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Patient Registration

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Dear
Community Members

Haak’u Health Center is now operating as a 638 Tribal health facility since August 1, 2025. Because we are no longer part of the Indian Health Service (IHS), we must make sure we are providing care to our Native community members who qualify for our services. To do this, we need to update everyone’s information under our new Haak’u Health Center system—even if you have turned in these documents before under ACL.

We kindly ask all patients to bring or submit copies of the following:

Certificate of Indian Blood (CIB): This helps us confirm your Tribal membership.

Photo ID: This helps us make sure we have the right name and information in your record.

Birth Certificate (for anyone under 18): This helps us confirm parent or guardian information.

Marriage License (if you non-Acoma but are married to an Acoma Tribal member): This helps us confirm eligibility for PRC services through marriage.

We appreciate your understanding and cooperation as we work to strengthen and protect health services for our Native Communities. By providing this information, you help us follow Tribal and federal guidelines. We can continue to deliver safe, compliant, and community-focused care for all who rely on Haak’u Health Center for their health services.

If you need help or have questions about these documents, our Patient Registration team or Medical Records team are happy to assist you.

Respectfully,

Janay Maupin | CEO

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Patient 
Forms

Notice of Privacy and Practices

(Download)

Rights as a Patient

(Download)

Patient Responsibilities

(Download)

Patient Acknowledgement

(Download)

General Facility Consent

(Download)

Minor Consent

(Download)

Paternal Consent for Maternity Care

(Download)

Notice of Privacy Practice

(Patient signature) 

(Download)

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