Health Services Patient Handbook Welcome…

I would like to take this opportunity to welcome you as a patient and thank you for choosing Cherokee Nation Health Services. The Cherokee Nation is dedicated to providing optimal health care as a service to our tribal citizens and all Native American people. Our goal is to deliver excellent clinical results and provide care that is delivered with respect for our Native American culture and each individual we care for. We are committed to providing a safe an effective physical and spiritual healing environment for you and your family. Please take the time to review your patient handbook and prepare a list of questions for your health care team. You have a choice for your healthcare needs, thank you for choosing Cherokee Nation.

Sincerely,

Principal Chief Bill John Baker

Quality Statement We are dedicated to working with our communities, families and individuals to promote and improve their health. Page 1 The Cherokee Nation Tribal Jurisdictional Service Area (TJSA) is comprised of 14 counties in northeastern Oklahoma. This rural area stretches from Tulsa east to the Arkansas and Missouri borders and north to the Kansas border. Cherokee Nation (CN) is composed of Washington, Nowata, Craig, Mayes, Rogers, Cherokee, Adair, Sequoyah, Delaware, Ottawa, Tulsa, Muskogee, Wagoner, and McIntosh counties. Cherokee Nation has a land base totaling 4,336,200 acres with a jurisdictional service area covering over 9,200 square miles. Currently, Cherokee Nation has over 311,000 registered tribal citizens, a majority of whom reside within the 14 counties of the TJSA. Tribal headquarters are located at the W.W. Keeler Complex in Tahlequah, Oklahoma, the capitol of Cherokee Nation. Cherokee Nation Health Services is the largest tribally-owned health care system in the nation operating eight health centers and one hospital throughout the tribe’s jurisdiction. All Cherokee Nation facilities are designated as tobacco-free facilities.

Cherokee is a distinct culture with its own language, social organization, and spiritual beliefs and practices. The Cherokee language is not only spoken, but also written using a special syllabary with 86 characters developed by Sequoyah. The Tribe has seven clans and is a matrilineal society.

The Indian Health Service (I.H.S) is a federal agency designated to provide health services to citizens of federally recognized Tribes and their descendants. Under the Indian Self-Determination and Educational Assistance Act (P.L. 93-638) Tribes can contract or compact to provide services that the IHS would otherwise provide. Cherokee Nation is a self-governance Tribe and operates all ambulatory health centers and a hospital located within its jurisdiction. One hospital, Claremore Indian Hospital, within the Cherokee Nation is operated by Indian Health Service.

Page 2 Overview of Health Services Cherokee Nation Health Services (CNHS) originated with the establishment of the Community Health Representative Program in 1972. Since then, CNHS has grown tremendously and has become the largest group in the tribal government, employing over 2,000 health care professionals and support staff. Cherokee Nation Health Services includes a comprehensive care hospital, Cherokee Nation W.W. Hastings Hospital (CNWWH), and eight outpatient ambulatory health centers in Salina, Jay, Sallisaw, Stilwell, Nowata, Muskogee, Vinita and Ochelata. The Cherokee Nation Health Services has been referred to as the nationwide model for rural health care because of the quality comprehensive care that is provided through the coordination of services rendered by the individual programs. Health System Accreditation By law hospitals must be accredited by a Medicare-approved accreditation program in order to be reimbursed for care provided to patients covered by the Centers of Medicare and Medicaid (http://www.cms.gov/). Without it, most hospitals would only be able to provide care for a small fraction of the community they now serve.

In 2009, Cherokee Nation Health Services sought out and achieved accreditation by DNV GL a division of Det Norske Veritas Germanischer Lloyd (DNV GL), an independent foundation dedicated to safeguarding life, property and the environment (http://www.dnvgl.com). DNV is the first new federally-approved accreditation program in more than 30 years and offers Cherokee Nation Health Services the opportunity to simultaneously satisfy its Medicare accreditation requirement and implement the ISO 9001:2008 Quality Management System.

Emergency Medical Services (EMS) In 2005, Cherokee Nation Emergency Medical Services (CNEMS) became the first EMS agency in Oklahoma and the first Tribe across the Nation to achieve accreditation by the Commission on Accreditation of Ambulance Services (CAAS) http://www.caas.org . CAAS is an independent Commission that established a comprehensive series of standards for the ambulance service industry. CAAS accreditation signifies that CNEMS meets the gold standard determined by the ambulance industry to be essential in a modern emergency medical service provider. These standards often exceed those established by state or local regulation. The CAAS standards are designed to increase operational efficiency and clinical quality, while decreasing risk and liability to Cherokee Nation.

Page 3 Jack Brown Center (JBC)

The Jack Brown Center is accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF) which is also known as CARF International http://www.carf.org/home/. CARF accreditation focuses on quality results for clients, providers, the public and payers. Clients, consumers and families look for CARF accreditation as assurance that providers strive to offer the highest quality services. Accreditation assists service providers to improve the quality of their services and met internationally recognized standards. Funders, insurers, referral agencies and government regulators recognize that CARF-accredited providers are accountable and a better risk.

Mammography Services The Cherokee Nation Radiology Program is accredited by the American College of Radiology (ACR). All facilities providing mammography must be certified by the Food and Drug Administration (FDA). To be certified, a facility must be accredited. The FDA has designed the ACR as an accrediting body and ensures processes and results for: peer review, educationally-focused evaluation of practice, documented need for equipment, continuing education, expert assessment of image quality, provide formal reviews to ensure criteria is met for ACS, state or federal government, or third-party payers and meet requirements set by the Centers of Medicare and Medicaid Services (CMS).

Page 4 Laboratory Accreditations Health Center Laboratories are accredited by the Commission on Laboratory Accreditation (COLA) which is the premier clinical laboratory education, consultation and accreditation organization. COLA accreditation enables clinical laboratories and staff to meet CLIA and other regulatory requirements, act in accordance with Quality Systems, and provide the best possible patient care (http://www.cola.org/).

The Cherokee Nation W.W. Hastings Hospital Laboratory is accredited by the College of American Pathologists (CAP). The CAP Laboratory Program is an internationally recognized program and is the only one of its kind that utilizes teams of practicing laboratory professional inspectors. The program is based on rigorous accreditation standards that are translated, detailed and focused on a checklist of requirements. The checklist provides a practice blueprint for laboratories to follow.

