Patient Information Booklet

The Karuk Trial Health Program Patient Information Booklet is now available. Copies may be picked up at the clinics or at the Happy Camp Administration office. 

Patient Rights

The Karuk Tribal Health and Human Services Program (KTHHSP) provides considerate and respectful health care services to Native Americans and other peoples living within its’ service area (Siskiyou and Eastern Humboldt counties).  These services are provided through equal access, and treatment, and consider the patient’s personal values and beliefs.  All patients shall receive services regardless of their age, sex, race, color, creed, or national origin, or their financial ability to pay.

Our patients have the right to be treated with consideration, respect, dignity, and recognition of individuality and privacy, regardless of condition or reputation.  This includes freedom from mental, physical, sexual, and verbal abuse, neglect, and exploitation

The patient has the right to confidential and private assessment and reassessment and treatment.

The patient has the right to confidential treatment of his/her medical record and to refuse release of those records to other agencies or providers.

Our patients, and when appropriate, family members have the right to be informed of and participate in care decisions regarding the patient’s treatment plan or medical condition, which includes unanticipated outcomes.  If the patient’s treatment or diagnosis is not in the patient’s best interest to know, the patient has the right to choose another person to act in his/her behalf.  These persons may be family, friends or a guardian.  When the patient is a minor, family or guardians are legally responsible except in accordance with appropriate laws. 

The patient has a right to receive the following services (in accordance with available resources):

  • Evaluation – diagnosis of the patient’s general health condition.
  • Treatment -  procedures to prevent, control or cure illness
  • Referral    -   for additional required services unavailable at Karuk clinics, or       when a conflict with our mission or philosophy arises.
  • Pain Management – Our patient’s report of pain will be respected and acted upon appropriately and quickly.  Your right to effective pain management includes referral to alternative treatments, and the development of an individualized pain management plan (see also patient responsibilities).

For your convenience, we have placed our provisions for after-hours and emergency care on the back outside cover of the Patient Handbook.  If you are having a true emergency (life threatening) please call 911 immediately.

Fees for service and our payment policies are available upon request.  Your fees may be adjusted to our sliding fee scale with proof of income.

In accordance with law and regulation, the patient has the right to refuse treatment and to refuse treatment in experimental research, (not presently conducted at KTHHSP), or to allow trainees to participate as a learning experience. In addition, the patient has the right to be informed of the risk involved in discontinuing treatment against medical advice.

The patient has the right to informed consent.  Informed consent means that:

  • You are able to understand the nature, extent and likely consequence of planned treatments;
  • You are able to make sensible decisions about the risks and benefits of alternate procedures; and
  • You are able to demonstrate that you understand by using any method of communication.

The patient or their representative has the right to know the name and credentials of his/her providers responsible for his/her care. 

Elder or other patients who have trouble understanding, hearing, communicating, or if they speak a different language have the right to have a  representative act in their behalf or have the information translated or explained. 

The patient has the right to name someone to make decisions about his/her medical treatment for when the patient is unable to make those decisions.  This is called an “Advanced Directive”, and is a document that states your choice about medical treatment.  Advance Directives are signed in advance (before you become unable to communicate) to let your doctor or other health care providers know your requests concerning your medical care.  They enable you to make legally valid decisions about your future medical care and treatment.

If you are concerned about your future health care, our staff can help you prepare a Durable Power of Attorney for Health Care (advanced directive).  Please contact a clinic receptionist or tell your physician you want to create an advanced directive.  They will refer you to a staff member who can help you.  For more information, Contact the Tribe’s local Community Health Representative (CHR), or Elders Worker.

The patient has the right to know that all clinic staff are required to report all cases of suspected or known abuse and neglect, whether it be child or elder, as mandated by law.

The patient has a right to change medical, dental, or behavioral health providers when a conflict in care develops and other qualified providers are available.

The patient has the right to know that the suggestion box placed in the lobby is for the submission of their suggestions.



The patient has the right to make a complaint about health services.  When a complaint is made:

a. The staff of the Karuk Tribal clinics first will attempt to resolve the complaint.  If this initial effort is not successful, a patient may submit a formal written complaint.

b. A patient, parent (s), or guardian (s) has the right to request review of their complaint by completing a Patient Complaint Form.

c. The complaint will be submitted to the Clinical Operations Administrator for review, investigation, and response.

