The Indian Health Service (IHS) is a health program within the Department of Health and Human Services. (Agency Overview n.d.) Provides federal health services to eligible American Indians and Alaska Natives at IHS facilities. (Agency Overview n.d.) Services provided by IHS include medical, dental and vision services, ancillary services, such as laboratory and pharmacy, specialty care which includes services provided by the doctor or specialist. (Agency Overview n.d.) Factors that influence the type of health care depend on community needs, level of funding, and medical necessity of treatment (Marx n.d.) American Indians and Alaska Natives may receive direct care at hospitals, health centers and can be managed at the federal or tribal level. (Marx n.d.) If a direct care facility is unable to provide services, the individual will be referred to a public or private provider. (Marx n.d.) IHS is located on or near Indian reservations and services are provided by Indian tribes, urban Indian organizations, or IHS. IHS is responsible for providing medical and public health services to members of federally recognized Indian tribes and Alaska Natives. (Agency Overview) In order for a tribe to be recognized, it must meet that state's specific criteria that also include land and rights that are accepted (Agency Overview). IHS has a mission to educate the people of India about physical, mental, social and spiritual health (Agency Overview). American Indians and Alaska Natives preside over their members and their lands (Indian Health Service Definition 2012). The United States continues to work with Indian tribes on an individual basis focusing on issues related to tribal governance and other rights (Definit...... middle of document ...... 24 Nov 13).National Indian Health Board (2009). THE REAUTHORIZATION OF THE INDIAN HEALTH CARE IMPROVEMENT ACT [ONLINE] Available at: www.nihb.org/docs/11182009/IHCIA%20Fact%20Sheet_Senate [Last accessed 25 Nov 13].Office of Tribal Self-Governance (OTSG). ) (n.d.). [ONLINE] Available at: www.ihs.gov/SelfGovernance/index.cfm?module=dsp_otsg_about [Last accessed 20 Nov 13].Ojibwa (2010 Indian Self-Determination Threatened ] Available at: www. nativeamericannetroots.net/diary/782 [Last accessed 23 Nov 13].The Synder Act (nd) [ONLINE] Available at: http://www.ihs.gov/chs/documents/SNYDER_ACT.pdf November 13].Trujillo, Michael H., MD, MPH, MS (2000 Testimony on the Indian Health Care Improvement Act [ONLINE] Available at: http://www.hhs.gov /asl/testify/t000308c.html [Last accessed November 23 13].