The Choctaw Tribe is the first and only tribe to develop a health delivery system to take over an existing Indian Health Service inpatient facility. The takeover was accomplished in January 1984 under the Indian Self-Determination Act through a contract with the Indian Health Service. The Choctaw Health Delivery System includes a 35-bed general medical facility, dental facilities, a community mental health center, a supplemental nutrition program, a hemodialysis treatment program, and satellite clinics in three outlying communities. The report provides an historical overview of the takeover process, including brief sections on the three planning stages. The developmental and operational phase section has 24 sub-sections covering such matters as the kinds of methods used to determine what programs would be offered, how the tribal personnel system was affected, and aspects of the 2-year Health Education/Risk Demonstration Project (including implementation of the School Health Curriculum in grades 5-6 at Bureau of Indian Affairs schools). A section on the future of the system examines the potential of a nursing home project and providing health services to non-Indians. The summary and recommendations section lists positive results of the completed take-over and shares experiences learned from the process. A bibliography, a list of abbreviations, and five exhibits close the report. (BRR)