of clinics, the 
19 handling of cases, the providing of/hospital schools and, in 
20 cooperation with the auditor general the fixing of fees and 
21 institutional rates, the payment of bills, and the carrying 
22 out of all of the provisions of this act imposing duties upon 
23 it. 
Program of 
Services 
f or 
Crippled 
Children 
1 Sec. 5* Services for crippled children. The commission is 
2 hereby designated as the agency of the state to administer a 
3 program of services for children who are crippled or who are 
k suffering from conditions which lead to crippling, and to 
5 supervise the administration of those services included in 
6 the program which are not administered directly by it. The 7 purpose of such program shall be to develop, extend and im- 
8 prove services for locating such children, and for providing 
9 for medical, surgical, corrective, and other services and 
10 care, including after care and custodial care, and for 
11 facilities for diagnosis, hospitalization and special edu- 
12 cation. 
Federal 
Annual Plan, 
Records, 
P-eports, 
Cooperation 
With Other 
Agencies 
1 Sec. 6. Plan or plans; cooperation with federal government, 
2 The commission is hereby authorized: 
3 (a) To formulate and administer a detailed plan or plan for 
purposes specified in section five, and make such rules 
5 and regulations as may be necessary or desirable for 
6 the administration of such plans and the provisions of 
7 this act. Any such plan shall include provisions for 
8 (1) Financial participation by the stats; 
9 (2) Administration of the plan or plans by the com- 
10 mission, and supervision by the commission of the 
11 administration of those services included in the 
12 plan or plans which are not administered directly 
13 by it; 
(3) Such methods of administration as are necessary for 
15 efficient operation of the plan or plans; 
16 (4) Maintenance of records and preparation of reports 
1? ‘ of services rendered; 
18 (5) Cooperation with medical, health, nursing, and 
19 welfare groups and organizations, and with any 
20 agency of the state charged with the administration 
21 of laws providing for vocational rehabilitation 
22 and special education of physically handicapped 
23 children. 
24 (6) Carrying out the purposes specified in section five. 
25 (b) To expend in accordance with such plan or plans all funds 
26 made available to the state by the federal government for 
27 such purposes. 
Social 
Security 
Act 
28 (c) To cooperate with the federal government, under part two, 
29 title five of the federal social security act, through 
30 its appropriate agency or instrumentality, in developing, 
31 extending, and improving such services, and in the ad- 
32 ministration of such plan or plans. Bequests, 
Trusts, 
Gifts 
1 Sec. 7. Bequests; trust fund. The said commission shall 
2 have power and authority to receive and hold the title to 
3 property, both real and personal, by gift, devise, bequest 
4 and conveyance, to be used by said commission for the 
5 purpose of carrying out the provisions of this act, and 
6 all property so accepted shall be held and used as a trust 
7 fund for the purposes for which received. 
Books and 
Accounts, 
Biennial 
Report 
1 Sec. 8. Books and accounts; report. The books and accounts 
2 of the commission shall be open at all times for examination. 
3 The commission shall make a biennial report to the governor 
4 and the state administrative board showing the amount of 
5 money received and expended and a detailed statement of its 
6 activities for said period, and a copy of such report shall 
7 be furnished each member of the legislature at its first 
8 session following the filing of such report with the governor. 
TITLE IV. REGISTRATION OF CRIPPLED CHILDREN 
Forms, 
Census 
1 Sec. 9. Forms. The forms prepared by the superintendent of 
2 public Instruction for the enumeration of children of school 
3 age in this state, as provided by law, shall contain space 
4 for the special enumeration of crippled children as defined 
5 in this act. On supplementary blanks to be printed and 
6 furnished by the commission, shall be shown such information 
7 as shall be required by the commission for such children from 
8 birth to twenty-one years of age. 
Duties 
Census 
Enumerators 
1 Sec. 10, Duties of census enumerators. Each school census 
2 enumerator shall register in the space and on the blanks pre- 
3 scribed by section nine every crippled child as herein 
4 defined within his school district or subdivision thereof, 
5 and make report thereof to the superintendent of public 
6 instruction. 
1 Sec, 11. Duty of superintendent of public instruction. The 
2 superintendent of public instruction shall forthwith forward 
3 to the secretary of the commission the supplementary reports 
4 as herein required. 
Investigation 
Census 
Reports 
1 Sec. 12. Investigation and report. It shall he the duty of 
2 the commission, upon receipt of the completed supplementary 
3 school census reports, to cause to he investigated in collahor- 
4 ation with local authorities the needs of such children and to 
5 arrange for their proper care and education, as provided for 
6 in this act. 
TITLE V. EXAMINATION AND DIAGNOSIS. 
Clinics 1 Sec. 13. Holding of clinics. It shall he the duty of the 
2 commission to hold diagnostic clinics for crippled children 3 in such places and at such times as circumstances and con- 
4 ditions may warrant. Preparations for, and the organization 
5 and administration of, such clinics shall be under the dl- 
6 rection of the commission, which shall make suitable rules 
7 for their conduct. 
Reports of 
Clinics 
1 Sec. 14, Surgeons and specialists; reports. The orthopedic 
2 surgeons and other necessary medical specialists who are to 
3 examine children at clinics shall be chosen by the commission 
4 in cooperation with the local county medical societies. It 
5 shall take detailed stenographic reports of the examining 
6 specialists at the clinics, Including their recommendations, 
7 and prepare special blanks upon which such reports are to be 
8 recorded. Copies of such reports shall be furnished to 
9 properly interested persons and agencies in the counties 
10 where the respective children have their residences, includ- 
11 ing parents who are able to pay any part of the costs of the 
12 treatment recommended. 
TITLE VI. TREATMENT 
Treatment, 
Investigation, 
Residence 
1 Sec, 15. Investigation and report. Whenever there shall be 
2 found in any county a crippled child as herein defined, whose 
3 condition can be remedied and whose parents or guardians are 
4 unable to provide proper care and treatment, it shall be the 
5 duty of the commission, or such person or agency as shall be 
6 available and approved by the commission, as the case may be, 
7 to make an investigation and a certificate showing the phy- 
8 sical and mental condition of such child and the financial 
9 condition of the family and setting forth a copy of the re- 
10 port of such investigation and of the report of a duly li- 
11 censed practitioner of medicine with reference to such child, 
12 Such certificate shall be forwarded to the Judge of probate 
13 of the county. 
Order of 
Court, 
Financial 
and Medical 
Reports, 
Commission 
Responsibility 
1 Sec. 16. Order of probate Judge; responsibility of com- 
2 mission. Upon the receipt of such certificate, it shall be 
3 the duty of the Judge of probate promptly to consider the 
4 matter and to make a determination with reference thereto. 