The procedures for making a complaint are:

1.  Complaints must be in writing and submitted to:

The Clinical Operations Administrator
Karuk Tribal Health and Human Services Program
P. O. Box 1016
Happy Camp, CA 96039

2.  You may use the Patient Complaint Form available at each clinic as your written complaint.

3.  Investigation of the complaint will begin within three working days after receipt.

4.  Within five working days, the patient will receive notification by letter or telephone that their complaint is under investigation.

5.  The Clinical Operations Administrator will have 15 working days to resolve the complaint or to make a recommendation to the Karuk Tribal Health Board.

6.  The patient may submit their complaint to the Karuk Tribal Health Board only after receiving an unsatisfactory response from the Clinical Operations Administrator.  Call the Tribal Administration Office at 530-493-1600 and ask to be placed on the agenda for a Tribal Health Board meeting.

Patient Responsibilities

    1. Appointments:
    Patients are responsible for keeping their appointments at the scheduled time, and for notifying the clinic 24 hours in advance, if unable to keep an appointment.

The patient is responsible for checking in with the receptionist before being seated in the lobby, and providing truthful and accurate information regarding their medical history, current problem, complaint, medication, advanced directive, billing, and personal information or identification.

If the patient does not understand his/her medical or dental condition or treatment plan, it is the patient’s responsibility to ask questions until satisfaction is achieved.

    2. Care Instructions:
    The patient is responsible for following his/her individualized treatment plan, whether he/she is being treated at the medical or dental clinic or at home, and to take medications as directed by his/her provider.

If the patient does not understand his/her medical or dental condition or treatment plan, it is the patient’s responsibility to ask questions until satisfaction is achieved.

The patient understands it is his/her responsibility to find a responsible adult to transport patient home when indicated by his/her provider, and remain with the patient for 24 hours if necessary.

    3. Pain Management:
    It is the patient’s responsibility to help the provider assess your pain, and to tell your provider when your pain is not relieved.  It is the patient’s responsibility to participate in alternative therapies as pain relief options, and to follow your individualized Pain Management Plan, which may include a Pain Management Contract for Opioid treatment.

It is the patient’s responsibility to discuss with your provider any worries you have regarding your pain, complications, or treatments.  If you do not understand your condition, treatment or plan, it is your responsibility to ask questions.

It is the patient’s responsibility to comply with your provider’s instructions and/or pain contract.  It is the patient’s responsibility to understand non-compliance will not be permitted in regards to treatment with controlled substances. 

    4. Dental Complications:
    It is the patient’s responsibility to notify his/her dental provider whenever dental problems exist, and to follow scheduled emergency hours listed in the patient handbook.  It is the patient’s responsibility to wait to be seen between scheduled visits when he/she appears for an emergency and is instructed that he/she needs to be seen.

It is the patient’s responsibility to follow instructions or treatment plan, whenever medical conditions require evaluation or treatment prior to receiving dental services. 

Dental patients are responsible for keeping teeth clean by brushing and flossing daily or as instructed.

    5. Patient Conduct:
    It is the patient’s responsibility to wait in the clinic waiting area until called.  While waiting, it’s the patient’s responsibility to be courteous, kind, and considerate to other patients waiting to be seen. 

It is the patient’s responsibility to control their children and keep them quiet, and while parent or surrogate is being treated to seek care for the children prior to his/her visit.  It is a parent’s responsibility to understand that staffs are unable to watch children during clinic hours. 

It is the patient’s responsibility to conduct them selves in an orderly manner, and to understand that voiced or physical hostility will not be tolerated under any circumstances.

It is the patient’s responsibility to be respectful and considerate to all staff members.

It is the patient’s responsibility to understand that disruptive behavior will be cause for refusal of services.   Services may be continued, at a later time, if proper behavior has been established.

Advanced Directives Policy

PURPOSE.     To provide a mechanism for our patients, 18 years or older, to give directions about their future medical care or designate another person(s) to make medical decisions about accepting or refusing life sustaining treatment.

POLICY.     The Karuk Tribal Health & Human Services Program (KTHHSP) shall provide staff to assist in the formulation of an advanced directive utilizing an established form that meets California State requirements.

Employees of the KTHHSP may not represent any client as a witness to an advanced directive unless they are related to the client.

The health care providers, the Community Health Representatives (CHR’s) and the Elder’s Workers shall receive training in the formulation of advanced directives.

KTHHSP shall honor all Durable Power of Attorneys or Living Wills if initiated in California and completed appropriately.

