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Kiowa County Memorial Hospital

Kiowa County Memorial HospitalKiowa County Memorial HospitalKiowa County Memorial Hospital
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    • Home
    • Services
      • Emergency Services
      • Laboratory
      • Radiology
      • Physical Therapy
      • Rural Health Clinics
      • Swing Bed & Acute Care
      • Specialty Clinics
      • Conference Center
    • Patient Rights
    • Health Needs Assesment
    • KCMH Patient Portal
    • About Us
      • Mission & Values
      • Our Green Initiative
      • The Tornado
      • KCMH Boards
    • Providers
    • Financial Assistance
    • Standard Charges
    • Locations
    • Employment Opportunities
    • Records Request
    • Health Resources
      • Educational Videos
      • Asbestos.com
      • Mesothelioma.net
    • COVID-19 Self Assessment

Kiowa County Memorial Hospital

Kiowa County Memorial HospitalKiowa County Memorial HospitalKiowa County Memorial Hospital

EN

  • Home
  • Patient Rights
  • Health Needs Assesment
  • KCMH Patient Portal
  • Providers
  • Financial Assistance
  • Standard Charges
  • Locations
  • Employment Opportunities
  • Records Request
  • COVID-19 Self Assessment

Medical records request

 

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

Medical Records Release Authorization (pdf)

Download

KORA Records request

All record under the Kansas Open Records Act (KORA) must be submitted in writing.  Use of this form will assist our staff in locating the records you are requesting.  

Please return this form to:

ATTENTION: KORA Request

Administrator's Office

Mary Sweet, Information Officer

721 W. Kansas Ave

Greensburg, KS 67054

Records Release Request (pdf)Download
Records Release Policy (pdf)Download

Copyright © 2018 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 


  • Patient Rights
  • Health Needs Assesment
  • KCMH Patient Portal
  • Financial Assistance
  • Standard Charges
  • Employment Opportunities
  • Records Request
  • COVID-19 Self Assessment

KCMH Board Meeting

The next regular board meeting will be held on Friday, March 26, 2021 at 9:30 am.

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