5 The said Judge of probate may enter an order, a copy of which 
6 shall be sent forthwith to the commission, including the re- 
7 port of the financial and medical investigators, directing 
8 that such child be conveyed to a hospital in the state which 
9 has been approved and designated by the commission for the 
10 care of such children, as herein defined. Upon receipt of 
11 the copy of such order, the commission shall become charged 
12 with the responsibility for the proper handling of the case, 
13 and may transfer such child to some other hospital for treat- 
14 ment better adapted to its needs, or because of lack of room 
15 or facilities, or for other adequate reason, the intent of 
16 this provision being that it shall be the duty of the cora- 
17 mission to secure for each child such care and treatment as 
18 the particular necessities of the case may require. 1 Ssc. 17. Designation of hospitals. Any hospital approved 
2 "by the American college of surgeons may he approved hy the 
3 commission, if it maintains orthopedic equipment and con- 
h valescent and educational facilities including qualified 
5 instructional service and an attending orthopedic surgeon 
6 and other specialists approved hy the commission. 
Hospital 
Reports, 
Admittance, 
Discharge, 
Progress 
1 Sec. 18. Hospital reports. Approved hospitals receiving 
2 patients under the provisions of this act shall report with- 
3 in 10 days to the commission, on blanks to be provided by 
the commission for that purpose, the dates of admission to 
5 and discharge from such hospital, the name of the approved 
6 physician and/or the surgeon who operated, and such other 
7 information as the commission may require, and a copy of such 
8 report shall be sent by the commission to the probate judge 
9 and to any other properly interested person or agency of the 
10 county from which such patient was sent. Each approved hos- 
11 pital shall report progress to the commission on the treat- 
12 ment of all crippled children remaining in such hospital in 
13 excess of 15 days in the manner required by the commission; 
14- Provided, That when the progress report submitted by the 
15 hospital does not indicate the need for further acute care, 
16 the convalescent rates established by the commission shall 
17 prevail. 
Hospital 
Care and 
Treatment 
1 Sec. 19. Hospital care and treatment. It shall he the duty 
2 of the superintendent of such hospital to provide a bed in 
3 the hospital to which such child shall be assigned for oper- 
k ation or treatment or both of the deformity or malady in 
5 the particular case and the care and treatment of such child. 
6 The physician or surgeon approved by the commission shall 
7 proceed as promptly as necessary to perform such operation 
8 or to bestow such treatment upon such child as in his judg- 
9 ment shall be proper. No compensation shall be charged or 
10 allowed to the admitting physician nor to the physician or 
11 surgeon at the hospital of the university of Michigan who 
12 shall treat such child other than is provided for in this act. 
TITLE VII. EDUCATION. 
Hospital 
Schools 
1 Sec. 20. Hospital schools. Hospital schools for educational 
2 training for convalescent crippled children shall he provided 
3 by the hospital authorities in approved hospitals of the 
b state receiving crippled children for treatment as may in the 
5 judgment of the superintendent of public instruction he deemed 
6 advisable. 
School Re- 
quirements 
1 Sec, 21, Requirements. All courses of study, attendance 
2 record systems, the adequacy of methods of instruction, the 3 qualifications of teachers, the conditions under which 
k teachers are employed and the purchase of necessary equip-, 
5 ment for the instruction of such children in hospital 
6 schools shall comply with the requirements prescribed by 
7 the state superintendent of public instruction. 
School 
Records 
Reports 
1 Sec, 22. Records; reports. Hospital schools shall keep 
2 daily records on the regular child accounting forms used 
3 in the public schools in the state, showing all children 
4 actually receiving instruction. Said hospital schools shall 
5 transmit such reports to the superintendent of public in- 
6 struction as he shall request. 
TITLE VIII. ORTHOPEDIC CE1TTERS, 
Out-Patient 
Follow-up and 
Convalescent 
Care, 
Education 
1 Sec, 23. Minor orthopedic cases; out-patient and convales- 
2 cent department; follow-uo supervision. The commission may 
3 from time to time establish treatment and educational centers 
k in various districts of the state, where, in the opinion of 
5 the commission it is necessary to give clinical examination, 
6 treatment of minor orthopedic conditions, out-patient treat- 
7 ment and education and follow-up supervision, including con- 
8 valescent periods for patients from approved and designated 
9 hospitals provided for in section seventeen of this act, 
10 For this purpose the commission may designate and approve 
11 local hospitals and surgeons and convalescent schools for 
12 the care and education of such convalescent patients, and 
13 those suffering from minor orthopedic maladies, and fix 
their compensation therefor. 
Commitment, 
Hesnonsihility 
1 Sec, Commitment; responsibility. The probate Judge of 
2 any county may make orders for the conveying of any such 
3 children to any such center, and the commission shall be 
4 charged with the responsibility for and the care and treat- 
5 ment of such children to the same extent as provided in 
6 section sixteen of this act. 
TITLE IX. CUSTODIAL CASES 
Custodial 
Cases 
1 Sec. 25. Definition. A custodial case shall be deemed to 
2 be that of a person, under twenty-one years of age, who, be 
3 cause of his or her physical handicap, can improve very 
k little or not at all by orthopedic treatment; who needs 
5 dependent care, either total or partial; who, under normal 
6 conditions, cannot be profitably educated, vocationally 
7 trained or placed in remunerative employment; but who may, 
8 under proper conditions especially provided, be enabled to 
9 contribute to his or her own partial support or well-being. 
7 Care and 
Education 
1 Sec, 26. Care and education. The commission shall have 
2 power and it shall he its duty to arrange for the care and 
3 education of crippled children requiring custodial care, for 
whom no other provision is made: Provided, That such per- 
5 sons committed before attaining the age of twenty-one, shall 
6 continue thereafter to receive such care and education if 
7 considered hy the commission necessary and proper. Custodial 
8 care shall he given hy the commission on the order of the 
9 prohate court in family homes or private or public institu- 
10 tions which are suitable and licensed hy the state under act 
11 number one hundred thirty-six of the public acts of nineteen 
12 hundred nineteen and act number three hundred of the public 
13 acts of nineteen hundred thirteen, as amended, respectively. 
TITLE X. FINANCE. 
Expenses of 
Comnission, 
Gifts and 
Grant s 
1 Sec. 27. Expenses of commission. The expenses of the com- 
2 mission in carrying out the provisions of this act shall be 
3 paid pursuant to appropriations made from time to time out 
k of the general fund: Provided, however, That if any funds 
5 are made available to the commission by gift or grant, they 
6 shall be expended in accordance with the provisions of such 
7 gift or grant. 
Clinic 
Expense 
1 Sec. 28, Expense of clinics. The per diem compensation of 
2 orthopedic surgeons and medical specialists in diagnostic 
3 clinics shall be fixed by the commission in cooperation with 
the auditor general and paid in addition to necessary travel- 
5 ing expenses. The commission may also incur and pay any other 
6 incidental expense for service in connection with the holding 
7 of such clinics. 
Cost of 
Investigations 
1 Sec. 29. Cost of investigations and reports. The costs of 
2 the investigational and medical reports required by section 
3 fifteen of this act shall be paid by the state according to 
such schedule of fees and expenses as shall be adopted by 
5 the commission. 
Hospital 
Accounting, 
Fee and Pate 
Schedules, 
Annual 
Maximum Fee 
1 Sec. 30. Hospital accounting; standardization of fees and 
2 rates. The superintendent of the approved hospital shall 
3 keep a correct account of all hospital, hoarding or convales- 
b cent home services, including all ordinary care and such 
5 other necessities furnished to said child in accordance with 
6 the hospital, convalescent or hoarding home rates as fixed hy 
7 the commission. The hospitals1 financial records shall he 
8 ouen to audit hy any person designated hy the commission. 
