Health Resources

1. Oklahoma Advance Directive for Health Care
2. The Health History Questionnaire
3. Health Information Authorization

4. MRSA Fact Sheet 
5. Seasonal Flu Information
6. Quitting Tobacco

7. No Patient Left Alone Act  

1. Oklahoma Advance Directive for Health Care
The Advance Directive for Health Care can be used to ensure your wishes are followed if you later become incapacitated and incapable of making an informed decision regarding your health care. If you signed a Directive to Physicians or other Advance Directive for Health Care under Oklahoma law prior to 2006, it is recommended that you complete the new Advance Directive because of additional options under the current law.

The Advance Directive requires two witnesses who are eighteen years or older and not named in your will or related to you. It does not have to be filed with any official or office to be effective. You should retain originals accessible at home and make copies for your doctor and family members.

Your use of this statutory Advance Directive form should be based on your personal health care situation and prior consultation with your physician and attorney. Nothing in this section should be considered as legal advice for an individual situation. Please consult your attorney for individual advice.

2. The Health History Questionnaire
The Health History Questionnaire is to be completed at the first scheduled appointment for a visit at the Specialty Clinic. This form can be printed so you can fill it out prior to your appointment. Having the form completed and with you for your appointment will help reduce the wait time. If you have any questions about completing the form, please call (918) 485-2093.

Click here to download Health History Form

3. Authorization For Use Or Disclosure Of Protected Health Information


The HIPAA Authorization Form may be used to request the release of patient medical records. The completed form may be faxed to 918-485-1383. If you have any questions about the use of this form or release of medical records, call 918-485-1300.

Click here to download HIPAA Authorization Form

4. MRSA (Methicillin Resistant Staphylococcus 
Aureus) Fact Sheet

MRSA infection is caused by Staphylococcus aureus bacteria — often called “staph.” MRSA stands for methicillin-resistant Staphylococcus aureus. It’s a strain of staph that’s resistant to the broad-spectrum antibiotics commonly used to treat it.

Click here to download MRSA Fact Sheet

5. Seasonal Flu Information

Click here to visit Flu Information Website

6. Quitting Tobacco
If you want to quit tobacco use call the Oklahoma Quit Line 1-800-QUIT NOW. Or visit one of the following websites for cessation advice, tips and programs.

7.  No Patient Left Alone Act (63 O.S. § 1-706a)

Minor children who are admitted to an Oklahoma licensed hospital have the right to have a parent, guardian or person standing in loco parentis present when the minor patient is receiving hospital care. An adult who is admitted to an Oklahoma licensed hospital has the right to designate a spouse, family member or care giver who may be present while the patient is receiving hospital care.”

Click here to download the No Patient Left Alone Fact Sheet