Medical Forms

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The forms listed below are for our patients' convenience.

These forms can be downloaded by clicking on their titles. They are in the universal "PDF" format. If you don't already have the free Adobe Reader software (or Adobe Acrobat Reader), you can download it here.

  • Financial Assistance Form -- request form to allow I-70 Community Hospital to make a determination of patient's ability to pay for health care services provided by I-70 Community Hospital.

  • Patient Registration Form -- form to allow patients to fill out and save time before their visit to I-70 Community Hospital.
  • Medical Records Release Form -- gives permission to authorized persons to give out patient's health information under certain circumstances.

  • Durable Power of Attorney for Medical Decisions -- A form that specifies who shall make decisions about receiving care in the event the patient is unable to make them.

  • Health Care Treatment Directive-- Also called a "living will," this form gives healthcare providers guidelines about circumstances in which the patient would prefer to avoid life-extending procedures.

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