Forms

Forms & Documents

The following are frequently used documents and forms from Bates County Memorial Hospital (BCMH). These are available for you to download and fill out, or to review. Please bring the appropriate forms with you when you visit BCMH as a patient.

Advance Directives and Durable Power of Attorney

• English – Download: Advance Directives and Durable Power of Attorney
• Español – Descargar: Directivas anticipadas y poder notarial duradero

Conditions of Admission

• English – Download: Conditions of Admission
• Español – Descargar: Condiciones de admisión

Financial Assistance Application

• English – Download: Financial Assistance Application
• Español – Descargar: Solicitud de asistencia financiera

Authorization for Release of Protected Health Information (Medical Records)

Authorization for Release of Protected Health Information (Medical Records)

 

Family Care Clinic patients

New Patient Orientation Packet

New FCC Patient Paperwork

Now that you are 18

Consent For Treatment of a Minor Brochure