Surgical Technology Program The Surgical Technology Program is located at the Cherokee Nation W.W. Hastings Hospital and is accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) http://www.caahep.org/. CAAHEP is the largest programmatic accreditor in the health sciences field. In collaboration with its Committees on Accreditation, CAAHEP reviews and accredits over 2000 educational programs in twenty-three (23) health science occupations. CAAHEP is recognized by the Council for Higher Education Accreditation (CHEA) and is a member of the Association of Specialized and Professional Accreditors (ASPA).

Durable Medical Equipment The Accreditation Commission for Healthcare (ACHC) www.achc.org represents agencies as being credible with continuous compliance and patients are provided equipment and supplies that are of the highest standard of quality. Page 5 Looking to the future In addition to the accreditations above, Cherokee Nation Health Services is working toward additional accreditations with the Public Health Accreditation Board (PHAB) for our Public Health System, The Committee on Accredited of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) www.coaemsp.org for the Emergency Medical Services Training Program, and Baby Friendly USA (BFUSA) www.babyfriendlyusa.org which is a hospital initiative that promotes breastfeeding and the natural development of the infant. We also achieve and maintain multiple certifications and program recognitions which all contribute to safe, quality patient care and services.

Health Services

Eligibility Policy To be eligible for services, a person must have or be one of the following: • A person of Native American ancestry with a Certified Degree of Indian Blood (CDIB) card, a tribal citizenship card, OR letter of descendancy issued by a federally recognized tribe; • A non-Native American female currently pregnant with a Native American male’s (who has either a CDIB or a tribal citizenship card) child for the duration of the pregnancy (including initial pregnancy test) through postpartum (usually 6 weeks); • A non-Native American residing in a Native American household when services are necessary to control a public health hazard; or • A non-Native American child under the age of 19 years who is the adopted child, step-child, foster-child or legal ward of state of an eligible Native American. Non-discrimination Policy Cherokee Nation Health Services, including the Cherokee Nation W. W. Hastings Hospital, does not exclude, deny benefits to, or otherwise discriminate against any person that is eligible for services (as outlined in the Cherokee Nation Health Services Eligibility Policy) on the grounds of disability, age or sex in the admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by Cherokee Nation Health Services, including CNWWH directly through a contractor or any other entity with which Cherokee Nation Health Services, including CNWWH arranges to carry out its programs and activities. Page 6 Documents Needed to Get Care • Social Security card; • Certificate of Degree of Indian Blood (CDIB) card, a tribal citizenship card OR letter of descendancy issued by a federally recognized tribe; • Photo identification; • Current insurance information (Medicaid, Medicare, Sooner Care or private insurance); • For children’s charts, this may include a parent’s CDIB card and a state issued birth certificate.

Patient’s Bill of Rights When you receive services from Cherokee Nation Health Services, you have the right: • To be treated with consideration, respect and dignity, free from all forms of abuse and harassment, in a safe environment; • To have your cultural, psychosocial, spiritual, personal values, beliefs and preferences respected and to have pastoral and other spiritual services available; • To have confidentiality of your medical treatment and records; and to have privacy during case discussion, counseling, examination and treatment; • To review your medical records with a medical provider; • To know the name and qualifications of staff providing care; • To have your care and services explained in a language or format you understand and to receive as much information about any proposed treatment or procedure as needed in order to give informed consent or to refuse the course of treatment. Except in the case of an emergency, this information shall include a description of the procedure or treatment, or the anticipated results of non-treatment; • To actively participate in the development, decisions and implementation of the plan of care, including the right to pain management; • To have a second medical opinion from another appropriate Cherokee Nation practitioner, if requested, and to change primary or specialty physicians/dentists if available; • To request and/or refuse treatment and to leave against medical advice; • To be advised if research affecting your care or treatment is proposed and the right to refuse to participate; • To receive a Beneficiary Notice of non-coverage and the right to appeal premature discharge; • To voice complaints and suggest changes to any caregiver without reprisal and have your complaint or suggestion addressed; • To prompt notification of admissions to the patient and/or patient’s representative and physician; • To formulate advance directives and to have them honored; • To appoint and/or designate a person to make medical decisions on behalf of the patient; • To be free from restraints of any form that are not medically necessary; • To receive visitors whom the patient designates, including, but not limited to, a spouse, domestic partner (including a same-sex domestic partner), family member, friend; and the patient’s right to withdraw or deny such consent at any time for whom he/she designates. Visitation is not restricted based on race, color, national origin, religion, marital status, sex, sexual orientation, gender identity, or disability.

Page 7 Patient Medical Treatment Rights under Oklahoma Law No Discrimination Based on Mental Status or Disability: Medical treatment, care, nutrition or hydration may not be withheld or withdrawn from an incompetent patient because of the mental disability or mental status of the patient. (Required by Section 3080.5(B) of Title 63 of the Oklahoma Statutes)

What Are Your Rights If a Health Care Provider Denies Life-Preserving Health Care? • If a patient or person authorized to make health care decisions for the patient directs life-preserving treatment that the health care provider gives to other patients, your health care provider may not deny it: 1. On the basis of a view that treats extending the life of an elderly, disabled, or terminally ill individual as a lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill; or 2. On the basis of disagreement with how the patient or person legally authorized to make health care decisions for the patient values the trade-off between extending the length of the patient’s life and the risk of disability. (Required by Nondiscrimination in Treatment Act Sections 3090.2 and 3090.3 of Title 63 of the Oklahoma Statutes).

Your Rights When Treatment is denied for Other Reasons: • If treatment is directed by a patient with decision-making capacity, or by or on behalf of the patient under a valid advance directive: - The health care provider must, as promptly as practicable, take all reasonable steps to arrange care of a qualified patient by another physician or health care provider willing to comply, and - Pending completion of transfer, the health care provider must provide any directed treatment whose denial would in reasonable judgment be likely to result in the death of the patient EXCEPT ➢ treatment the provider is physically or legally unable to provide ➢ treatment the provider is physically or legally unable to provide without thereby denying the same treatment to another patient ➢ the requirement does not change any legal obligation or lack of legal obligation the provider may have to provide treatment, nutrition, or hydration to a patient who refuses or is unable to pay for them Required by Oklahoma Advance Directive Act (Section 3101.9 of Title 63 of the Oklahoma Statutes)

What if a Health Care Provider Disagrees with Your Decision to Withhold or Withdraw Medical Treatment? The health care provider must, as promptly as practicable, take all reasonable steps to arrange care of a qualified patient by another physician or health care provider willing to comply (Required by Oklahoma Advance Directives Act Section 3101.9 of Title 63 of the Oklahoma Statutes).

What Laws Govern Cardio-Pulmonary Resuscitation (CPR) and Do Not Resuscitate (DNR) Orders?

