a plenary body at the initiative of its president or at the initiative of one-third of its members; plenary meetings occur at least four times a year. to some extent, this is a formality: resolutions from cisns commissions are typically adopted by consensus. cooperation agreements to conduct joint health actions are formalized in cisns agreements. under the law of cohesion, cisns functions mainly through the adoption of and compliance with joint accords, through the political use of the plenary sessions, with each member making an uncompromising defense of the interests of its region. presentations, committees, and working groups have been very important, some more than others. important committees include: public health committee (comisión de salud pública) permanent pharmacy committee (comisión permanente de farmacia) scientific-technical committee of the national health system (comisión científico-técnica del sistema nacional de salud) committee to monitor the health cohesion fund (comisión de seguimiento del fondo de cohesión sanitaria) permanent committee on insurance, funding, and benefits (comisión permanente de aseguramiento, financiación y prestaciones) committee against gender violence (comisión contra la violencia de género) transplant committee (comisión de trasplantes) articles 69, 70 and 71 of the law of cohesion regulate the principal functions of the interterritorial council of the sns. the principal aspects of the interterritorial council are: the interterritorial council is constituted by the minister of health and consumer affairs , who holds its presidency, and by the councilors with purview over matters of health of the autonomous communities. the vicepresidency of the body will be fulfilled by one of the councilors with purview over matters of health of the autonomous communities, elected by all of the councilors who make up the body. the cisns will come to know, debate among other things, and, as appropriate, make recommendations on the following matters: a) the development of the portfolio of services corresponding to the catalog of services of the national health system, as well as its actualization. b) the establishment of health services complementary to the basic services of the national health system on the part of the autonomous communities. c) minimal guarantees of safety and quality for the authorization of the opening and placing into function of the health centers, services and establishments. d) the general and common criteria for the development of collaboration between pharmacy offices. e) the basic criteria and conditions of the convocations of professionals to assure their mobility throughout the state. f) declaration of the necessity to realize coordinated actions in matters of public health to which this law refers. g) general criteria for the public financing of medicines, medical products and their variables. h) establishment of criteria and mechanisms in order to guarantee at all times the financial sufficiency of the system. map of the autonomous communities of spain. the prior functions shall be exercised without prejudice to the legislative purview of the cortes generales and, as appropriate, the norms of the general administration of the state; likewise the normal developmental, executive and organizational purview of the autonomous communities. purview of the autonomous communities in matters of health article 41 of the general health law establishes that: the autonomous communities exercise the purview assumed in their statutes and those that the state transfers to them or, as appropriate, delegates to them. the public policies and actions foreseen in this act which are not expressly reserved for the state will be deemed to have been delegated to the autonomous communities. sign for the headquarters of a health office (delegación de salud) in andalusia. the state finances, through general taxes, all health benefits and a percentage of pharmaceutical benefits. this tax is shared among the several autonomous communities according to various sharing criteria now that the communities are responsible for health in their respective territories. each year the cisns, after deliberation, establishes the portfolio of services covered by the national health system, which is published by a royal decree of the ministry of health. each autonomous community then establishes its respective portfolio of services, which includes at least the service portfolio of the national health system. purview of local governments in matters of health air pollution; this photo is from shanghai, china. article 42 of the general health law sets out that ayuntamientos—municipal governments—have the following responsibilities with respect to health, without prejudice to the purview of other public administrative bodies: a) health control of the environment: air pollution, water supply , wastewater treatment, urban and industrial residue. b) health control of industries, activities and services, transport, noise and vibrations. c) health control of buildings and places of human residence or gathering, especially of food centers, hairdressers, saunas and centers of personal hygiene, hotels and residential centers, schools, tourist campsites and areas of physical activity for sports and recreation. d) health control of perishable food distribution and supply, beverages and other products directly or indirectly related to human use or consumption, such as means of transport. e) health control of cemeteries and mortuary health policy. territorial organization as a consequence of the decentralization contemplated by the spanish constitution, each autonomous community has received adequate transfers to create a health service, the administrative structure that manages all of the centers, services and establishments of the community itself, as well as its deputations, municipal governments, and whatever other territorial administrations fall within that community. the law of cohesion establishes the interterritorial council (cisns) as the organ of coordination and cooperation of the sns. in the autonomous cities of ceuta and melilla the corresponding health services are provided by the national institute of health management, ingesa. autonomous community royal decree constituting the autonomic health service identification of the autonomic health service logo population served catalonia 1517/1981, 8 july servei català de salut (catsalut) 7,467,423 andalusia 400/1984, 22 february servicio andaluz de salud (sas) 8,285,692 basque country 1536/1987, 6 november osakidetza 2,155,546 valencian community 1612/1987, 27 november agència valenciana de salut 5,094,675 galicia 1679/1990, 28 december servizo galego de saúde (sergas) 2,794,796 navarre 1680/1990, 28 december servicio navarro de salud-osasunbidea 629,569 canary islands 446/1994, 11 