9 The commission shall pay for the day of admission hut not for 
10 the day of discharge. Hospitals shall he paid their ward cost 11 up to but not in excess of $11.00 per day for acute care 
12 and ward costs up to but not in excess of $7.00 per day for 
13 convalescent hospital and convalescent home care: Provided, 
14 That no hospital shall be paid more per patient day than is 
15 charged private patients for ward care: And provided 
16 further, That no hospital shall be paid more per patient 
17 day than is charged for the ward care of patients whose care 
18 is paid for out of county funds. Cost as herein used shall 
19 be determined by the commission in accordance with official 
20 bulletin 210—hospital accounting and statistics of the 
21 American hospital association. Professional fees shall not 
22 exceed $90.00 for a major operation, and in no case shall 
23 surgical and/or medical fees exceed $200.00 to any 1 doctor 
24 for any 1 patient in a 12 month period. Said superintendent 
25 and physician shall make and file with the commission affi- 
26 davits containing itemized statements of such services 
27 rendered. No compensation shall be charged or allowed to 
28 the admitting physician of any hospital; or to any physician, 
29 surgeon or nurse who shall attend or treat any such child at 
30 the hospital of the university of the state of Michigan, 
31 other than the salary or compensation paid to such person by 
32 that hospital: Provided, however, That said university hos- 
33 pital may charge for the service of its resident staff if 
34 such child has medical or surgical insurance coverage, said 
35 charge to be against the medical service or insurance com- 
36 pany providing that service. Any physician or surgeon except 
37 residents treating any such child at any hospital other than 
38 the hospital of the university of Michigan shall bill the 
39 commission for comoensation as fixed by the commission and be 
40 paid by a separate warrant drawn to his order and'forwarded 
41 to him at his professional address. This affidavit and 
42 statement shall in all instances be furnished not later than 
43 60 days after the release or discharge of a child from the 
44 hospital. The commission shall fix schedules of compensation 
to be paid to any hospital, physician or surgeon for the 
46 clinical examination, treatment and out-patient care of a 
47 crippled child. The schedules of fees and rates herein pro- 
48 vided for shall be established and published by the commission 
49 at such time as the commission may deem necessary. 
Hospital, 
Physicians, 
Conveyance 
1 Sec. 31. Upon filing the affidavit with the auditor general, 
2 it shall be the duty of said auditor general to audit the 
3 same according to the rates fixed by the commission and the 
4 auditor general and forthwith to draw an order on the trea- 
5 surer of the state of Michigan for the amount of such expendi- 
6 tures and forward the same to the treasurer of such hospital 
7 or to the physician. All expenses incurred in conveying 
8 crippled children to and from any such hospital shall, when 
9 approved by the Judge of probate ordering such services, and 10 when fully itemized he audited hy the auditor general and 
11 paid out of the general fund of the state* Provided, That 
12 the expense of sending such children home may he paid hy 
13 the hospital, and when fully itemized as traveling expense, 
14 charged in the regular hill for maintenance with the ap- 
15 proval of the commission, Th* co ,en ation as fixed hy the 
16 commission and the auditor general and approved hy them 
17 shall he paid to the approved physician or surgeon perform- 
18 ing services hereunder, hy a separate warrant drawn to his 
19 order, except at the hospital of the university of Michigan, 
20 The warrant of the auditor general shall he made payable to 
21 the particular hospital or physician rendering services here- 
22 under and delivered to it or him in payment of such services. 
Payments by 
Parents, 
Husbands, 
Guardians 
1 Sec. 32. Payments by parents, husbands or guardians. Such 
2 portion of the charges for the care and treatment of the 
3 children whose parents, husbands or guardians are of suffici- 
4 ent ability to pay any part of the same, or who have persons 
5 or kindred bound by law to maintain them, shall be paid to 
6 the state treasurer by such persons or such kindred in such 
7 amount, and at a rate to be determined by agreement with the 
8 probate Judge and the commission. Payment of such costs by 
9 such husband, parents or guardians shall be made to the 
10 treasurer of the county from which the child was admitted in 
11 accordance with the agreement. Said treasurer shall forward 
12 to the commission on the 15th of each month all payments re- 
13 ceived, and the commission shall duly credit the account, 
14 forward the moneys received to the treasurer of the state, 
15 who shall credit these payments to the fund for the cost of 
16 the care of crippled children under this act. The com- 
17 mission shall furnish all necessary blank forms for such 
18 agreement and payment. 
Hospital 
Bedside 
Education 
1 Sec. 33* The hospital authorities conducting educational 
2 programs approved by the superintendent of public instruction 
3 shall include in their budgets a sufficient fund to provide 
4 the instructional program. To reimburse the hospital for 
5 such expenditures as are approved, the state treasurer is 
6 hereby authorized to pay to the treasurer of the proper hos- 
7 pital, out of the general fund of the state, on or before 
8 the following December fifteenth of each year, upon the 
9 warrant of the auditor general, the actual expense incurred 
10 for reimbursable items for such educational programs which 
11 shall have been conducted in accordance with the regulations 
12 of the superintendent of public instruction: Provided, That 
13 no hospital may be reimbursed under this act for which finan- 
14 cial aid is paid under any other state or federal act: 
15 Provided further, That should the legislative appropriation 
16 for this purpose be less than the approved claims, the super- 
17 intendent of public instruction shall make an equal percentage 
18 cut in reimbursement to each hospital. Cost of 
Clinic 
Conveyance 
1 Sec. 34. Expense, orthopedic centers. The accounting of 
2 the costs incurred under commitments pursuant to section 24 
3 and the payment thereof from the general fund through the 
4 office of the auditor general, including conveyance costs 
5 as provided by law contracted for by the commission, shall 
6 be made in the same manner as in the case of commitments to 
7 hospitals under this act. 
Cost of 
Custodial Case, 
Recharge to 
County 
Transportation 
1 Sec. 35* Costs in custodial cases. Payments for necessary 
2 transportation and for custodial care shall be made in the 
3 same manner, and subject to the same limitations, as for 
4 other crippled children committed under this act to hos- 
5 pitals by the probate court: Provided, That 50 per cent of 
6 the costs of care in each case shall be recharged by the 
7 state to the county of which the custodial crippled child 
8 is a legal resident, upon the presentation of bills for such 
9 care approved by the commission. 
Payment by 
State Not 
Pauper Aid 
1 Sec, Payment by state not pauper aid. Such charges as 
2 are paid by the state shall not be deemed to have been paid 
3 as state or pauper aid, and no person shall be deemed a 
4 pauper in consequence of his inability to pay for the care, 
5 treatment and education of a child in said hospital or in an 
6 approved hospital school. 
