Southern Ute Indian Tribe

Eligibility

Who Is Eligible For Services?

American Indians/Alaska Natives from federally recognized tribes are eligible for direct services. Direct services include services provided by Southern Ute Tribal Health Department (SUTHD) that are available on-site, unless otherwise noted.

How do I Register?

1. New patients must submit a Patient Registration Packet and copies of all required documentation.
2. A complete Patient Registration Packet must be received prior to scheduling your first appointment.
3. Once all required documents are received, they will be reviewed for determination of eligibility. This process normally takes two to three business days but can be expedited in case of a true medical emergency.
4. Newborn children and new patients with an emergency may be able to be seen immediately when documents cannot be provided.  If documents are not provided within 90 days, charts will be inactivated.
5. As soon as eligibility is determined, the applicant will be notified by mail or phone.
6. Patient Registration Packets are available on this website and at all SUTHD locations. Please call us if you would like to receive a Patient Registration Packet by mail.
7. Additional consent forms and authorizations may be required onsite.

Required Documentation

To access direct services available through the Tribal Health Department, all patients must provide:

1. Certificate of Indian Blood (CIB) or other verifiable Tribal document from a Federally recognized Tribe acknowledging membership or descent
2. Driver’s license or other government-issued photo ID such as a passport

To verify eligibility for all potential Tribal Health services (including PRC funds), all patients must provide:

1. Certificate of Indian Blood (CIB) or other verifiable Tribal document from a Federally recognized Tribe acknowledging membership or descent
2. Driver’s license or other government-issued photo ID such as a passport
3. Birth certificate
4. Proof of residence
5. Social Security number

*All individuals that seek care through the Southern Ute Tribal Health Department are required to apply for the governmental benefits for which they qualify; which include but are not limited to:

• VA Benefits
• Medicare
• Medicaid
• Other

If you need assistance applying for other benefits, call the business and tribal health benefits office.

Forms

Patient Registration Forms

Both packets should be completed and brought or mailed to the front desk of the facility at which you are trying to make an appointment.

• Patient Registration Packet
• Patient Registration Health Questionnaire

Fill out these forms to have another facility send medical information to SUHC or for SUHC to send medical information to another facility

From Outside Facility To Southern Ute Facility	From Southern Ute Facility To Outside Facility
To Health Center	From Health Center
To Behavioral Health	From Behavioral Health
To Business and Health Benefits

Fill out this form if you need to change or give permission for the healthcare team to share medical information with a family member or friend

• Patient Authorization Form

Forms may be mailed, faxed, or e-mailed to:

Attn: Medical Records
c/o Southern Ute Tribal Health Department

69 Capote Dr
PO Box 899
Ignacio, CO 81137

Fax: 970-563-0206

suhc_frontdesk@southernute-nsn.gov

Patient Rights

As a patient, you have the right to:

• Be treated with respect, consideration, and dignity in a safe and secure environment.
• Be treated with respect and regard for privacy, individuality, personal values, beliefs, spiritual and cultural traditions.
• Receive information regarding your health status, diagnosis, prognosis, the course of treatment, the benefits and risks of treatment, and the prospects for good health in terms you can understand.
• Personal privacy and confidentiality. Consultation, examination, treatment and case discussion are confidential and will be conducted discreetly.
• Receive timely and quality, evidence-based care in a setting appropriate to health care needs.
• Receive referrals to staff and services in a timely manner consistent with quality professional practice.
• Know the professional status and name of the person(s) directing and/or providing care and those giving medical advice after hours.
• Participate in decisions affecting your care and treatment according to your desires, needs, and understanding including the choice to have family and friends participate in the process.
• Refuse care, treatment and services, to the extent permitted by law. You will be fully informed of possible consequences of such refusal.
• The right to receive care within the scope of services provided by the Health Center.
• Be informed of specialized services at other clinics or hospitals.
• Submit an Advance Directive and appoint someone to make health care decisions for you if you are unable to. If you do not have an Advance Directive, we can provide you with information and help you complete one. All patients’ rights apply to the person whom you elect.
• Express satisfaction regarding services rendered and to comment and make suggestions for improvement of the quality of care and services.
• File a complaint and to receive a response in a timely manner without fear of discrimination.
• Access your medical records, approve and refuse the release of your medical records. Records are maintained private and confidential in a safe and secure environment.
• Know, in advance of services, the cost of services and any applicable payment policy.
• Refuse the presence of healthcare students or refuse to participate in research/experimental activities.
• Change your provider if other qualified practitioners are available.

