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)


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:


Administrator's Office

Mary Sweet, Information Officer

721 W. Kansas Ave

Greensburg, KS 67054