Appropriations, 
Allocation 
of Funds, 
Revision of 
Allocation 
1 Sec, 37* Appropriations. The cost of carrying out the pro- 
2 visions of this act shall he paid from money appropriated 
3 for that purpose hy the legislature. Appropriations under 
4 this act made for the uses of the commission and to reimburse 
5 the general fund for expenditures hereunder shall he separate 
6 and apart from the appropriations under any other act. The 
7 appropriations for the crippled children commission shall he 
8 allotted in accordance with a schedule to he submitted hy the 
9 commission and recommended for approval hy the state budget 
10 director to the state administrative hoard on or before the 
11 beginning of each fiscal yep.r. Said schedule shall he based 
12 upon the equitable allocation to counties of the appropriations 
13 provided herein for the treatment of crippled children, which 
14 allocations shall he based solely upon the resources and needs 
15 of the respective counties, any other provision to the contra- 
16 ry notwithstanding. Nothing in this section shall prevent a 
1? revision of such schedule during the fiscal year when necessary 
18 to meet emergency conditions. It is the purpose of this 
19 section to so limit the liability of the state that the state 
20 will not he required to spend funds beyond the amount of each 
21 such appropriation. This section shall be so construed as to 
22 effect this purpose, and it shall he absolutely binding upon 
23 every official or body concerned in the administration of the 
24 aforesaid appropriations. In administering the budget the 
25 commission shall have the power to surcharge the county for 26 excessive hospitalization of any case, and in its discretion 
2? shall return to the probate Judge or Judges of the county 
28 responsible therefor, bills for such excessive hospitalization, 
29 who shall order such sums paid from the general funds of the 
30 county: Provided however, That no county shall be liable 
31 for excessive hospitalization in such events as epidemics or 
32 emergencies reouiring use of the provisions of this act. 
1 Sec. 38. Disposition of income. All sums paid to the com- 
2 mission for the training of crippled children shall be paid 
3 promptly by the commission into the state treasury to be 
4 credited to the hospital bedside education fund to be dis- 
5 bursed for the benefit of pupils in approved hospital schools, 
6 All money, securities or like personal property received by 
7 said commission by gift, devise, or bequest, shall be paid 
8 promptly into the state treasury to be credited to the fund 
9 of the state of Michigan, designated by the donor or the cora- 
10 mission. The income from all notes, stocks, bonds or other 
11 securities shall likewise be paid promptly into the state 
12 treasury to be also credited to the fund so designated and to 
13 be likewise disbursed. The treasurer of the commission shall 
14 give a bond to the state of Michigan in such amount as shall 
15 be by the governor from time to time prescribed. 
Disposition 
of Income to 
State 
Treasurer 
Federal Funds 1 Sec. 39. Funds received from federal government. The state 
2 treasurer shall (l) receive all funds granted to the state by 
3 the federal government under the provisions of section 6 of 
4 this act; (2) act as custodian of such funds; (3) keep them 
5 in a special fund to be known as “the fund for services for 
6 crippled children”, or other designation; (4) and disburse 
7 the funds upon certification by the treasurer of the com- 
8 mission. 
TITLE XI. MISCELLANEOUS* 
Act Not 
Compulsory 
1 Sec. 40. Provisions of act not compulsory. No official or 
2 agent, or representative, in carrying out the provisions of 
3 this act, shall enter any home or take charge of any child over 
4 the objection of the parents, or either of them or the person 
5 standing in loco parentis or having other custody of such child, 
6 and nothing in this act shall be construed as limiting the power 
7 of a parent or guardian or person standing in loco parentis to 
8 determine what treatment or correction shall be provided for a 
9 child or the agency or agencies to be employed for such purpose. 
Eepeal 1 Sec, 41, Act number two hundred thirty-six of the public acts 
2 of nineteen hundred twenty-seven, as amended, being sections 
3 twelve thousand eight hundred ninety-six to twelve thousand nine 
4 hundred nine, Inclusive, of the compiled laws of nineteen hundred 
5 twenty-nine, and all other acts and parts of acts inconsistent 
6 with the provisions of this act are hereby repealed. Severing 
Clause 
1 Sec. Should any provision or section of this act "be held 
2 to be invalid for any reason, such holding shall not be con- 
3 strued as affecting the validity of any remaining portion of 
k such section or the act*, it being the legislative intent that 
5 this act shall stand, notwithstanding the invalidity of any 
6 such provision or section. 
Title of 
Act 
1 Sec. This act may be known and cited as the "Crippled 
2 Children's Act". 
False 
Statements 
1 Sec. hh. Any person found guilty of wilfully making a false 
2 statement or of wilfully giving false information for the pur- 
3 pose of securing aid under this act, shall be punished by a 
h find of not more than five hundred dollars or imprisonment in 
5 the county Jail for not more than ninety days, and any 
6 official of any hospital or any physician who shall bill the 
7 state for the care of a patient in accordance with the fee 
8 schedules established under this act, and also attempt to 
9 force any parent, relative or guardian of such patient to pay 
10 an additional sun for such care, and who shall be found guilty 
11 thereof, shall be punished in the same manner. 
This act is ordered to take immediate effect. 
Approved July 8, 1937. AFFLICTED CHILDREN5S ACT 
No. 283 of the Public Acts of 1939 
As Amended By 
Act 225 of the Public Acts of and 
Act 218 of the Public Acts of and 
Act 228 of the Public Acts of and 
Act 232 of the Public Acts of 19if7 
Bill 
Powers 
Duties 
1 AN ACT to declare the policy of the state of Michigan with 
2 reference to afflicted children; to provide for the medical and 
3 surgical treatment of children who are afflicted with a curable 
if malady or are pregnant, and whose parents or guardians are 
5 unable to provide proper treatment; to prescribe the function 
6 of the probate court and the Michigan crippled children com- 
7 mission in such cases; to provide for, and regulate the making 
8 of appropriations to carry out the purposes of this act; and to 
9 repeal all acts and parts of acts inconsistent with the pro- 
10 visions of this act. 
THE PEOPLE OF THE STATE OF MICHIGAN ENACT 
Policy 
of State 
1 Sec. 1, Policy of state. It is hereby declared to be the 
2 public policy of the state to provide medical and surgical 
3 treatment for afflicted children as hereafter defined. The 
k authority for the administration of this act is hereby vested 
5 in the Michigan crippled children commission, hereinafter known 
6 as the commission. 
Definition 1 Sec, 2. Definition, For the purposes of this act, an afflicted 
2 child is hereby defined to he any child under 21 years of age, 
3 married or unmarried, whose parents or guardians have resided in 
if this state for 1 year, who is afflicted with a physical defect 
5 or illness which can he remedied, including acute fracture, or 
6 who is pregnant. 
Specific 
Powers and 
Duties 
Approval of 
Hospitals & 
Convalescent 
Homes, 
Pees and 
Bates, 
Services of 
Private 
Agencies 
1 Sec. 3. Commission; specific powers and duties. The commission 
2 shall have power here conferred (l) to administer this act, as 
3 hereinafter provided and to this end may employ a director who 
h shall he a regularly qualified and licensed physician of the 
5 state of Michigan, a secretary and any other personnel necessary 
6 for the carrying out of the provisions of this act; (2) to adopt, 
7 alter, amend and rescind rules and regulations to carry out its 
8 provisions; (3) to administer a program of services for the 
9 afflicted child as defined in section 2 of this act; (4) to make 
10 and enforce rules and regulations concerning employees serving 
11 the commission, the approval of hospitals and of treatment and 
12 the handling of cases; the approval of convalescent homes, 
13 hoarding homes, caring for afflicted children as herein defined; 
lif (5) the fixing of fees and Institutional rates and the approval 
15 of hills. The said commission may in its discretion accept from 
16 private agencies, groups, associations, or individuals, funds or 17 subscriptions to provide through its appropriate agency or 
18 instrumentality in developing, extending, and improving services 
19 for afflicted children and the administration thereof. 
