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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)
DownloadAll 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
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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
The next regular board meeting will be held on Friday, June 25, 2021 at 9:30 am.
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