• Every patient is assumed to consent to CPR whenever the patient undergoes cardiac or respiratory arrest. UNLESS the health care provider has actual knowledge of one of the following: - The patient’s medical record accurately records the patient’s refusal to consent to CPR, given to the attending physician. - A Do Not Resuscitate (DNR) order under the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act was executed for the patient. Page 8 - A minor’s medical records accurately record the parent or guardian’s refusal to consent to CPR for the minor, provided ➢ If the minor has sufficient understanding and appreciation of the nature and consequences of the refusal and is capable of objecting, the medical record accurately records that the minor has not objected ➢ In the case of a disabled infant with life-threatening conditions, if in reasonable medical judgment CPR will be most likely to be effective in correcting or ameliorating the life- threatening conditions, in reasonable medical judgment: A. The infant is chronically an irreversibly comatose; B. The provision of such treatment would: - Merely prolong dying - Not be effective in ameliorating or correcting all the infants life-threatening conditions; or - Otherwise be futile in terms of the survival of the infant; or C. The provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane

- The patient’s medical record accurately records refusal to consent to CPR based on the known wishes of the patient by an incapacitated patient’s guardian, health care proxy, or attorney-in- fact for health care decisions AND ➢ The reason the guardian, proxy, or attorney-in-fact, rather than the patient, directed the DNR is recorded in the patient’s medical record ➢ Prior to the decision, the patient’s attending physician has: A. Instructed the guardian, proxy, or attorney-in-fact in writing that he or she is deciding what the incapacitated patient would have wanted if the patient could speak for himself or herself B. Encouraged consultation among all reasonably available representatives, family members, and persons close to the incapacitated patient to the extent feasible in the circumstances of the case C. Whenever possible, explained to the guardian, proxy, or attorney-in-fact and family members the nature and consequences of the decision to be made; evidence of its provision is to be documented in the patient’s medical record - The attending physician for an incapacitated patient without a representative knows by clear and convincing evidence that when competent, on the basis of information sufficient to constitute informed consent, the patient refused to consent to CPR ➢ “Clear and convincing evidence” includes oral, written, or other acts of communication between the patient, when competent, and family members, health care providers, or others close to the patient with knowledge of the patient’s personal desires • A health care provider is not required to begin or continue CPR when, in reasonable medical judgment, it would not prevent the imminent death of the patient • A health care agency is not required to institute or maintain the ability to provide CPR or to expand its equipment, facilities or personnel to provide CPR, but an agency must communicate in writing to a patient or the patient’s representative prior to the person coming under the care of the health care agency that it does not provide CPR. Required by Oklahoma Do-Not-Resuscitate Act (Section 3131.4 of Title 63 of the Oklahoma Statutes) and 42 U.S.C 5106a (b) (2) (c) (iii) &5106g (5)

What are Oklahoma’s Requirements Concerning Food and Fluids for Patients?

• It is assumed that any incompetent patient has directed hydration and nutrition (fluids and food) to a degree that is sufficient to sustain life UNLESS their withdrawal or withholding would not be because of the mental disability or mental status of the patient AND: Page 9 - The patient’s advance directive specifically authorizes the withholding or withdrawal of nutrition and/or hydration and the advance directive: ➢ Is an Oklahoma advance directive (under current or prior law) that is either in the statutory form or that specifically authorizes the withholding or withdrawal of artificially administered nutrition and/or hydration in the patient’s own words or by a separate section, separate paragraph, or other separate subdivision that deals only with nutrition and/or hydration and which is separately initialed, separately signed, or otherwise separately marked by the patient or ➢ Is an out-of-state advance directive that as executed by a person who was not a resident of Oklahoma at the time of execution of specifically authorizes the withholding or withdrawal Separate section, separate paragraph, or other separate subdivision that deals only with nutrition and/or hydration and which section, paragraph, or other subdivision is separately initialed, separately signed, or otherwise separately marked by the person executing the advance directive ➢ A court has directed that artificially administered hydration or nutrition be withheld withdrawn (a court can do so only based on clear and convincing evidence that the patient, when competent, decided on the basis of information sufficient to constitute informed consent to reject them) ➢ The attending physician knows that the patient, when competent, decided on the basis of information sufficient to constitute informed consent that artificially administered hydration or nutrition should be withheld or withdrawn from the patient ➢ Withholding or withdrawal of hydration or nutrition would not result in death from dehydration or starvation (rather than from the underlying terminal illness or injury) and in the reasonable medical judgment of the attending doctor and a second consulting doctor. A. The patient is chronically and irreversibly incompetent B. The patient is in the final (last) stage of a terminal illness or injury (meaning that, even with the use of medical treatment, the patient is in the dying process and will die within a reasonably short period of time, and C. The patient’s death is imminent Required by Hydration and Nutrition for Incompetent Patients Act (Sections 3080.2 through 3080.5 of title Oklahoma Statutes)

Whom Can You Contact If You Suspect a Health Care Provider Is Violating Your Rights Under the Laws Described in this Disclosure Statement?

Report suspected violations of any of the laws summarized in the brochure listed above, or attempts to violate any such laws, to the State Licensing Board of the profession(s) of all health care providers involved in the violation.

Oklahoma Board of Medical Licensure and Supervision www.okmedicalboard.org 405-962-1400 1-800-381-4519 (Toll free outside the 405 area code)

Oklahoma Board of Osteopathic Examiners www.ok.gov/osboe/ 405-528-8625

Oklahoma Board of Nursing www.ok.gov/nursing 405-962-1800

Page 10 If you are unsure which profession or Licensing Board applies to a particular health care provider, you may call the Oklahoma Board of Medical Licensure and Supervision at 405-962-1400, or outside the 405 area code, call toll-free 1-800-381-4519

Pursuant to state law (Title 63, Okla. Stat. Ann, Section 3163B), any entity to which the requirements of the federal Patient Self-Determination Act under Medicare or Medicaid [42 U.S.C., Section 1395cc(f) or 42 U.S.C., Section 1396a(w)] apply shall, at the time of providing the written information relating to advance directives required by 42 U.S.C, Section 1395cc(f)(1)(A)(i) or 42 U.S.C., Section 1396a(w)(1)(A)(i), include a copy of this disclosure statement with the materials federal law requires be provided to the patient or the patient’s representative. Do You Have an Advance Directive? It is your right to accept, refuse, or stop any treatment. It is also your right to make an Advance Directive. An advance directive is a document that directs us regarding how to take care of you if you have a terminal condition and are unable to give us that information. Decisions addressed by an advance directive include the following: • Life-sustaining treatment (respirator or resuscitation); • Artificial hydration (IV’s); • Artificial nutrition (tube feedings); • Other specific treatment; • Appointment of a healthcare proxy; • Organ and tissue donations