march servicio canario de la salud (scs) 2,075,968 asturias 1471/2001, 27 december servicio de salud del principado de asturias (sespa) 1,085,289 cantabria 1471/2001, 27 december servicio cántabro de salud (scs) 582,138 la rioja 1473/2001, 27 december servicio riojano de salud 321,702 region of murcia 1474/2001, 27 december servicio murciano de salud (sms) 436,870 aragon 1475/2001, 27 december servicio aragonés de salud (salud) 1,326,918 castile-la mancha 1476/2001, 27 december servicio de salud de castilla-la mancha (sescam) 2,081,313 extremadura 1477/2001, 27 december servicio extremeño de salud (ses) 1,102,410 balearic islands 1478/2001, 27 december servei de salut de les illes balears (ib-salut) 1,071,221ae community of madrid 1479/2001, 27 december servicio madrileño de salud (sermas) 6,271,638 castile and león 1480/2001, 27 december sanidad castilla y león (sacyl) 2,553,301 marqués de valdecilla university hospital, part of the cantabrian health service. health coverage in spain under chapter iii of the 1978 spanish constitution, all spanish citizens are beneficiaries of public health services. concretely, it establishes that: article 39: the public powers assure social, economic and juridical protection of the family. article 43: the right to health protection is recognized. it is the responsibility of public authorities to organize and act as guardian over public health through preventive measures and the provision of necessary services. the law will establish the rights and duties of all in this respect. the public powers will promote health education, physical education and sports. article 49. the public powers will bring into existence a policy of prevention, treatment, rehabilitation and integration of those with physical, sensory or psychological disabilities. further, the organic law 4/2000 (ley orgánica 4/2000) establishes the rights and liberties of foreigners resident in spain. its effect on the healthcare provision can be seen in the following articles: article 3. foreigners will enjoy in spain, in equal conditions with the spanish, the rights and liberties recognized in title i of the constitution and in the laws that develop it, in terms established in this organic law. article 10. foreigners will have the right to engage in remunerated activity in self-employment or working for others, such as access to the social security system, in terms foreseen in this organic law and in the dispositions that develop it. article 12. foreigners who are registered in spain in the municipality in which they are habitually resident have the right to health services on the same conditions as the spanish. foreigners who are in spain have the right to urgent health services in the event of contracting severe illness or having an accident, whatever may be the cause, and the continuity of this care until the time of discharge. foreign minors of less than 18 years who are in spain have the right to health care on the same conditions as the spanish. pregnant foreigners who are in spain have the right to health care during the pregnancy, while giving birth, and post partum. financing of the health system article 10 of the law of cohesion establishes that the financing of the spanish health system is the responsibility of the autonomous communities in conformity with the accords of transfer and the current system of autonomic financing, notwithstanding the existence of a third party liable to pay. sufficient financing of services is determined by the resources assigned to the autonomous communities in conformity to what is established in the laws of autonomic financing. inclusion of a new service in the catalog of services of the national health system is accompanied by an economic memo that contains the positive or negative financial impact it is expected to imply. this memo is brought up to the council of fiscal policy and finance for analysis and approval as to whether to proceed. fairness in financing prior to 1986, public financing of health care occurred mostly through highly regressive payroll taxes. in 1986, the law that established the spanish national health system also shifted financing toward progressive general taxes and away from payroll taxes. in a 2000 report, the world health organization ranked spain 26th of 191 countries in its fairness in financing. in 1999, reform to income tax deductions allowed high income earners to deduct more for private insurance. although this reform was intended to decrease overconsumption of health care services, it had the side effect of more regressive financing of public health services. nevertheless, that same year payroll taxes were completely phased out while higher indirect taxes (on excise goods such as alcohol and tobacco) were earmarked for health care. functional organization individual health card an individual health card (tarjeta sanitaria) for the andalusian health service (2010) article 57 of the law of cohesion establishes that citizens' access to health services will be facilitated by use of an individual health card (tarjeta sanitaria individual), as the administrative document that accredits its holder and provides certain basic data. in order to best facilitate collaboration, quality, and continuity of services, the each card includes a standardized form of basic identification data for the holder, and indicates in which autonomic health service the person is enrolled. in particular, the cards incorporate a digital form of this information; health facilities throughout spain have appropriate equipment to read the digital information from the cards. a cardholder should thereby be able to access all the services of all relevant health professionals throughout the country. clinical history a patient's clinical history is a medical-legal document that arises from the interactions between health professionals and their clients. from a medical and legal point of view, the clinical history is the only document valid to track this history of interactions. in primary care, where methods of health promotion are important, the clinical history document is sometimes known as a "health history" (historia de salud) or "life history" (historia de vida). clinical histories in the sns the clinical history of the national health system (historia clínica digital del sistema nacional de salud, hcdsns) is intended to guarantee citizens and health professionals access to whatever clinical information is relevant for medical care of a particular patient. this history should be available at all authorized locations, but nowhere else: except as needed for treatment, the information is considered confidential and access is restricted. health areas the term "health area" (área de salud) refers to an administrative district that brings together a functional and organizational group of health centers and primary