Patient Rights

Please click on the links below to view KCMH patient policies. Kiowa County Memorial Hospital does not discriminate with regard to patient admissions, room assignment, patient services, or employment on the basis of race, color, national origin, gender, religion, disability, or age. If assistance or communication aids for impaired hearing, vision, speech, or manual skills are needed, KCMH will make reasonable accommodations.

If you believe that Kiowa County Memorial Hospital or Greensburg Family Practice has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the Hospital Administrator, Kiowa County Memorial Hospital 721 W. Kansas Avenue, Greensburg, Kansas 67054 (620) 723-3341 administration@kcmh.net. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Hospital Administration is available to help you.

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at 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.

Patient Rights and Responsibilities (PDF)
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Non-Discrimination Policy (PDF)
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Section 1557 Notice (PDF)
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Visitation Policy (PDF)
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Grievance Complaint Policy (PDF)
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NOTICE OF PRIVACY PRACTICES (PDF)
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Release of Health Records

If you would like to request copies of your medical records, please download the file below and fill it out completely. You can then fax or mail the completed form and someone from our HIM department will contact you.

Fax Number: (620) 723-2195

Mail Form: Kiowa County Memorial Hospital

Attention HIM Department

721 W. Kansas Ave.
Greensburg, KS 67054

Authorization for Release of Information (PDF)
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