KCMH Financial Assistance

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)

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Solicitud de Asistencia Financiera (pdf)

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English Financial Assistance Program and Collection Policy - 2022 Update (pdf)

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2022 Financial Assistance Application Spanish (pdf)

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2022 Plain Language Summary Spanish (pdf)

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2022 Plain Language Summary (pdf)

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2022 Programa de asistencia financiera y política de cobranza (pdf)

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Copy of Appendix A (pdf)

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APPENDIX B 2022 (pdf)

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APPENDIX C 2022 (pdf)

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APÉNDICE C (pdf)

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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

KCMH Financial Assistance

payment options

Partnership with PayZen

KCMH Financial Assistance

payment options

Partnership with PayZen

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