Books and 
Accounts; 
Biennial 
Report 
1 Sec. 4. Books and accounts; report. The commission shall keep 
2 such books and accounts as it deems necessary to adequately 
3 record and control its transactions and furnish data necessary 
4 for policy determination. The commission shall make a biennial 
5 report to the governor and the state administrative board show- 
6 ing the amount of money received and expended and a detailed 
7 statement of its activities for said period, and a copy of such 
8 report shall be furnished each member of the legislature at its 
9 first session following the filing of such report with the 
10 governor. 
Application, 
Investigation, 
Duty Judge of 
Probate, 
Order of 
Conveyance, 
Approved 
Hospital, 
Effective 
Date of 
Order, 
Who may 
make 
Application, 
1 Sec. 5- Application for treatment, investigation and report; 
2 duty of probate Judge; order sending child to hospital. Whenever 
3 there shall be found in any county an afflicted child as herein 
4 defined, whose condition can be remedied and whose parents or 
5 guardians are unable to provide proper care and treatment in 
6 whole or in part, application for treatment shall be made to the 
7 representative of the commission or probate Judge of that county 
8 who shall cause to be made an investigation into the physical 
9 and mental condition of such child and the financial condition 
10 of the family and the written certificate of the physician or 
11 surgeon with reference to such child. It shall be the duty of 
12 the probate Judge to approve or reject such application, and if 
13 approved, he may provide for such care and treatment In the 
14 child’s home, if possible, at local expense. If such treatment 
15 cannot be provided, it shall be his duty to enter an order direct- 
16 ing that such child be conveyed by one who is approved by the 
17 commission to a hospital in the state selected by the attending 
18 physician, and which has been approved and designated by the 
19 commission for the care of afflicted children as herein defined. 
20 Application for an order admitting an afflicted child to an 
21 approved hospital as a state charge must be made not later than 
22 10 days from date of admission. Such order shall carry the 
23 date of application, and the effective date of the order which 
24 in no case can be earlier than 10 days prior to date of the 
25 application. Application may be made by the father, mother, 
26 guardian, next of kin, husband, or wife, any peace officer, 
27 custodian, health officer or publicly employed physician or 
28 surgeon, and superintendent of the poor or officer of the county 
29 or city welfare commission, or anyone else whom the probate Judge 
30 in his discretion approves. 
Responsibility 
of Commission, 
Eligibility 
of case as 
State case 
1 Sec, 6, Responsibility of commission. Upon receipt of such 
2 order, it shall be the duty of the commission promptly to deter- 
3 mine the eligibility of the case as a state charge. Upon the 
4 issuance of such order by the probate Judge the commission shall Transfer to 
Crippled 
Act 
5 become charged with the responsibility for the proper handling 
6 of the case. The commission may transfer such child to some 
7 other hospital for treatment better adapted to its needs, or if 
8 the condition of the child becomes such that it classifies as 
9 a crippled child, the commission shall transfer the child to a 
10 hospital approved for the care of crippled children under the 
XI crippled children's act, the intent of this act being that it 
12 shall be the duty of the commission to secure for each child 
13 such care and treatment as the particular necessities of the 
14 case, in the opinion of the commission, may require. 
Designation 
of Hospitals, 
Neuro- 
Psychiatric 
Institute, 
Sterilization 
1 Sec. 7. Designation of hospitals. Any hospital which fulfills 
2 the requirements as set forth in the rules and regulations 
3 of the Michigan crippled children commission in force pursuant 
4 to the provisions of this act may be approved for the care of 
5 the afflicted child as herein defined: Provided, however, That 
6 the state neuro-psychiatric institute shall not receive compen- 
7 sation for patients admitted under this act: And provided 
8 further. That approval of a hospital under this act shall not 
9 include performance of operations for sterilization of mental 
10 defectives as provided by Act 281 of the Public Acts of 1929. 
ReportIng 
Admission, 
Discharge, 
Request for 
Extension 
1 Sec, 8. Hospital reports. Approved hospitals receiving patients 
2 under the provisions of this act shall promptly report to the 
3 commission on blanks to h© provided by the commission for that 
4 purpose, the date and hour of admission to and discharge from 
5 such hospital, the name of the physician and/or the surgeon who 
6 is in attendance, and such other information as the commission 
7 may require. Notification of the admittance of an afflicted 
8 child shall be made to the commission by the superintendent of 
9 the hospital within 10 days. A discharge report, giving the 
10 date of the discharge, and such other information as the com- 
il mission may require, must be filed within 1 week from date of 
12 discharge. No bill for the care of a child shall be approved 
13 unless an entrance and discharge report has been filed with the 
14 commission. Bach approved hospital shall report progress to the 
15 commission on the treatment of all afflicted children remaining 
16 in such hospital in excess of 15 days in the manner required by 
17 the commission! Provided, That when the progress report sub- 
18 mitted by the hospital does not indicate the need for further 
19 acute care, the convalescent rates established by the commission 
20 shall prevail. 
1 Sec. 9. Hospital care and treatment. It shall he the duty of 
2 the superintendent of said hospital, upon receiving such child, 
3 to provide such child with proper hospital service, either in 
4 the in-patient or out-patient service of the hospital. The 
5 staff of the hospital shall he responsible for the prompt and 
6 proper medical or surgical treatment of the child except where 
7 such child is under the care of a private physician or surgeon. 
Hospital 
Care and 
Treatment 
Hospital 
Supt. and 
Staff Type of 
Acceptable 
Cases, 
Tuberculosis, 
Communicable, 
Incurable 
Mental, 
Method of 
Transfer 
8 No child shall he sent to or received into said hospital unless 
9 there is a reasonable chance for him to he benefited hy the 
10 proposed medical or surgical treatment, and as an aid to the 
11 diagnosis, prognosis and treatment of such case, a complete 
12 history of each case shall he furnished to the hospital and 
13 the commission hy the examining physician upon request. Any 
lh child who shall he diagnosed after admission as a crippled 
15 child as defined hy the crippled children's act, or as suffer- 
16 ing at admission only from acute pulmonary tuberculosis, or 
17 only from any other communicable disease, or only from an incur- 
18 able mental illness or defect shall he retained in the hospital 
19 under this act only for such period as may he necessary to dis- 
20 charge him to his home or to the Jurisdiction of some other 
21 state act for the care of afflicted children. Appropriate rules 
22 and regulations may he adopted to- effectuate the transfer of 
23 patients pursuant to this section. 
