Skiatook Family Clinic Compassionate Quality Care (918) 396-1262

Patient notices

Notices & privacy practices

These notices describe your rights as a patient of Skiatook Family Clinic, how we protect your health information, and the help available to you at no cost.

Notice of nondiscrimination

Skiatook Family Clinic complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, or sex. We do not exclude people or treat them differently because of these characteristics.

Skiatook Family Clinic provides, free of charge and in a timely manner:

  • Reasonable modifications for people with disabilities, and appropriate auxiliary aids and services to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats).
  • Language assistance services for people whose primary language is not English, such as qualified interpreters and information written in other languages.

If you need these services, ask any staff member or call (918) 396-1262.

If you believe Skiatook Family Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you may contact the clinic manager at 201 East Second Street, Skiatook, OK 74070, phone (918) 396-1262, fax (918) 238-6577.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal at ocrportal.hhs.gov, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201; 1-800-368-1019, 800-537-7697 (TDD).

This notice is available on our website at skiatookfamily.com/notices.html and at the front desk.

Language assistance and auxiliary aids

English: ATTENTION: If you speak English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call (918) 396-1262 (TTY: 711) or speak to your provider.

Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. También están disponibles de forma gratuita ayuda y servicios auxiliares apropiados para proporcionar información en formatos accesibles. Llame al 918-396-1262 (TTY: 711) o hable con su proveedor.

Việt (Vietnamese): LƯU Ý: Nếu bạn nói tiếng Việt, chúng tôi cung cấp miễn phí các dịch vụ hỗ trợ ngôn ngữ. Các hỗ trợ dịch vụ phù hợp để cung cấp thông tin theo các định dạng dễ tiếp cận cũng được cung cấp miễn phí. Vui lòng gọi theo số 918-396-1262 (Người khuyết tật: 711) hoặc trao đổi với người cung cấp dịch vụ của bạn.

中文 (Chinese): 注意：如果您說中文，我們可以為您提供免費語言協助服務。也可以免費提供適當的輔助工具與服務，以無障礙格式提供資訊。請致電 918-396-1262（TTY：711）或與您的提供者討論。

한국어 (Korean): 주의: 한국어를 사용하시는 경우 무료 언어 지원 서비스를 이용하실 수 있습니다. 이용 가능한 형식으로 정보를 제공하는 적절한 보조 기구 및 서비스도 무료로 제공됩니다. 918-396-1262(TTY: 711)번으로 전화하거나 서비스 제공업체에 문의하십시오.

Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlose Sprachassistenzdienste zur Verfügung. Entsprechende Hilfsmittel und Dienste zur Bereitstellung von Informationen in barrierefreien Formaten stehen ebenfalls kostenlos zur Verfügung. Rufen Sie 918-396-1262 (TTY: 711) an oder sprechen Sie mit Ihrem Provider.

العربية (Arabic): تنبيه: إذا كنت تتحدث اللغة العربية، فستتوفر لك خدمات المساعدة اللغوية المجانية. كما تتوفر وسائل مساعدة وخدمات مناسبة لتوفير المعلومات بتنسيقات يمكن الوصول إليها مجانًا. اتصل على الرقم 918-396-1262 (711) أو تحدث إلى مقدم الخدمة.

မြန်မာ (Burmese): သတိပြုရန်- သင်က မြန်မာဘာသာစကား ပြောဆိုပါက၊ အခမဲ့ ဘာသာစကားအကူအညီ ဝန်ဆောင်မှုများကို ရနိုင်ပါသည်။ အသုံးပြုနိုင်သော ဖော်မတ်များဖြင့် အချက်အလက်များ ဖော်ပြပေးရန် သင့်လျော်သော အရန်အကူအညီများနှင့် ဝန်ဆောင်မှုများကိုလည်း အခမဲ့ ရရှိနိုင်ပါသည်။ 918-396-1262 (TTY: 711) သို့ဖုန်းခေါ်ပါ သို့မဟုတ် သင်၏ ဆောင်ရွက်ပေးသူနှင့် စကားပြောပါ။

Lus Hmoob (Hmong): LUS CEEV TSHWJ XEEB: Yog hais tias koj hais Lus Hmoob muaj cov kev pab cuam txhais lus pub dawb rau koj. Cov kev pab thiab cov kev pab cuam ntxiv uas tsim nyog txhawm rau muab lus qhia paub ua cov hom ntaub ntawv uas tuaj yeem nkag cuag tau rau los kuj yeej tseem muaj pab dawb tsis xam tus nqi dab tsi ib yam nkaus. Hu rau 918-396-1262 (TTY: 711) los sis sib tham nrog koj tus kws muab kev saib xyuas kho mob.

Tagalog (Tagalog): PAALALA: Kung nagsasalita ka ng Tagalog, magagamit mo ang mga libreng serbisyong tulong sa wika. Magagamit din nang libre ang mga naaangkop na auxiliary na tulong at serbisyo upang magbigay ng impormasyon sa mga naa-access na format. Tumawag sa 918-396-1262 (TTY: 711) o makipag-usap sa iyong provider.

