https://nl.ivisa.com/american-samoa-health-declaration-form
It is highly recommended to fill in the American Samoa Health Declaration Form at least 21 days prior to your departure. It doesn't matter if you travel by sea or air. Due to different CO Sindications regulations may differ depending on the country of origin. You must understand that no one will check your health on board nor can they demand you to do so when you land at their port of call. It is important that you declare your health.
In American Samoa there are several laws and regulation regarding health issues. Despite this, American Samoans have freedom of choice in regards to their health issues. A resident of American Samoa may freely choose the healthcare professional or any other healthcare provider that he or she would like to see. American Samoan institutions require that healthcare professionals, such as doctors or nurses, have specialized credentials. On receipt of the health declaration form the doctor or nurse will be accredited and certified by American Samoan institutions.
American Samoans must sign a health declaration form in order to be allowed to seek treatment in the USA. The health declaration form includes details about the applicant's medical history and physical condition. The applicant must also provide information about his or her citizenship, permanent resident status, and immigration status. The duration of time for which a person must be treated on board a domestic Caribbean hospital or an American Samoan hospital is dictated by the laws, regulations and rules of the American Samoan Health Administration or SAMOA.
This is usually done by filling out a HIPAA form. The HIPAA regulates privacy of personal medical information. It outlines how protected information can disposed of and establishes guidelines for security. In order to obtain an American Samoan passport, applicants need to sign and return to the embassy or Consular office a copy of the HIPAA health insurance card. This is important as all health care providers in American Samoa are required to register with SAMOA. This ensures that healthcare providers who treat American Samoans meet the international standards on health care and privacy issues. If one does not possess an American Samoa passport then one will still be eligible for healthcare services in American Samoa.
Before one receives healthcare services he or she must obtain a Health Insurance Card or a Health Declaration. A Health Insurance Card is a document that proves your identity and your entitlement to receive health care in American Samoa. It is also useful in providing additional medical assistance should an emergency arise. A person who has an American Samoa Health Insurance Card needs to show it at the time they apply for healthcare services. American Samoa does not allow anyone to apply for health services without a valid health insurance card.
It is advisable to get a Health Declaration if you or anyone in your family is suffering from an ailment or disease which could potentially result in financial loss. This is because you will need to have health insurance in case you need surgery or major medical treatment. For example, someone who has diabetes will require an insulin prescription. Anyone undergoing a course of treatment for cancer will need a bone scan or a tissue scan. The amount of your monthly out-of pocket medical expenses will be determined by a medical examination. Your declaration will also provide a list of all diseases or medical conditions you have, their treatments and the amount you will be reimbursed for such treatments.