Frequently Asked Questions

1. Financial Assistance Program (FAP) (Click to download application)
2. HIPAA Notice of Privacy Practices (Click to download)
3. Media Policies
4. Nondiscrimination Policies

1. Financial Assistance Program (FAP)


 Who do I contact about getting qualified for financial assistance?
You may contact our on-site Business Office by phone or walk-in to request the Financial Assistance Program (FAP) application. If you need assistance to complete the application you may call 918-485-1306 for an appointment, if no answer, please leave a message.

What needs to be done once I receive my application for assistance?
You will need to gather all the requested information like verification of income (last month’s paycheck stub, social security award letter, etc.), copy of last year’s tax return, a listing of any assets you have (i.e. house, cash, stock/bonds, year/make/model of autos owned, or any other assets you may have), verification of any liabilities including monthly payment amount (i.e. bank loans, car loans, credit union, doctor/hospital bills for all facilities, and any other liabilities), and verification of any other monthly expenses (i.e. rent/mortgage payment, food expenses, car/house/medical insurance payments, utilities, or any other miscellaneous expenses incurred monthly). Other information may be requested after the application has been submitted.

Once I have everything together what do I do?
You will need to return the application and all required documents to the Wagoner Community Hospital on-site Business Office.

What happens next?
The application is reviewed for completion. If there is any additional information needed you will receive a letter informing you. This information will need to be submitted in a timely manner.

How do you determine if I am eligible?
All applications are reviewed monthly. Only completed applications will be processed. Your information will determine the discount. Applicants are eligible for discounts from 10% - 100% according to the information provided. Not everyone will qualify. Your application will then be sent to Wagoner Community Hospital’s CEO and/or CFO for approval. Once your application has been approved or denied you will receive a letter informing you of the decision that has been made. Please allow 60 days for processing.

2. HIPAA Notice of Privacy Practices

What is Wagoner Community Hospital’s HIPAA Notice of Privacy Practices?
To download WCH’s HIPAA Notice of Privacy Practices

3. How will the Affordable Care Act affect me?
To download a detailed explanation from the Oklahoma Hospital Association,
4. Media Policy
Media representatives and photographers must contact the hospital spokesperson for assistance in obtaining interviews and/or photographs of patients, employees, and areas of the hospital. Hospital policies require that a hospital representative accompany news personnel ANY time they are on hospital grounds. The following activities require written authorization (signed consent form) from the patient:

Releasing a detailed statement (includes anything other than a one-word condition); the patient or his/her legal representative should approve written statements;

Taking photographs (either video or stills) of the patient; and Media interviews with patients.
No photographs, audio/video recordings or interviews of patients may be taken within the facility or on hospital property without the patient’s prior written consent, or the written permission of a parent or legal representative. The release forms are available under Media Consent Forms.

Deceased or unconscious patients are not to be photographed UNDER ANY CIRCUMSTANCE, regardless of whether they are in the hospital or on hospital property.

Definitions of Patient Conditions
The following five terms are official hospital conditions, as defined by HIPAA:

Undetermined: Patient is awaiting assessment.

Good: Vital signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent.
Fair: Vital signs are stable and within normal limits. Patient is conscious, but may be uncomfortable. Indicators are favorable.
Serious: Vital signs may be unstable and not within normal limits. Patient is acutely ill. Indicators are questionable.
Critical: vital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.

WCH Will NOT Release Any Information

When the patient requests that NO information about him/her is released.

When knowledge of a patient’s location within the hospital could result in embarrassment for the patient (i.e. MHU/substance abuse, miscarriage, isolation for infectious disease);

When knowledge of a patient’s presence or location in the hospital could place the patient, hospital employees, and/or medical staff in danger (i.e. a stalker or abusive partner);

When the hospital and/or members of the medical or nursing staff are, or may be, parties to litigation;

When the patient is in the custody of the state (DHS, incarcerated or in psychiatric care); or

When, in the judgment of the patient’s physician, the nursing staff or hospital official, an interview would aggravate a patient’s condition, or is inappropriate due to unique circumstances, hospital spokespersons are justified in denying access to the patient without seeking consent. As soon as circumstances permit, hospital public relations or CEO will make the request for an interview to the patient.

Before information confirming a death is released to the media or others, a written authorization from the next-of-kin or the decedent’s legal representative is needed.

If the death is subject to an investigation by the Oklahoma State Medical Examiner’s Office, inquiries or requests for details should be directed to the M.E.’s office (405) 239-7141.

Matters of Public Record

While law and/or regulations require health care facilities to report a variety of information to public authorities, it is not the responsibility of facilities to provide that information in response to calls or inquiries from the media or other parties. Once the patient’s name has been provided to the CEO by the media, only the one-word condition will be given.

Requests for additional information should be directed to the appropriate public authority. The public entity will be guided by the applicable federal or state statutes as to the release of information.

5. Nondiscrimination Policy 
As a recipient of Federal financial assistance, the Wagoner Community Hospital does not exclude, deny benefits to, or otherwise discriminate against any person on the ground of race, color, or national origin, or on the basis of gender identity or gender expression, or on the basis of disability or age in admission to, participation in, or receipt of the services and benefits of any of its programs and activities or in employment therein, whether carried out by Wagoner Community Hospital directly or through a contractor or any other entity with whom the Wagoner Community Hospital arranges to carry out its programs and activities.

This statement in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations Part 80, 84, and 91. (Other Federal Laws and Regulations provide similar protection against discrimination on grounds of sex and creed.)

In case of questions concerning this policy, or in the event of a desire to file a complaint alleging violations of the above, please contact:

Wagoner Community Hospital

Debbie Sparks, Human Resources Coordinator