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 records 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
Morgan Allison
721 W. Kansas Ave
Greensburg, KS 67054

Records Request Policy 2022 (PDF)
Download

Records Release Request Form (PDF)
Download