A “Health Care Proxy” is a person designated by the patient to make decisions based on the patient’s known intentions, personal views, or best interests. The advance directive may be changed or revoked at any time a patient wishes. The advance directive is a legal document and, if you have one, a current copy should be given to the doctor who cares for you and your close relatives or friends. Please inform your healthcare professional if you want information or assistance with an advanced directive. You may also contact

Your Right to Decide: Five Wishes – Aging with Dignity LifeShare Transplant Donor 405-528-0858 888-594-7437 Services of Oklahoma www.OklahomaSeniorLaw.org www.agingwithdignity.org 1-800-826-5433 www.oag.state.ok.us http://okpalliative.nursing.ouhsc.edu

Page 11 Patient Responsibilities When you are a patient at Cherokee Nation Health Services, you have the responsibility: • To understand that your lifestyle affects your health and to take an active part in your own wellness and health care; • To follow the agreed upon treatment plan; • To provide your healthcare provider with complete and accurate information; • To report to your healthcare provider all medications you are taking as well as over-the-counter products, herbal remedies and dietary supplements; • To provide a copy of your living will, power of attorney or advance directive; • To arrange transportation by a responsible adult following certain medical procedures; • To treat healthcare professionals, staff members and other patients with consideration, respect and dignity; • To report if you have Sooner Care, Medicare, VA benefits, or other health care insurance which may be necessary to apply for Contract Health Services; • To observe the rules of the facility and/or program and to respect the property by not defacing or destroying any part of it; • To take an active role in your health care. If you are not able, designate someone else ahead of time who knows you well enough to be involved; • To learn about your illness, tests and treatment. Obtain literature and ask questions. If you do not understand the information, ask for more information; • To be familiar with your treatment plan and medications. Be able to identify your medications and know what they are for and when to take them. If you have questions about what is given to you, have the nurse or pharmacist explain. If your medication does not look familiar, ask about it. If something does not look right, call it to the nurse’s attention; • To ask questions if you do not understand your test results or health care. Keeping a log of events while you are in the hospital is a good idea. You may also write questions for the doctors and nurses so you won’t forget them; • To have your identity checked by two types of identification (DOB, Chart Number, Identification Band, Name, etc.). If anyone administers treatments or medications to you, make sure they double check your identification; • To make sure the health care workers wash their hands before taking care of you. If you did not see them washing their hands, you may ask them if they have; • To discuss with your nurse, doctor, or nursing supervisor if you have concerns about your care or safety. • We encourage you to ask our staff if they have washed their hands before they contact you.

Pain Care Bill of Rights When you receive services from Cherokee Nation Health Services, you have:

• The right to have your report of pain taken seriously and to be treated with dignity and respect by doctors, nurses, pharmacists and other healthcare professionals; • The right to have your pain assessed; • The right to be informed by your doctor about what may be causing your pain, possible treatments, and the benefits and risks of each; • The right to participate in decisions about how to manage your pain; • The right to have your pain reassessed regularly and your treatment adjusted if your pain has not been eased; • The right to be referred to a pain specialist if your pain persists; • The right to clear answers to your questions; take time to make decisions, and refuse a particular type of treatment if you choose. Page 12 Taking Charge of your Pain • Ask your Nurse or Physician what to expect regarding your pain and pain management; • Ask for pain relief before your level of pain gets too high. Pain can delay your recovery, and puts you at more risk for complications; • Discuss pain relief options with your Nurse or Physician; • Advise the Nurse or Physician if your pain is not relieved; • Relate any concerns you have about taking pain medications. Most side effects can be treated effectively. Discuss any concerns such as: “Is this habit forming?” “Could I become addicted?”

Unable to do any activities 9 because of pain

7 Unable to do some activities because of pain

6 MISERABLE, DISTRESSING

Unable to do some activities because of pain 5

4 NAGGING PAIN, UNCOMFORTABLE, TROUBLESOME

Can do most activities 3

2 MILD PAIN, ANNOYING Pain is present but does not limit activity 1

Page 13 Interpreters Cherokee Nation Health Services will reasonably accommodate a means of communication to patients who have hearing and/or speech impairments that limit their ability to communicate. In order to ensure confidentiality of information and accurate communication, children and other residents will not be used to interpret languages. Interpreters are available as needed. Please contact a staff member for assistance. Complaints and Grievances Complaints/grievances will be addressed to the fullest extent possible and can be taken by any/all Cherokee Nation Health Services employees. The person making the complaint should be informed that the process is kept confidential and they can be identified or remain anonymous. Cherokee Nation Health Services supports the patient’s right to freely present concerns, needs, complaints or grievances without fear of reprisal or access to care being compromised. Cherokee Nation Health Services gives prompt and full consideration to comments, complaints and grievances from patients, family members or others regarding care or services. Notification of the grievance process is communicated to patients through written literature, signage at facilities and verbal instruction. DNV GL: 1-866-496-9647 www.dnvgl.com/industry/healthcare Accreditation Commission of Healthcare (ACHC) 1-855-937-2242 Centers of Medicare Services: 1-800-633-4227

Oklahoma State Department of Health: 1-800-522-0203

No Tobacco Policy It is the policy of Cherokee Nation to prohibit the use of all tobacco products, including smokeless tobacco and e-cigarettes inside and outside all Cherokee Nation Governmental properties, facilities, health centers, including restrooms, conference rooms, lounge areas, break rooms, storage rooms, warehouse spaces, hospital, and lunch rooms/cafeterias. For information on smoking cessation classes, please contact Cherokee Nation at (918) 453- 5000.

