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Medical Records
Kansas Health Information Exchang
e

If you wish to restrict access to your records through the exchange, you must submit a restriction request to the Kansas Health Information Exchange, Inc. Contact the KHIE Support Center at (785) 783-8984 or visit www.khie.org for more details. Even with restricted access, your information may still be available to authorized individuals when required by law, such as for reporting communicable diseases or suspected abuse incidents.

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For your protection, each restriction request undergoes verification procedures. Please allow adequate time for processing. Incomplete information may lead to delays or denial of your request.

Records Release

If you need copies of your medical records, please download and completely fill out the provided form. Ensure it is signed and dated by you or your legal representative. Once completed, you can fax or mail the form, and our Health Information Management (HIM) Department will contact you.

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Mail to: Kiowa District Hospital

HIM Department

1002 S. 4th, PO Box 184

Kiowa, KS 67070-1825

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In-Person Return: Clinic Front Desk

Fax: (620) 825-4667

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