Boarding 
Home s, 
Convalescent 
and Out- 
Patient 
Service 
1 Sec. 10, Boarding homes; convalescent and out-patient service, 
2 An afflicted child who has been assigned to an approved hospital 
3 whose treatment can he rendered through the out-patient depart- 
b ment of that hospital, may he assigned hy the commission to a 
5 hoarding or convalescent home approved hy the state department 
6 of public welfare, and supervised hy that department, or any 
7 other agency approved hy the commission, the cost of such con- 
8 valescent or hoarding care and treatment to he hilled to the 
9 state as provided for in the rules and regulations and in 
10 accordance with the rates and fees set hy the commission. 
Expenses of 
Commission; 
Cost of In- 
vestigation 
and Medical 
Treatment 
Appropri- 
ations 
1 Sec. 11. Expenses of commission. Expenses of the commission in 
2 carrying out the provisions of this act shall be paid pursuant 
3 to appropriations made by the legislature from time to time out 
k of the general fund of the state. Appropriations for the pur- 
5 poses of this act made to pay the cost of investigations and 
6 treatment and for the use of the commission shall be made to the 
7 commission and shall be separate and apart from appropriations 
8 to make effective the provisions of any other act. 
Cost of In- 
vestigation 
and Report; 
Sates set 
hy Com- 
mission; 
Itemized 
Statement 
1 Sec, 12. Cost of investigation and report. The cost of the 
2 economic and medical Investigation hy this act shall he paid hy 
3 the state according to such schedule of fees and expenses as 
shall he adopted hy the commission; Provided, That no person 
5 in the ennloy of the state or any county shall he allowed any 
6 compensation or traveling expense other than that provided hy 
7 law. All claims for compensation shall he itemized for each 
8 child and rendered monthly under oath to the commission. When 
9 such claims are found to he correct and approved, they shall he 
10 paid out of the general fund of the state, appropriated for that 
11 purpose. Hospital 
Accounting, 
Examination 
of Records, 
Average per 
Diem, 
Maximum 
Physician 
Pees, 
Statement of 
Services 
Rendered, 
Payment of 
Physicians, 
Authority 
for Schedule 
of Pees, 
Out-patient 
Services, 
Publication 
Pee Schedules 
1 Sec. 13. Hospital accounting. The superintendent of the 
2 approved hospital shall keep a correct account of all hospital, 
3 boarding or convalescent home services Including all ordinary 
h care and such other necessities furnished to said child in 
5 accordance with the hospital, convalescent or boarding homes1 
6 rates as fixed by the commission. The hospitals1 financial 
7 records shall be open to audit by any person designated by the 
8 commission. The commission shall pay for the day of admission 
9 but not for the day of discharge. Hospitals shall be paid their 
10 ward cost up to but not in excess of $11.00 per day for acute 
11 care and ward costs up to but not in excess of $7*00 per day 
12 for convalescent hospital and convalescent home care: Provided, 
13 That no hospital shall be paid more per patient day than is 
lh charged private patients for ward care: And provided further, 
15 That no hospital shall be paid more per patient day than is 
16 charged for the ward care of patients whose care is paid for out 
17 of county funds. Cost as herein used shall be determined by the 
18 commission in accordance with official bulletin 210—hospital 
19 accounting and statistics of the American hospital association. 
20 Professional fees shall not exceed $90,00 for a major operation, 
21 and in no case shall surgical and/or medical fees.exceed $200.00 
22 to any 1 doctor for any 1 patient in a 12 month period. Said 
23 superintendent and physician shall make and file with the com- 
2k mission affidavits containing itemized statements of such ser- 
25 vices rendered. No compensation shall be charged or allowed to 
26 the admitting physician of any hospital; or to any physician, 
27 surgeon or nurse who shall attend or treat any such child at 
28 the hospital of the university of the state of Michigan, other 
29 than the salary or compensation paid to such person by that 
30 hospitals Provided, however, That said university hospital may 
31 charge for the service of its resident staff if such child has 
32 medical or surgical insurance coverage, said charge to be 
33 against the medical service or Insurance company providing that 
34 service. Any physician or surgeon except residents treating any 
35 such child at any hospital other than the hospital of the univer- 
36 slty of Michigan shall bill the commission for compensation ae 
37 fixed by the commission, and paid by a separate warrant drawn 
38 to his order. The commission shall fix schedules of compensation 
39 to be paid to any hospital, physician or surgeon for the clinical 
UC examination, treatment and out-patient care of an afflicted child 
hi The schedules of fees and rates herein provided for shall be 
h2 established and published by the commission at such time as the 
h3 commission may deem necessary. 
Audit and 
Payment of 
Hospital 
Expenses by 
the 
Commission 
1 Sec. lh, Upon filing the affidavit with the commission, and 
2 following the approval by the commission, it shall "be the duty 
3 of the auditor general to audit the same according to the rates 
h fixed "by the commission and to draw an order on the treasurer 
5 of the state of Michigan for the amount of such costs and for- 
6 ward same to the approved hospitals. The compensation as fixed 
7 and approved by the commission shall be paid to the physician Auditor 
General, 
To Physicians 
Surgeons 
and 
Hospitals; 
60 Day Limit 
on 
Hospital 
Billings 
8 or surgeon performing the services hereunder by a separate 
9 warrant drawn to his order and forwarded to him at his pro- 
10 fessional address, except at the hospital of the university 
11 of the state of Michigan, The warrant of the auditor 
12 general for hospital services shall be made payable to the 
13 particular hospital rendering services hereunder and delivered 
lA to it in payment of such services: Provided, That no crippled 
15 child as defined by the crippled children's act, or any other 
16 child exempted by this act, shall be entitled to care to be 
17 paid for by the state under this act. Payment shall be 
18 refused on any billing rendered 60 days or more after the 
19 discharge of the patient from the hospital. 
Communicable 
Diseases 
1 Sec, 1$. Communicable diseases. All costs of care for com- 
2 municable diseases of afflicted children while in approved 
3 hospitals under this act shall be paid by the state and re- 
h charged to the county from which the child was committed as 
5 provided in the laws dealing with the treatment of communicable 
6 diseases. 
Transportation 
Costs 
Afflicted 
Children 
1 Sec, 16, Transportation costa. The cost of transportation of 
2 such child to and from such hospital shall be paid by the county 
3 in which such child resides or from which said child was ad- 
4 mitted, and it shall be the duty of the county treasurer to 
5 pay such transportation expense out of the general fund of the 
6 county upon receipt of the proper certificate of approval 
7 thereof from the probate court or the commission. 
Repayments, 
Determination 
Agreement to 
Repay, 
Collection 
and 
Remittance, 
Reallocation 
of 
Collections, 
Certification 
of 
Categorical 
Cases 
1 Sec. I?. Payments by husband, parents or guardians. Ho child 
2 shall be committed to any hospital for medical or surgical 
3 treatment under this act until the husband, parents or guardians 
4 of such child have entered into an agreement with the state of 
5 Michigan that they will repay, if they have been determined by 
6 the commission and the probate judge to be financially able to 
7 do so, the state of Michigan, for the actual cost of such 
8 medical or surgical treatment on such terms as shall meet the 
9 approval of the commission and the probate judge. Payment of 
10 such costs by such husband, parents or guardians shall be made 
11 to the treasurer of the county from which the child was admitted, 
12 in accordance with the agreement. Said treasurer shall forward 
13 to the commission on the fifteenth of each month all payments 
received, and the commission shall duly credit the account, 
15 forward the moneys received to the treasurer of the state, who 
16 shall credit these payments to the fund for the cost of the 
17 care of afflicted children under this act. The probate Judge 
18 may, where the child is found by him to be emancipated, accept 
19 the signature of such child in lieu and stead of the parent, 
20 guardian or husband, and in such cases as the probate judge finds 
21 the child to be neglected, abandoned, or deserted, or his 
22 parents a subject of public relief or social security so cer- 
23 tify to the commission in the order of admission. Payment by 
State not 
Pauper 
Aid 
1 Sec, 18, Payment by the state not pauper aid. Such charges as 
2 are paid by the state shall not be deemed to have been paid as 
3 state or pauper aid, and no person shall be deemed a pauper in 
b consequence of his Inability to pay for the care and treatment 
5 of a child in an approved hospital under this act. 