Page 14 Cherokee Nation W.W Hastings Hospital 100 S. Bliss Ave Tahlequah, OK 74464 Main (918) 458-3100 Fax (918) 458-3639 The majority of the 350,000 annual patient visits and 18,000 admissions are from Cherokee citizens in the 5 counties (Sequoyah, Muskogee, Cherokee, Adair and McIntosh) comprising Cherokee Nation, although many patients come from other Oklahoma counties, Arkansas, Missouri, Texas and other states. • The hospital employs more than 850 highly skilled staff. • The Obstetric department delivers more than 750 babies per year in a newly remodeled and equipped Labor and Delivery that is staffed with highly qualified nurses, midwives and obstetricians. The remodeled “Birthplace” has private rooms for the mother and baby to stay together. This unit is seeking to be the first tribal facility to become certified as a Baby-Friendly Hospital.The OB department is one of the most advanced in a tribal or Indian Health Service facility. • The 6-bed Intensive Care Unit (ICU), 3-bed Step-Down Unit (SDU) and Medical-Surgical Unit are equipped with advanced monitoring equipment. All rooms are private. • Our Surgery Service annually provides over 4000 necessary surgeries, including surgeries for weight loss for people who have completed the HELP program. • The Emergency Department (ED) and Urgent Care together annually have more than 54,000 patient visits. • The hospital maintains professional affiliations with schools and universities for health professionals such as but not limited to: nursing, optometry, radiology, medical, administrative, and respiratory. Scope of Service

• Audiology • Laboratory • Respiratory • Behavioral Health • Medical-Surgical • Sleep Study • Contract Services • Nutrition Services • Social Services • Dentistry • OB/Newborn Inpatient • Step Down • ECG • Occupational Health • Surgery Clinic • Emergency Services • Orthopedics • Surgery Services • Eye Care Services • Pediatrics • Transport Services • HELP Clinic • Pharmacy • Urgent Care • Infectious Disease • Podiatry • WIC • Intensive Care Unit (6 beds) • Public Health Nursing • Woman’s Health/Gynecology • Internal Medicine/Family Medi- • Radiology • Wound Care cine/Primary Care • Rehabilitation Services Page 15 Hospitalized Patient Information Visiting Hours • Visiting hours are over at 8:00 PM unless specified by department. • For security reasons, all visitors for ICU or OB must call from the phones outside the unit before being allowed to visit. • Visitors for patients in isolation are required to adhere to hospital isolation policies. Visitors who do not comply must leave. • All patients enjoy full and equal visitation privileges consistent with their preferences. Visitation is not restricted based on race, color, national origin, religion, marital status, sex, sexual orientation, gender identity or disability. Personal Belongings Valuables should be sent home and not kept at the hospital. If you have money or anything worth more than a few dollars, please have the nurse notify the Security Office so it can be locked in a safe. Parents of Children who are Patients It is strongly recommended that a parent stay at the bedside if the patient is an infant or small child. Our staff will assist the parent with the infant, if a break is needed. Medical Safety It is important for you and your family to know what you can do to prevent potential errors. You will be asked questions, sometimes repeatedly, about your illness and medications. We gather this information to guide us in your medical care. Telephones There is a telephone at the bedside for local calls. You must first dial “9” and then the telephone number. To make collect or credit card calls, dial 9 + 0 for an outside operator. Your friends and family may call you. They may call (918) 458-3100. The operator will transfer your call to the room or nurse’s station. Chaplain Service There are daily visits by the hospital chaplain. However, we will be happy to contact the clergy of your choice. Pressure Ulcer Prevention We will try to make your stay as comfortable as possible. We will ask you questions related to your nutrition and skin. We may have special things we can do to prevent you from developing pressure ulcers (bed sores). If you have question, concerns or special needs regarding your stay here, please let your nurse or medical provider know. Safety and Fall Prevention Patient safety is top priority. We will ask you questions that relate to your risk of falling while you are in the hospital. Based on these questions, we may make safety recommendations to prevent falls and injuries while you are here. Page 16 Meals Patient meals will be provided and depend on the diet the doctor has ordered. Menus are provided if you want to order something other than what is being served. Meal times are at 8:00 A.M, 12:00 P.M, and 5:00 P.M. Complimentary juice, tea and coffee are provided for our patients. There are vending machines available by Café Hastings on the second floor for visitors. Café Hastings serves breakfast and lunch Monday thru Friday.

Complaints and Grievances for Hospital Services If you have complaints or grievances regarding your care or treatment at this facility, please contact one of the following:

Medical/Surgical Nurse Executive (918) 458-3189

Intensive Care Unit (918) 458-3111

Obstetrical Unit Nurse Executive (918) 458-3185

Surgery Nurse Executive (918) 458-3118

Patient Advocate (918) 207-3721

It is your right to address grievances directly to:

DNV GL: 1-866-496-9647 www.dnvgl.com/industry/healthcare

Accreditation Commission of Healthcare (ACHC): 1-855-937-2242

Centers of Medicare Services: 1-800-633-4227

Oklahoma State Department of Health: 1-800-522-0203

Page 17 Discharge Planning A discharge planner and/or case manager is available during the day Monday through Friday and they will help you make arrangements if you need special care or equipment when you go home. A Registered Dietitian is available during the day Monday through Friday to answer questions about your diet before you go home. Referral Education During the referral process, patients are educated regarding all of their treatment options, including the option to refuse referrals. This education is ordinarily provided by a licensed practitioner during a clinical visit. Education should include the type of provider to which you are being referred, as well as any costs that may be incurred. Costs incurred may include examinations if you choose to go to a provider outside the Cherokee Nation Contract Health System. The final choice is the decision of the patient. Clarification: While you may go to any provider you choose, for any reason, Cherokee Nation will ONLY PAY for care if you use a provider contracted with and approved by Contract Health. It is important for you and/or your caregivers to understand the difference between a patient’s right to choose a provider and the responsibility to pay for services. Cherokee Nation DOES NOT PAY for services outside the Contract Health Service Network or for services that are not authorized through a Contract Health Purchase Order.

Page 18 OUTPATIENT HEALTH CENTERS

A-Mo Health Center 900 N Owen Walters Blvd. Salina, OK 74365 Phone: (918) 434-8500 Toll Free: 1-877-434-8500 Fax: (918) 434-8625

The A-Mo Health Center is located on ten acres of land where, it is said, Cherokee and other residents once came to trade for salt, hence its name, A-Mo, translated from Cherokee to mean “The Salt Place”. The center opened in April of 1996 and has an estimated 28,840 square feet of space. Scope of Service

• Behavioral Health • Medical Social Work • Contract Care • Nutrition Services • Dental • Pediatrics • Eye Care Services • Pharmacy • Family Medicine • Public Health Nursing • Health Promotion/Disease Prevention • Radiology • Laboratory • WIC

Hours of operation

Monday through Friday from 8:00 a.m. until 5:00 p.m. (hours may vary for specialty programs)

Page 19 Cooweescoowee Health Center 395200 West 2900 Road Ochelata, OK 74051

“Koo-wi-s-gu-wi” was Chief John Ross’s Cherokee name, thus an interpretation into “Cooweescoowee.” The Cooweescoowee Health Center is on 20 acres and is a stand-alone facility boasting 28,000 square feet of space, replacing the previous 5,000 square foot satellite clinic known as the Bartlesville Health Center. With additional space, the clinic will be able to offer many more services to people in this region. The clinic broke ground in December of 2013.