When indicated, transfer (referral) information will state that an advanced directive is on file and may be obtained upon request.



Notify health care provider, CHR or Elder’s Worker when a request for assistance to formulate an advanced directive has been made.

The health care provider, CHR or Elder’s Worker shall schedule an appointment with the patient and provide the following instructions:

  • Discuss plan with attending physician. Tell them they have the right to be told:
  • The nature of the illness in words they can understand
  • The pros and cons of the proposed treatment
  • The risk of not taking recommended treatments
  • Alternative treatments available
  • Bring name, address, and telephone number of person(s) you wish to name as your agent and/or alternative agent.
  • Discuss desires or wishes for future health care.
  • Ask patient to return with witnesses or to contact a California Notary Public.  Witnesses must not be a patient’s agent, health care provider or facility or employer of such.  At least one witness must not be related by blood, marriage, or adoption, or entitled to any part of the estate upon the death of the patient.
  • Ask patient to bring a California Driver’s License or DMV Identification Card or current/issued within the last five years, U.S. Passport.

Completion of the Legal Advanced Directive Form.        

  • Review all material on the legal form with the patient during formulation of the directive.
  • Patient signs his/her name appointing an agent.  Write or type name, address and telephone number of agent.
  • Patient initials box or circles if statement reflects desires.
  • Add other statements of medical treatment desires or limitations in space provided.
  • List names, addresses, and telephone numbers of alternate agents.
  • Patient signs.
  • Witnesses are shown patient identification and then are asked to sign in space provided for first and second witness.
  • If patient is in a skilled nursing facility, a patient advocate or Ombudsman must sign.
  • If witnesses are not used, then complete the certificate of acknowledgment of Notary Public.
  • Make six copies of the original and place one in the patient health record.  Give the other copies to the patient and ask him/her to give them to their agent and/or family members.

Receipt of Patient’s Advanced Directive formulated elsewhere.

  • A staff formulator (health care provider, CHR, Elder’s Worker) will review all incoming advanced directives for appropriateness.  If not completed appropriately, return form to patient.
  • If completed appropriately, send to medical records.

Receipt of Advanced Directives.

  • All completed advanced directives will be submitted to medical records, but will be reviewed by the patient’s health care provider prior to becoming a permanent part of the medical record.
  • Advanced Directives will be filed in the miscellaneous section of the medical record.
  • The medical record clerk will enter that an advanced directive is located in the medical record by entering “Adv.Dir.” on page 8 of the RPMS patient registration document.  Entering M1 Adv .Dir., M2 Adv. Dir., or M3 Adv. Dir. will inform the providers or medical records personnel that the advanced directive is located in the medical record at the Yreka, Happy Camp, or Orleans Medical Clinic.

Information and Considerations


Must be a California resident, at least 18 years, of sound mind, and acting of own free will.


Only become effective when patient is no longer able to make his/her own health care decisions.        

Exceptions to Implementation.   

While patient is able to give informed consent; when Durable
Power of Attorney has expired; if divorced from spouse acting as your agent; or if not completed as required by California law.


  • Avoiding prolonged pain and suffering

  • Being treated with respect

  • Remaining at home as long as possible

  • Believing life is sacred

  • Becoming a burden to your family

  • Being comfortable when you’re dying

  • Being treated in accordance to your religious beliefs and traditions.


By California and Federal law you have a right to make the
following decisions about your healthcare.

  • To decide what medical care or treatment to accept, reject or discontinue.

  • To name someone to make healthcare decisions for you.

  • To make your decisions known to your doctor or hospital.

  • To have your rights respected.


You never know what can happen during an injury or illness. If you suffered irreversible brain damage, permanent coma or a terminal illness causing unconsciousness, your opportunity
to communicate your wishes is gone.



  • You are not required to have an advanced directive  and you will still receive medical care.

  • You may cancel or change your advanced directive  by destroying the original document, writing and dating a new one, and providing copies to your
    appropriate parties.

  • A lawyer is not required to assist you in making out your advanced directive, but may be helpful to you.

  • Store your advanced directive in a safe place where  family members or representative can find them.

  • Post DNR order where EMT personnel or ambulance can easily locate it (in signed envelope on refrigerator).


  • Life Support

  • Tube Feeding

  • Kidney Dialysis

  • Respirator

  • CPR

  • IV’s

  • Antibiotics

  • Cancer Therapy

  • Transfusion

  • Diagnostic Test

  • Uniform Gift Act


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