Appropriation 
1 Sec, 19. Appropriation, The cost of carrying out the pro- 
2 visions of this act shall be paid from money appropriated to 
3 the commission for that purpose by the legislature. Approprl- 
4 ations under this act made for the use of the commission and to 
5 reimburse the general fund for expenditures hereunder shall be 
6 separate and apart from appropriations under any other act. 
Limitation 
of State 
Liability, 
Allocation 
of Funds, 
Revision of 
Allocation 
1 Sec, 19a, Limitation of state liability, 
2 1, The appropriations mad© for any fiscal year for medical 
3 treatment of afflicted children or for any other service 
4 furnished under this act, shall be allotted in accordance with 
5 a schedule to be submitted by the commission and recommended for 
6 approval by the state budget director to the state adminis- 
7 trative board on or before the beginning of each fiscal year. 
8 Said schedule shall be based upon the equitable allocation to 
9 counties of the appropriation provided for the treatment of 
10 afflicted children which allocation shall be based solely upon 
11 the resources and needs of the respective counties as determined 
12 by commission. Nothing in this section shall prevent a revision 
13 of such schedule during the fiscal year when necessary to meet 
14 emergency conditions. It is the purpose of this section to so 
15 limit the liability of the state that the state will not be 
16 required to spend funds beyond the amount of each appropriation, 
17 This section shall be so construed as to effect this purpose, 
18 and it shall be absolutely binding upon each official or body 
19 concerned in the administration of the aforesaid appropriations. 
Recharge to 
Counties, 
Surcharge 
to 
Counties 
20 2. In the administration of the afflicted children’s act the 
21 crippled children commission shall have the power to charge back 
22 to the county and to return to the probate judge or judges of 
23 each county bills for excessive or unnecessary hospitalization 
24 due to neglect of county authorities as in the discretion of the 
25 commission shall seem just and shall have authority to surcharge 
26 any county which has in the opinion of the commission unnecessarily 
27 used an amount in excess of its fair allocation of funds. 
Federal 
Funds 
1 Sec. 20. Funds received from federal government and/or other 
2 sources. The state treasurer shall (l) receive all funds granted 
3 to the state by the federal government and/or other sources for 
4 expenditures under the provisions of this act; (2) act as 
5 custodian of such funds; (3) keep them in a separate account; 
6 (4) and disburse the funds upon certification by the treasurer 
7 of the commission. Provisions of 
Act not 
Compulsory 
1 Sec, 21. Provisions of act not compulsory, No official or 
2 agent, or representative, in carrying out the provisions of 
3 this act, shall enter any home or take charge of any child 
k over the objection of the parents, or either of them or the 
5 person standing in loco parentis or having other custody of 
6 such child, and nothing in this act shall be construed as 
7 limiting the power of a parent or guardian or person standing 
8 in loco parentis to determine what treatment or correction 
9 shall be provided for a child or the agency or agencies to bo 
10 employed for such purpose except by judicial order. 
Penalty 1 Sec. 22. Any parent or guardian, official of hospital, physician, 
2 employee of county or state or any other person found guilty of 
3 wilfully making a false statement or of wilfully giving, accept- 
h ing, or concealing false information for the purpose of securing 
5 aid under this act shall be guilty of a misdemeanor and shall be 
6 punished by a fine of not more than $500,00 or imprisonment in 
7 the county Jail for not more than 90 days. Any official of any 
8 hospital or any physician who shall bill the state under the pro- 
9 visions of this act for the care of a patient and also attempt 
10 to force any parent, relative, or guardian of such patient or 
11 the patient to pay an additional sum for such care, and who 
12 shall be found guilty thereof, shall be punished in the same 
13 manner, 
1 Sec, 23. Act number of the public acts of 1913» as amended, 
2 being sections 12889 to 12895. Inclusive, of the compiled laws 
3 of 1929. is hereby repealed. All other acts and parts of acts 
k Inconsistent with the provisions of this act are hereby repealed, 
1 Sec, 2h. Should any provision or section of this act be held 
2 to be invalid for any reason, such holding shall not be construed 
3 as affecting the validity of any remaining portion of such 
4 section or this act, it being the legislative Intent that this 
5 act shall stand, notwithstanding the Invalidity of any such pro- 
6 vision or section. 
1 Sec, 25. This act may be known and cited as the "afflicted 
2 children’s act". 
This act is ordered to take immediate effect. 