Scope of Service

• Behavioral Health • Nutrition Services

• Dental • Pharmacy

• Eye Care Services • Public Health Nursing

• Family Medicine • Radiology

• Health Promotion/Disease Preven- • WIC tion

• Laboratory

Hours of Operation Monday through Friday from 8:00 a.m. until 5:00 p.m. (hours may vary for specialty programs).

Page 20 Redbird Smith Health Center

301 S. JT Stites Blvd Sallisaw, OK 74955 Main (918) 775-9159 Toll Free 1-888-797-9159 Fax (918) 775-4778

This facility was the first Indian Health Clinic to be constructed new in the Cherokee Nation under tribal management. Located on five acres this facility has 21,945 square feet of floor space and provides services such as Dental, Administration, Behavioral Health, and Public Health Nursing.

In 2008 an additional 11,444 square foot building was constructed to increase the capacity of the current health center. In 2014 another 30,000 square feet of space was added to this building to allow for further expansion of services. This building houses such services as Eye Care, Family Medicine, Laboratory Services, Pharmacy, Radiology, Physical Therapy, Mammography Services, and WIC. Scope of Service:

• Behavioral Health • Nutrition Services • Contract Care • Pediatrics • Dental • Pharmacy • Eye Care Services • Physical Therapy • Family Medicine • Public Health Nursing • Health Promotion/Disease Prevention • Radiology • Laboratory • WIC • Medical Social Work

Hours of operation Monday through Friday from 8:00 a.m. until 5:00 p.m (hours may vary for specialty programs)

Page 21 Sam Hider Health Center 859 Melton Drive Jay, Ok. 74346 Main (918) 253-1700 Toll Free 1-877-293-4271 Fax (918) 253-4938

The Sam Hider Health Center first opened its doors in 1989 in the former Jay Memorial Hospital and has since moved to the current facility in 2015. The health centers square footage went from 28,345 to 42,000 square feet of floor space. With the growing demands for additional health services, the Cherokee Nation started constructing a larger facility to better serve its citizens. This expansion allows Sam Hider to add Physical Therapy and Bone Density Testing.

Scope of Service

Hours of operation

Monday through Friday from 8:00 a.m. until 5:00 p.m (hours may vary for specialty programs)

Page 22

Three Rivers Health Center 1001 S. 41st Street East Muskogee, OK 74403 Main (918) 781-6500 Toll Free 1-877-781-6511 Fax (918) 683-2922

The Three Rivers Health Center resulted from a Joint Venture Program with the Indian Health Service to construct a facility with the appropriate size and scope of services for its service population. The Three Rivers Health Center in Muskogee is more than 100,000 square feet and opened in 2008.

Scope of Service

• Behavioral Health • Nutrition Services • Contract Care • Medical Social Work • Dental • Pharmacy • Eye Care Services • Physical Therapy • Family Medicine • Podiatry • Health Promotion/Disease Prevention • Public Health Nursing • Laboratory • Radiology • Pediatrics • WIC

Hours of operation

Monday through Friday from 7:00 a.m. until 7:00 p.m (hours may vary for specialty programs)

Page 23 Vinita Health Center 27371 S. 4410 Rd Vinita, OK 74301 Main (918) 256-4800 Fax (918) 256-4598

The Vinita Health Center opened its doors for service in 2001 as a satellite facility of the Will Rogers Health Center. In 2012, we moved into a newly constructed 95,000 square foot facility that was the result of a joint venture between the Indian Health Service and Cherokee Nation. The new facility has allowed us to expand the number and type of services we are able to offer patients seeking outpatient care. The Vinita Health Center has been recognized as a Certified Excellent Healthy Business and received awards for “Best Outcome of Children Immunization” and “DM Ideal Control for A1c”. Scope of Service

• Behavioral Health • Medical Social Work • Contract Health • Nutrition Services • Dental • Physical Therapy • Eye Care Services • Podiatry • Family Medicine • Public Health Nursing • Pediatrics • Radiology • Pharmacy • Wellness Center • Health Promotion/Disease Prevention • WIC • Laboratory

Hours of operation

Monday through Friday from 7:00 a.m. until 5:30 pm (hours may vary for specialty programs). During Tribally recognized Holiday weeks, hours of operation are 8:00 am to 5:00pm. Page 24

Will Rogers Health Center 1020 Lenape Drive Nowata, OK 74048 Main (918) 273-7500 Fax (918) 273-9979

The first Nowata Primary Health Care Clinic got its start in 1989 by the Cherokee Nation. That clinic was located in a very small building and eventually was relocated to the community’s industrial park in 1997. The clinic’s floor plan was drawn to accommodate patient flow from check-in and exam to lab service and pharmacy. While this new facility (which also included 2 modular buildings) offered more space, the community demands quickly outgrew the location. As a result, the tribe took an initiative to construct a brand new state of the art facility to meet the growing demands and better serve its citizens. The new 27,005 square feet facility opened its doors in December 2007 and was renamed the Will Rogers Health Center.

Scope of Services

• Behavioral Health • Nutrition Services • Community Health Representative • Pediatrics • Contract Care • Pharmacy • Eye Care Services • Podiatry • Family Medicine • Public Health Nursing • Health Promotion/Disease Preven- • Radiology tion • WIC • Laboratory

Hours of operation

Monday through Friday from 8:00 a.m. until 5:00 p.m. (hours may vary for specialty programs)

Page 25 Wilma P. Mankiller Health Center Hwy 51 East Stilwell, OK 74960 Main (918) 696-8800 Toll Free 1-877-747-8800 Fax (918) 696-8840

The Wilma P. Mankiller Health Center opened its current facility in 1995 and was planned to be the baseline from which all other services were to be measured. It has 37,750 square feet of floor space. In 2015, a new 28,000 square foot addition was completed.

Scope of Service

• Behavioral Health • Nutrition Services • Bone Density Testing • Pediatrics • Contract Care • Pharmacy • Dental • Physical Therapy • Eye Care Services • Podiatry • Family Medicine • Public Health Nursing • Health Promotion/Disease Preven- • Radiology tion • WIC • Laboratory

Hours of operation

Monday through Friday from 7:30 a.m. until 6:00 p.m. (hours may vary for specialty programs)

Page 26 PROGRAMS

Cherokee Nation Emergency Medical Services 2214 S. Bald Hill Rd, Tahlequah, OK 74464 Main (918) 453-5200 Toll Free 1-888-238-7551 Fax (918) 458-4488

Cherokee Nation Emergency Medical Services (CNEMS) is a state licensed paramedic level ambulance service owned and operated by the Cherokee Nation. CNEMS consists of three major components: ambulance services, communications, and training.

