Medical Records

Your medical record contains documentation of the healthcare services you have received at Clay County Medical Center. These records help ensure continuity of care and may be shared with authorized healthcare providers, insurance companies, attorneys, or other individuals as permitted by law and your authorization.

What's Included in Your Medical Record?

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Medical records may include:

• Diagnoses

• Imaging studies (X-rays, MRIs, CT scans, etc.)

• Laboratory results

• Diagnostic testing

• Treatments and procedures

• Provider notes and medical observations

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Records may be maintained in paper, electronic, or hybrid formats.

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Request Your Medical Records

Clay County Medical Center maintains a federally compliant Authorization for Release of Health Information form. Authorization for Release of Health Information form allows you to specify which records you would like released and who is authorized to receive them.

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Patient Forms

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Authorization for Release of Health Information

• English Version (PDF)

• Spanish Version (PDF)

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Authorization for Release of Verbal Protected Health Information (PHI)

• Authorization of Release of Verbal Protected Health Information Form English (PDF)

• Authorization of Release of Verbal Protected Health Information Form Spanish (PDF)

 

Authorization To Request Health Information From Outside Provider/Facility

• Authorization To Request Health Information From Outside Provider/Facility Form English (PDF)

• Authorization To Request Health Information From Outside Provider/Facility Form Spanish (PDF)

 

Consent for Minors

• Consent for Minors Form English (PDF)

• Consent for Minors Form Spanish (PDF)

 

Daycare Physical Forms

• Daycare Physical Form English (PDF)

• Daycare Physical Form Spanish (PDF)

 

New Patient Health History Form

• New Patient Health History Form (PDF)

• Health Questionnaire Form Spanish (PDF)

 

Mental Health Client Intake Form

• Mental Health Client Intake Form English (PDF)

• Mental Health Client Intake Form Spanish (PDF)

 

Patient Registration Form

• Patient Registration Form English (PDF)

• Patient Registration Form Spanish (PDF)

 

Sports Physical Forms - Kansas State High School Activities Association

• Sports Physical Form English (PDF)

• Sports Physical Form Spanish (PDF)

 

Student Health Assessment Forms

• USD 379 (PDF)

• USD 379 (docx)