Translate:
EN
Translate:
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 mkenton@kcmh.net.
2022 Financial Assistance Application (docx)
DownloadSolicitud de Asistencia Financiera (pdf)
DownloadEnglish Financial Assistance Program and Collection Policy - 2022 Update (pdf)
Download2022 Financial Assistance Application Spanish (pdf)
Download2022 Plain Language Summary Spanish (pdf)
Download2022 Plain Language Summary (pdf)
Download2022 Programa de asistencia financiera y política de cobranza (pdf)
DownloadCopy of Appendix A (pdf)
DownloadAPPENDIX B 2022 (pdf)
DownloadAPPENDIX C 2022 (pdf)
DownloadAPÉNDICE C (pdf)
DownloadCopyright © 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 program.intake@usda.gov
The next regular board meeting will be held on Friday, December 16, 2022 at 9:30 am.
This website uses cookies. By continuing to use this site, you accept our use of cookies.