Ambulance Services: Providing Paramedic Level services to all citizens of Cherokee, southern Delaware, northern Sequoyah and western Adair counties. Operations are 24 hours a day, 7 days a week. Communications:

Provides Communication Officers and support within the Cherokee County 911 Center. Communications Officers are licensed EMTs and certified in Emergency Medical Dispatch. The 911 Center is staffed 24 hours a day, seven days a week. Training Program:

The Cherokee Nation Training Program provides education on a Local, State and National level and is certified through multiple agencies such as: American Heart Association, National Association of Emergency Medical Technicians, National Safety Council, American Geriatrics Society, and Oklahoma State Department of Health.

Page 27 Behavioral Health Services

Cherokee Nation Behavioral Health Services offers a variety of services for adults, adolescents and children for outpatient treatment for mental health, substance and alcohol abuse. Outpatient adult services include individual and family therapy, substance abuse counseling, relapse prevention, parenting education, disorders of childhood, domestic violence intervention, relaxation training, psychological testing and crisis intervention. Behavioral Health offers outpatient counseling services at all Cherokee Nation Health facilities as well as Claremore Indian Hospital. Additionally, outpatient psychiatry services are offered at our Tahlequah clinic, Claremore and all Cherokee Nation health facilities. Inpatient services are available via contract health at external facilities.

Our Tahlequah outpatient clinic also provides evidence based children services. The HERO Project is Cherokee Nation’s comprehensive strategy to improve outcomes for children. The HERO (Helping Everyone Reach Out) Project provides needed support to youth, families and communities to promote the overall wellbeing of children. The project provides an array of services such as individual counseling, group counseling and family counseling, family care management, assessments, parenting classes and training for parents, schools and communities. The HERO Project is supported by two cooperative agreements from the Substance Abuse and Mental Health Services Administration, a Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), and System of Care Expansion Implementation.

Our prevention programs, headquartered in Tahlequah are actively working with schools, law enforcement agencies and community organizations in Sequoyah, Cherokee, Muskogee, Adair, Delaware, Mayes, Craig, Rogers, Nowata, and Washington Counties. The prevention program currently focuses on substance abuse, underage drinking prevention, domestic violence, sexual assault, and suicide. Our Behavioral Health prevention program has received statewide and national recognition for its efforts to integrate prevention, treatment, and recovery services across both the mental health and substance abuse domains. Our prevention programs also provide training such as “Mental Health First Aid” and “Youth Mental Health First Aid” to communities, law enforcement and other professional agencies within the area.

Please contact our office for more information or to request services: Adult Services and Prevention Program: 918-207-4977, HERO children/family services: 918-772-4004

Page 28 Jack Brown Center (JBC) P.O. Box 948 Tahlequah, Ok 74465 Main (918) 453-5501 Toll Free 1-877-448-0496 Fax (918) 458-0499 The Jack Brown Center is a thirty-six bed co-educational facility providing residential chemical dependency treatment for Native American adolescents. JBC serve youth from 13-18 years of age who are experiencing substance abuse problems. The center addresses dual diagnosis, in addition to personal and/or family problems that may be referred to as mental health issues. Such issues often accompany a chemical abuse or dependency problem. The length of stay for completion is up to 120 days. The center provides a self-contained program of chemical dependency education and counseling, academic, recreational, psychological, and cultural treatment approaches and components. The Jack Brown Center is funded by the Indian Health Service and is operated by Cherokee Nation Health Service Group. Jack Brown is accredited by the State of Oklahoma and CARF.

Cherokee Nation Cancer Programs (918) 453-5442

The Cancer Program includes the Breast and Cervical Cancer Early Detection Program (CNBCCEDP), the Cancer Registry and the Comprehensive Cancer Control (CNCCC) Program.

The Breast and Cervical Cancer Early Detection Program offers clinical breast exams, screening mammography, diagnostic mammography, biopsies, breast ultrasound, diagnostic follow-up, Pap smear test, colposcopy, LEEP (a diagnostic procedure), community outreach and case management. Services are available to Indian women ages 40-64 who are uninsured and have a family income at or below 250% federal poverty level. The Comprehensive Cancer Control Program is a collaborative process through which Cherokee Nation and partner organizations pool resources to reduce the burden of cancer. These combined efforts help to reduce cancer risk, improve cancer detection, increase access to health and social services, increase the number of people who survive cancer and improve quality of life for cancer survivors. Page 29 CHEROKEE NATION DIABETES PROGRAM The Cherokee Nation Diabetes Program works to prevent diabetes in people who are at risk for the disease, and to prevent and treat diabetic complications in people with diabetes. The Diabetes Program employs clinical staff throughout the Cherokee Nation Health System to provide primary care and podiatry services, diabetes self-management support and education, and intensive diabetes management by pharmacists. Many Diabetes Program staff members are Certified Diabetes Educators, and all have extensive diabetes-related training.

The Cherokee Nation Diabetes Self-Management Education (DSME) Program is accredited by the American Association of Diabetes Educators (AADE) at six facilities: W.W. Hastings Hospital, Wilma P. Mankiller Health Center, Redbird Smith Health Center, Sam Hider Health Center, Amo Health Center, and Three Rivers Health Center. It is a four-session program that provides patients and interested family members with the knowledge, skill, and self-confidence to manage their diabetes on a daily basis. The Will Rogers Health Center at Nowata is currently working to achieve AADE accreditation in early 2015.

Cherokee Nation Diabetes Program provides glucose meters and test strips, lancets, and syringes to diabetes patients who receive their primary care at a Cherokee Nation facility or Claremore Indian Hospital. It also provides home blood pressure monitors to diabetes patients with hypertension who attend DSME Program or Blood Pressure Control Class.

The Cherokee Nation Diabetes Prevention Program provides a 16-week class and lifestyle coaching, follow-up, and quarterly “after-core” activities for people diagnosed with pre-diabetes, to reduce their risk for diabetes.