Français (French): ATTENTION : Si vous parlez Français, des services d'assistance linguistique gratuits sont à votre disposition. Des aides et services auxiliaires appropriés pour fournir des informations dans des formats accessibles sont également disponibles gratuitement. Appelez le 918-396-1262 (TTY : 711) ou parlez à votre fournisseur.

ລາວ (Lao): ເຊີນຊາບ: ຖ້າທ່ານເວົ້າພາສາ ລາວ, ຈະມີບໍລິການຊ່ວຍດ້ານພາສາແບບບໍ່ເສຍຄ່າໃຫ້ທ່ານ. ມີເຄື່ອງຊ່ວຍ ແລະ ການບໍລິການແບບບໍ່ເສຍຄ່າທີ່ເໝາະສົມເພື່ອໃຫ້ຂໍ້ມູນໃນຮູບແບບທີ່ສາມາດເຂົ້າເຖິງໄດ້. ໂທຫາເບີ 918-396-1262 (TTY: 711) ຫຼື ລົມກັບຜູ້ໃຫ້ບໍລິການຂອງທ່ານ.

ไทย (Thai): หมายเหตุ: หากคุณใช้ภาษา ไทย เรามีบริการความช่วยเหลือด้านภาษาฟรี นอกจากนี้ ยังมีเครื่องมือและบริการช่วยเหลือเพื่อให้ข้อมูลในรูปแบบที่เข้าถึงได้โดยไม่เสียค่าใช้จ่าย โปรดโทรติดต่อ 918-396-1262 (TTY: 711) หรือปรึกษาผู้ให้บริการของคุณ

اردو (Urdu): توجہ دیں: اگر آپ اردو بولتے ہیں، تو آپ کے لیے زبان کی مفت مدد کی خدمات دستیاب ہیں۔ قابل رسائی فارمیٹس میں معلومات فراہم کرنے کے لیے مناسب معاون امداد اور خدمات بھی مفت دستیاب ہیں۔ 918-396-1262 (TTY: 711) پر کال کریں یا اپنے فراہم کنندہ سے بات کریں۔

فارسي (Persian): توجه: اگر فارسی صحبت می‌کنید، خدمات پشتیبانی ‌زبانی رایگان در دسترس شما قرار دارد. همچنین کمک‌ها و خدمات پشتیبانی مناسب برای ارائه اطلاعات در قالب‌های قابل دسترس،‌ به‌طور رایگان موجود می‌باشند. با شماره 918-396-1262 (تله‌تایپ: 711) ‎‎تماس بگیرید یا با ارائه‌دهنده خود صحبت کنید.

Translations are the U.S. Department of Health and Human Services sample notices for the languages most commonly spoken in Oklahoma by people with limited English proficiency.

Notice of Privacy Practices

Effective date: September 24, 2026

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Skiatook Family Clinic keeps protected health information (“PHI”) private. PHI is any information, in any form, that identifies you and relates to your past, present, or future physical or mental health condition, and it includes your billing records. We are required by law to maintain the privacy of PHI, to give you this notice of our legal duties and privacy practices, to notify you following a breach of unsecured PHI, and to follow the terms of the notice currently in effect.

Uses and disclosures without your permission

  • Treatment: to provide, manage, and coordinate your health care with other providers.
  • Payment: for billing, including sharing PHI with your health insurance company.
  • Health care operations: for quality assessment, evaluating staff, and similar purposes.
  • Other disclosures permitted or required by law in limited circumstances, such as public health reporting, health oversight, legal proceedings, law enforcement, threats to health or safety, research, workers’ compensation, and specialized government functions.

Records with additional federal protection

Some records, such as records of substance use disorder treatment, receive additional protection under federal law (42 C.F.R. Part 2). These records, and testimony about them, may not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you unless you give specific written consent or a court issues an order that meets federal requirements. The full notice explains these protections.

Uses and disclosures requiring your written permission

We must obtain your written authorization before using or sharing your PHI for any purpose not described in the notice. You may revoke an authorization in writing at any time, except to the extent we have already acted on it. Marketing, sale of PHI, and psychotherapy notes each require authorization, with limited exceptions.

Your rights

  • Request restrictions on certain uses and disclosures. We must agree when you pay in full out of pocket for a service and ask us not to share that information with your health plan.
  • Confidential communications: ask us to contact you a certain way or at a certain location.
  • Inspect and get a copy of your PHI, including an electronic copy. A reasonable, cost-based fee may apply.
  • Request an amendment if you believe your PHI is incorrect or incomplete.
  • Get an accounting of certain disclosures we have made.
  • Get a paper copy of this notice at any time.

This page summarizes the notice. The complete Notice of Privacy Practices is the authoritative version.

Read the full Notice of Privacy Practices (PDF)

To ask a question or raise a concern about your privacy, contact our Privacy Officer at (918) 396-1262 or 201 East Second Street, Skiatook, OK 74070. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your right to a Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059. To ask us for an estimate, call (918) 396-1262.

Accessibility

We want every patient to be able to use this website and reach our services. This site is built to meet WCAG 2.1 Level AA guidance: text and controls meet contrast requirements, the site works by keyboard, it can be resized and read by screen readers, and it adapts to phones and tablets.

If any part of this website or any clinic document is difficult for you to access, call us at (918) 396-1262. We will provide the information in another format and fix the problem.