Forms
Use this comprehensive list of Citizens Health forms to complete admissions, financial assistance applications and other aspects of your care. If you do not find the form you require, please call us at (785) 462-7511.
Citizens Medical Center
Authorization for Release of Health Information
DNR – Do Not Resuscitate Directive
Medical Records Request Form – Incoming
Medical Records Request Form – Outgoing
Medical Records Request Form Incoming – Español
Medical Records Request Form Outgoing – Español