Page 30 Cherokee Nation Public Health Program The Cherokee Nation Public Health System encompasses a wide array of tribal, public, private and community organizations that work in partnership to promote and assure conditions in which people can be healthy. With more than 300,000 citizens, Cherokee Nation’s public health system and health care service delivery span the nation’s jurisdiction, covering fourteen counties in northeast Oklahoma. Cherokee Nation’s public health services are multifaceted and use a socio-ecological approach to facilitate policy, system and environmental change. They administer a broad of array of services, such as school and community-based health education and prevention programs, youth and elder care, violence prevention, public safety, chronic disease surveillance and reporting, behavioral health, and access to clinical care. Cherokee Nation Public Health’s philosophy is based on being dedication to implementing Performance Management in all Public Health efforts in order to maintain an environment of continuous quality improvement. This priority to public health performance management assures its ability to be accountable and transparent to the people we serve. Managing the largest tribally-operated health care system in the United States, Cherokee Nation is dedicated to promoting and improving health in order to ensure healthy communities for this and future generations. For nearly a decade, we, the Cherokee Nation, have pursued opportunities to strengthen its public health capacity and performance in order to address the health and wellness of our citizens. One such opportunity was to learn and participate in public health accreditation, a new national initiative to advance quality and performance within tribal, state and local public health departments. Accreditation offers national recognition to organizations that meet a set of national standards as established by the Public Health Accreditation Board. In 2010, Cherokee Nation was one of three Tribes selected to participate in the beta test of the public health accreditation standards and measures. Since its involvement in public health accreditation, Cherokee Nation has been working diligently to elevate the status of Cherokee Nation’s public health system. The Cherokee Nation’s public health system encompasses many tribal, public, private and community organizations that work in partnership to assure conditions in which people can be healthy. Such conditions include, but are not limited to social, economic, education and environmental factors. The Cherokee Nation’s public health system includes tribal departments and programs, local and state health agencies, public schools, community organizations, the health care delivery system, faith-based organizations, public safety, and education and youth development organizations, among many others.

Important Cherokee Nation public health system stakeholders include, but are not limited to: • Community Health Promotion Program • Environmental Health • Behavioral Health Prevention Program • Emergency and Risk Management • Cancer Program • Health Research Program and Institutional Review • Quality Improvement and Quality Management Board • Emergency Medical Services • Cherokee Marshal Services (Public Safety and Law Enforcement • Cherokee Elder Care • Geo Information Systems • Women, Infants & Children (WIC) • Diabetes Prevention Program • Jack Brown Center • Community Health Representatives • Public Health Nursing For more information about Cherokee Nation’s Public Health Programs, visit www.cherokeepublichealth.org

Page 31 Cherokee Nation Women’s, Infant, and Children (WIC) Program

WIC is a federally-funded health and nutrition program for women, infants, and children. WIC provides nutrition and health education, healthy foods, breastfeeding education support, and referrals for healthcare and other community services to eligible women, infants and children. Participants must meet WIC’s income guidelines. WIC serves women who are pregnant, breastfeeding-postpartum, or non-breastfeeding postpartum; infants, and children under the age of 5. Within the Cherokee Nation, WIC clinics are located inside the 14 county tribal jurisdictional boundaries providing services to more than 7,300 women, infants, and children each month. WIC is for all kinds of families: married and single parents, working or not working. If you are a father, mother, grandparent, foster parent or other legal guardian of a child under 5, you can apply for WIC for your child. Infection Prevention Continues at Home We care about preventing infections – not only while you’re in the hospital, but when you go home, too. Your recovery and continued good health are important to us. When you return home from the hospital, it’s important to take the following steps to help prevent infection and avoid spreading germs that could infect you or others. Ask everyone in your home to follow these guidelines, too.

Cover Your Sneeze or Cough Care for Wounds Germs are expelled into the air whenever you sneeze Your skin is your body’s first line of defense against or cough. germs, but an open wound leaves an easy way for To prevent the spread of infection: germs to enter your body. • Turn away from other people before coughing or To prevent infection: sneezing. • Clean your hands before and after changing wound • Cover your mouth or nose with a tissue when you dressings (Wear gloves to change dressings if recom- cough or sneeze. Discard the tissue in the trash. mended by your doctor) • If you don’t have a tissue, cough or sneeze into your • Take special care with IV lines or other medical de- upper sleeve, not your hands. vices inserted into the body. If you must touch them, • Always clean your hands after coughing or sneezing. clean your hands first. • And follow any specific instructions from your doctor for care of your wounds.

Page 32 Disinfect Germ “Hot-Spots” Take these steps to ensure your home is a healthy place for your recovery: • Disinfect commonly touched hard surfaces in your home like countertops, door handles, sinks, tabletops, phones, TV remotes and baby changing tables. • Products such as sprays and wipes that are labeled Proper Hand Washing “disinfectant” are designed to kill a broad spectrum Use soap and plenty of running water if your hands of harmful bacteria and viruses that other cleaners cannot. Follow the directions on your disinfectant’s are visibly soiled: label to maximize the benefits. • Wet hands with warm water and work soap into a • Use a clean, dry cloth or paper towel to clean and dry lather. all surfaces. Wiping surfaces with a dirty dishcloth, sponge, or towel will only spread germs. • Rub your hands vigorously for 15 seconds or longer. Get in between fingers and scrub wrists. • Never share toothbrushes, combs, drinking glasses, utensils, razor blades, face • Rinse your hands with warm running water and pat cloths and bath towels. them dry with a clean towel. Germs can be passed from person to person on these • Use a clean paper towel to turn off the water faucet, personal items. and discard it in a trash can. Clean Your Hands!

Clean hands are the best protection against spreading germs and preventing infection.

When to Clean Your Hands • Whenever your hands are visibly dirty Proper Use of Hand Sanitizers • Before you eat, and before touching Use a hand sanitizer for routine hand cleaning only if your mouth, nose or eyes your hands aren’t visibly dirty: • Before and after preparing food • Apply the hand sanitizer to the palm of one hand. • After contact with blood or body • Rub your hands together until they’re dry, making fluids, using the restroom, touching sure the sanitizer covers every spot on your hands and animals and pets, or changing diapers. fingers. • It should take about 15 seconds to rub your hands dry. If not, you didn’t apply enough hand sanitizer. Page 33 Important Numbers and Notes

______Page 34 The value of Cherokee Nation Health Services (CNHS) as an integrated health system of ambulatory health centers, programs and a hospital is multifaceted, providing strategically planned care and services to eligible patients across a 14-county Tribal Jurisdictional Service Area (TJSA) in Northeastern Oklahoma.

Phone: 918-453-5000 Fax: 918-458-6174

Health Services Group

P.O. Box 948 Tahlequah, OK 74465 918-453-5000 • www.cherokee.org