Approved June l6, 1939. MICHIGAN CRIPPLED CHILDREN COMMISSION 
Hospitals and Convalescent Homes 
Approved for Care of Afflicted and Crippled Children 
January 1, I9HU 
ALGER COUNTY 
♦Munising Hospital, Munising 
ALLEGAN COUNTY 
♦Allegan County Health Center, Allegan 
♦William Crispe Hospital, Plainwell 
AliPENA COUNTY 
♦Alpena General Hospital, Alpena 
BARRY COUNTY 
♦Pennock Hospital, Hastings 
BAY COUNTY 
♦Bay City General Hospital, Bay City 
♦Bay City Samaritan Hospital, Bay City 
♦Mercy Hospital, Bay City 
BERRIEN COUNTY 
♦Mercy Hospital, Benton Harbor 
♦Pawating Hospital, Niles 
♦St. Joseph Sanitarium, St. Joseph 
BRANCH COUNTY 
♦Branch County Health Center, Coldwater 
CALHOUN COUNTY 
♦Community Hospital, Battle Creek 
♦James W. Sheldon Memorial Hospital, Alhion 
♦♦Leila Y. Post Montgomery Hospital, Battle Creek 
CHARLEVOIX COUNTY 
♦Charlevoix Hospital, Charlevoix 
CHEBOYGAN COUNTY 
♦Community Memorial Hospital, Cheboygan 
CHIPPEWA COUNTY 
♦War Memorial Hospital, Sault Ste. Marie 
CLARE COUNTY 
♦Clare Hospital and Clinic, Clare 
CLINTON COUNTY 
♦Clinton Memorial Hospital, St. Johns 
CRAWFORD COUNTY 
♦Mercy Hospital, Grayling DELTA COUNTY 
♦St. Francis Hospital, Escanaba 
DICKINSON COUNTY 
♦Iron Mountain General Hospital, Iron Mountain 
♦Penn Iron Mining Company Hospital, Norway 
EATON COUNTY 
♦Hayes-Green-Beach County Memorial Hospital, Charlotte 
EMMET COUNTY 
♦Little Traverse Hospital, Petoskey 
’’Lockwood Hospital, Petoskey 
GENESEE COUNTY 
♦Goodrich General Hospital, Goodrich 
♦♦Hurley Hospital, Flint 
♦St. Joseph Hospital, Flint 
GOGEBIC COUNTY 
♦Grand View Hospital, Ironvood 
♦Wakefield Hospital, Wakefield 
GRAND TRAVERSE COUNTY 
♦Central Michigan Children's Clinic, Traverse City 
♦♦James Decker Munson Hospital, Traverse City 
GRATIOT COUNTY 
♦Carney-Wilcox-Miller Hospital, Alma 
♦H.B. Smith Memorial Hospital, Alma 
HILLSDALE COUNTY 
♦Hillsdale Community Health Center, Hillsdale 
HOUGHTON COUNTY 
♦Calumet Public Hospital, Laurium 
♦St. Joseph Hospital, Hancock 
HURON COUNTY 
♦Harbor Beach Hospital, Harbor Beach 
♦Hubbard Memorial Hospital, Bad Axe 
INGHAM COUNTY 
♦Edward W. Sparrow Hospital, Lansing 
♦St. Lawrence Hospital, Lansing 
IRON COUNTY 
♦Crystal Falls Community Hospital, Crystal Falls 
♦General Hospital Company of Iron River, Stambaugh 
ISABELLA COUNTY 
♦Central Michigan Community Hospital, Mt. Pleasant 
JACKSON COUNTY 
♦Florence Grittenton Hospital, Jackson 
♦Mercy Hospital, Jackson 
♦W. A. Foote Memorial Hosnital, Jackson KALAMAZOO COUNTY 
♦Borgess Hospital, Kalamazoo 
•Bronson Methodist Hospital, Kalamazoo 
OTP COUNTY 
♦♦Blodgett Memorial Hospital, Grand Rapids 
♦♦Butterworth Hospital, Grand Rapids 
♦Evangeline Horae and Hospital. Grand Rapids 
♦♦Mary Free Bed Convalescent Home, Grand Rapids 
♦♦St. Mary's Hospital, Grand Rapids 
LAPEER COUNTY 
♦Lapeer City Hospital, Lapeer 
LENAWEE COUNTY 
♦Emma L. Sixty Hospital, Adrian 
LIVINGSTON COUNTY 
♦McPherson Memorial Hospital, Howell 
LUCE COUNTY 
♦Newberry Clinic Hospital, Newberry 
MACOMB COUNTY 
♦♦St. Joseph Sanitarium and Hospital, Mt. Clemens 
MANISTEE COUNTY 
♦Mercy Hospital and Sanitarium, Manistee 
MARQUETTE COUNTY 
♦Ishperaing Hospital, Ishpeming 
♦Northern Michigan Children's Clinic, Marquette 
♦♦St. Luke's Hospital, Marquette 
MASON COUNTY 
♦Paulina Stearns Hospital, Ludington 
MECOSTA COUNTY 
♦Community Hospital, Big Rapids 
MENOMINEE COUNTY 
♦St. Joseph's Hospital, Menominee 
MONROE COUNTY 
♦Mercy Hospital, Monroe 
MONTCALM COUNTY 
♦Edmore Hospital, Edraore 
♦Kelsey Hospital, Lakeview 
♦United Memorial Hospital, Greenville 
MUSKEGON COUNTY 
♦Hackley Hospital, Muskegon 
♦Mercy Hospital, Muskegon 
NEWAYGO COUNTY 
♦Gerber Memorial Hospital, Fremont OAKLAND COUNTY 
•"♦Pontiac General Hospital, Pontiac 
♦♦St. Joseph Mercy Hospital, Pontiac 
OCEANA COUNTY 
♦Oceana Hospital, Hart 
OGEMAW COUNTY 
♦Tolfree Memorial Hospital, West Branch 
ONTONAGON COUNTY 
♦Ontonagon Hospital, Ontonagon (Approved for emergency cases only) 
OSCEOLA COUNTY 
♦Reed City Hospital, Reed City 
OTTAWA COUNTY 
♦Grand Haven Municipal Hospital, Grand Haven 
♦Holland City Hospital, Holland 
♦Huzinga Memorial Hospital, Zeeland 
SAGINAW COUNTY 
♦♦Saginaw General Hospital, Saginaw 
♦St. Luke's Hospital, Saginaw 
♦♦St. Mary's Hospital, Saginaw 
ST. CLAIR COUNTY 
♦Port Huron Hospital, Port Huron 
♦St. Clair Community Hospital, St. Clair 
ST. JOSEPH COUNTY 
♦Sturgis Memorial Hospital, Sturgis 
♦Three Rivers Hospital, Three Rivers 
SCHOOLCRAFT COUNTY 
♦Shaw General Hospital, Manistique 
SHIAWASSEE COUNTY 
♦Memorial Hospital, Owosso 
TUSCOLA COUNTY 
♦Caro Community Hospital, Caro 
VAN BUREN COUNTY 
♦South Haven Hospital, South Haven 
WASHTENAW COUNTY 
♦♦St. Joseph Mercy Hospital, Ann Arbor 
♦♦University Hospital, Ann Arbor 
WAYNE COUNTY 
♦♦Children's Hospital, Detroit 
♦Delray General Hospital, Detroit 
♦♦♦Detroit Orthopedic Clinic and 
George H. Cummings Memorial Hospital School, Detroit 
♦East Side General Hospital, Detroit 
♦Edyth K. Thomas Memorial Hosnital, Detroit WAYNE COUNTY (Continued) 
♦Evangelical Deaconess Hospital, Detroit 
♦Florence Crittenton Hospital, Detroit 
♦♦Grace Hospital, Detroit 
♦♦Harper Hospital, Detroit 
♦♦Henry Ford Hospital, Detroit 
♦Herman Kiefer Hospital, Detroit (Approved for 
obstetrical cases only) 
♦Highland Park General Hospital, Highland Park 
♦McGregor Health Foundation, Detroit 
♦♦Mount Carmel Mercy Hospital, Detroit 
♦Parkside Hospital, Detroit 
♦♦Providence Hospital, Detroit 
♦St. Francis Hospital, Hamtramck 
♦♦St. Joseph Mercy Hospital, Detroit 
♦♦St. Mary's Hospital, Detroit 
♦Saratoga General Hospital, Detroit 
♦Shurley Bye, Ear, Nose & Throat Hospital, Detroit 
♦Trinity Hospital, Detroit 
♦William J. Seymour Hospital, Eloise 
♦♦Woman's Hospital, Detroit 
♦♦Wyandotte General Hospital, Wyandotte 
WEXFORD COUNTY 
♦Mercy Hospital, Cadillac 
♦NOTE; The Salvation Army Home and Hospital, 
130 W. Grand Blvd., Detroit 16, Michigan, 
Wayne County, was approved for care of 
pregnancy cases only on 1-11-UU. 
♦Approved for care of afflicted children only. 
♦♦Approved for care of both afflicted and crippled children 
♦♦♦Approved for care of crippled children only.