Last updated: 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.
Please note: This notice is provided as a starting template written in plain language. Before publishing or relying on it, Clara Community Health Center should have it reviewed by a qualified attorney to confirm it meets all applicable federal (including HIPAA, 45 CFR Parts 160 & 164) and Oklahoma state requirements for the clinic's specific operations.
1. Website Privacy
This website is an informational resource for our community. We aim to collect as little information as possible from visitors.
- We do not require you to create an account or log in to use this site.
- We do not sell, rent, or trade any information about our visitors.
- If the site uses basic analytics to understand general traffic (such as page views), that data is aggregated and does not identify you personally.
- Any third-party links (for example, our social media pages) are governed by those services' own privacy policies, not ours.
The patient forms offered on this website are provided as a convenience so you can complete them before your visit. When you fill out a form on this site and print or save it, the information you type stays in your web browser on your own device. It is not transmitted to us or stored on any server through this website. You bring the completed, printed form with you to the clinic.
Because this website is not a secure medical records system, please do not email completed forms containing sensitive health information or identifiers. Bring them in person, or contact us for guidance.
For your protection, the online version of the Patient Verification Form does not collect your Social Security Number. If that information is needed, you will provide it in person at the clinic.
3. Your Health Information
When you receive care at the clinic, we create and keep a record of the care and services you receive. We understand that this information is personal, and we are committed to protecting it. This notice applies to the records of your care generated by the clinic and its volunteers.
4. How We Use Your Information
We may use and disclose your health information for the following purposes:
- Treatment. To provide, coordinate, or manage your health care with our volunteer providers and, when appropriate, with other providers to whom you are referred.
- Eligibility & operations. To confirm your eligibility for no-cost care, to run the clinic, and to improve the quality of the services we offer.
- As required by law. When federal, state, or local law requires it — for example, certain public health reporting.
- Public health & safety. To prevent or reduce a serious threat to anyone's health or safety, or to support public health activities such as communicable disease reporting.
5. When We May Share Your Information
We will not share your health information with others except as described in this notice or as you authorize in writing. When you ask us to release records to a person or organization you name, please understand:
- Once we disclose your health information at your request, we cannot guarantee that the recipient will not re-disclose it. The recipient may not be required to follow the same privacy laws we follow.
- You may request in writing at any time to inspect and/or obtain a copy of your health information maintained at the clinic, as provided in the Federal Privacy Rule, 45 CFR §164.524.
- Your records are protected and cannot be disclosed without your written permission, except where the law permits or requires it.
- An authorization you sign remains in effect for the period stated on it (by default one year from signing, unless otherwise noted) or until you provide written notice of revocation to the clinic.
6. Your Rights
You have the right to:
- Inspect and request a copy of the health information we hold about you.
- Request a correction to information you believe is incorrect or incomplete.
- Request restrictions on certain uses and disclosures of your information.
- Receive a list of certain disclosures we have made of your information.
- Request confidential communications (for example, by a specific phone number).
- Receive a paper copy of this notice on request, even if you agreed to receive it electronically.
- Revoke a prior written authorization, except to the extent we have already acted on it.
7. How We Protect Your Information
We maintain reasonable physical, administrative, and procedural safeguards designed to protect the personal and health information in our care. Access to patient records is limited to volunteers and staff who need it to serve you. Volunteers are expected to keep patient information confidential.
8. Consent & Authorization
By receiving care at the clinic, you acknowledge that the information you provide about your eligibility, income, and health is true and complete to the best of your knowledge. Providing false information may result in disqualification from the clinic's services. Your participation in care and any referral is voluntary, and care from our volunteer providers is offered at no charge to you.
If you have questions about this notice, want to exercise any of your rights, or believe your privacy rights have been violated, please contact us. You will not be penalized in any way for filing a complaint.
You may also have the right to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, if you believe your health-information privacy rights have been violated.
Disclaimer: The information on this website, including all forms and guidance documents, is provided for general informational purposes and does not constitute medical or legal advice. It is not a substitute for professional care. In a medical emergency, call 911.
