Day Kimball Hospital | Forms & Policies

Inpatient Admissions Packet (opens a PDF in a new tab) 

Day Kimball Hospital Authorization to Release Medical Records Form (opens a PDF in a new tab) 
This form must be presented at the Day Kimball Hospital Medical Records Office along with proof of identification in order to obtain records.

Notice of Privacy Practices (opens a PDF in a new tab)

Day Kimball Medical Group | Forms & Policies

No Show Policy (opens a PDF in a new tab)

Notice of Privacy Practices (opens a PDF in a new tab)

Receipt of Privacy Notice (opens a PDF in a new tab)

Consent for Basic Treatment (opens a PDF in a new tab)

Authorization for Release of Information (opens a PDF in a new tab)

Permission to Share (opens a PDF in a new tab)

Day Kimball Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, are deaf or hard of hearing, language assistance services are provided free of charge. Call (860) 928-6541 ext. 2342 or ext. 2229; for TTY, dial 711 and ask to be connected to (860) 928-6541 ext. 2342 or ext. 2229.