Norton County Hospital's Health Information Management (HIM) department is responsible for processing, indexing and filing all medical records.
Our services specifically include:
If you are a current patient in the hospital, you may ask your nurse to provide you with a request form authorizing the release of your medical information. If you are not currently a patient, you may print and complete the appropriate form below releasing your medical record to either yourself or to a third party such as an attorney, caregiver or life insurance company.
Authorization for Release of Medical Information
Please note: The form must be signed by a person of authorization of the released information, such as the individual patient, parent or guardian, or personal representative.
Please mail or fax the form to:
Norton County Hospital
P.O. Box 250
Norton, KS 67654
Fax: 785-877-3093
A fee may be charged for cost of copying records. Read more specifics below.
Continuing Care: In most cases, we will not impose a fee when sending your records to another healthcare provider who is involved in your care. Please enter the name and address of the provider where you would like records to be sent on the authorization form.
Other Purposes: For other requests, our average cost-based fee is $12 per request. In some cases, the costs to copy or produce records may exceed this fee, and we will attempt to communicate the anticipated cost in advance. If a third party is requesting your records, like an attorney, we will work with the person requesting your records on the fees that will be charged.
Monday - Friday 7:30 a.m. to 4:30 p.m.
If coming to the hospital in person to access your medical records, please enter through the hospital’s east main entrance (look for the long covered walkway). Once inside, turn left to access the main lobby, and tell the front desk representative that you would like to obtain your medical records. Feel free to park in the hospital's main lot adjacent to Hwy 36.
For more information, contact:
Whitney Criqui
Manager, Health Information Management
Phone: 785-877-3351
Fax: 785-877-3093
Email: wcriqui@ntcohosp.com