Patient Responsibilities

As a patient, you have the responsibility to:

• Participate in discussions and decisions regarding your health care.
• Provide complete and accurate information about your health and medical history, including present condition, past illnesses, hospitalizations, any medications, including over-the-counter products, traditional healing remedies, dietary supplements, illicit substances, and any allergies or sensitivities.
• Follow your provider’s health care instructions or inform provider if you cannot or will not follow the treatment plan.
• Accept consequences for refusing care or not following treatment plan.
• Discuss your health care problems, concerns, and personal needs with your provider in an honest manner and to inform the health care provider of any changes occurring in your health.
• Come to all appointments drug and alcohol free. Patients believed to be under the influence may be asked to leave.
• Cooperate with all health care personnel involved in your care and to conduct yourself in a polite and respectful manner.
• Respect the rights of your health care provider and to exchange information in a non-abusive manner either physically or verbally while receiving care.
• Show consideration and respect the rights and property of all health care professionals, employees, and other patients.
• Make and keep all scheduled appointments. To assure that all patients are served in a timely manner, patients are responsible for calling and changing appointments 24 hours in advance.
• Maintain continuity of care with their Primary Care Teams in accordance with Patient Centered Medical Home model.
• Provide patient registration with accurate, complete and current information pertaining to insurance coverage, physical address, telephone number, social security number, and verification for eligibility of services.
• Advise your provider of all changes in decisions concerning advance directives and/or persons designated by you to make health care decisions.
• Apply for all alternative health payment benefits, i.e..: Medicaid, Medicare, VA benefits, employer or private insurance.

HIPAA

Patient Confidentiality – HIPAA

Southern Ute Tribal Health Department (SUTHD) is dedicated to preserving our patient’s trust. SUTHD complies with all applicable laws and regulations, including the Health Information Portability and Accountability Act of 1996 (HIPAA). SUTHD employees and contractors owe a duty to its patients and stakeholders to act in a way that will merit the continued trust and confidence of the public. Our continued success is dependent upon your trust.

All patients must sign an Acknowledgement of Receipt of Privacy Practices. The SUTHD Notice of Privacy Practices outlines how information about you may be disclosed. We encourage our patients to carefully read this important document.

If you decide you would like to share your protected health information with another individual or healthcare facility, you will need to sign the appropriate release of information form.

If you need medical information sent to or from a Southern Ute Facility, please fill out the appropriate forms that can be found under the Forms Tab.

Patient Handbook

• Online Patient Handbook

Monthly

We are closed in the afternoons (12p-5p) every 1^st Thursday of the month.

Holiday Closures

Tribal Health offices will be closed on the following dates:

1/2/23 – New Year’s Day
1/16/23 – Martin Luther King Jr.
2/20/23 – President’s Day
5/29/23 – Memorial Day
6/19/23- Juneteenth
7/3/23-7/4/23 – Independence Day
9/4/23 – Labor Day
10/9/23- Indigenous Peoples Day
11/10/23 – Veteran’s Day
11/23-11/24/23 -Thanksgiving
12/11/23- Leonard C. Burch Day
12/25/23 – Christmas Day

Helpful Links

• American Academy of Pediatrics
• American Dental Association
• American Diabetes Association
• American Heart Association
• Centers for Disease Control and Prevention
• Family Doctor
• Med Line Plus
• Mouth Healthy (by ADA)
• Substance Abuse and Mental Health
• WebMD
• What to Expect During Pregnancy

Surveys and Reviews

• Patient Satisfaction Survey
• Please take the time to review us on Google! Leave a Google Review

Feedback

To provide formal feedback or to file a complaint, please complete the Tribal Health Department Feedback Form. The form will be reviewed by the Support Services Manager and routed to the appropriate supervisor who will investigate and provide a response to the complainant within 10 business days.

Tribal Health Department Feedback Form (fillable)  Fill out online, save, and email directly to the Support Services Manager at suhc_hsm@southernute-nsn.gov.

Tribal Health Department Feedback Form (printable)  Print, fill out, and return to the Support Services Manager at the Southern Ute Health Center office.