If you would like to apply for financial assistance, please complete the form below. Once completed, contact Misty Kenton at Kiowa County Memorial Hospital business office (620)723-3341, or by email at firstname.lastname@example.org.
2022 Financial Assistance Application (docx)Download
Solicitud de Asistencia Financiera (pdf)Download
English Financial Assistance Program and Collection Policy - 2022 Update (pdf)Download
2022 Financial Assistance Application Spanish (pdf)Download
2022 Plain Language Summary Spanish (pdf)Download
2022 Plain Language Summary (pdf)Download
2022 Programa de asistencia financiera y política de cobranza (pdf)Download
Copy of Appendix A (pdf)Download
APPENDIX B 2022 (pdf)Download
APPENDIX C 2022 (pdf)Download
APÉNDICE C (pdf)Download
Kiowa County Memorial Hospital is pleased to announce that we have partnered with PayZen
PayZen offers affordable payment options, so you can now pay your bill over time with no interest or fees. Enrollment is fast, easy, and automated, with customized payment plans that work for your budget.
If you have an outstanding balance greater than $250 and would like to enroll in a payment plan, sign up at kcmh.payzen.com
Copyright © 2022 Kiowa County Memorial Hospital - All Rights Reserved.
Notice of Privacy Practices. This institution is an equal opportunity provider and employer.
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at email@example.com
The next regular board meeting will be held on Friday, April 24, 2023 at 9:30 am.