Patient Forms, Policies & Guides
Important patient forms along with reference to LMH Health policies are provided below for your convenience. Forms are provided in PDF format and can be viewed with Adobe Acrobat Reader.
Important patient forms along with reference to LMH Health policies are provided below for your convenience. Forms are provided in PDF format and can be viewed with Adobe Acrobat Reader.
| Patient Forms | 20 Documents |
| Patient Resources | 1 Document |
| Policies | 9 Documents |
| Acknowledgment of Receipt of LMH Notice of Privacy Practices | |
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Description
The LMH Health Notice of Privacy Practices provides information about how we may use and disclose protected health information about you.
Owner
Health Information Management Systems (HIMS)
Last Updated
11/4/2020
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| Authorization for Medical Care of Child | |
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Description
Form that authorizes the treatment of a child.
Last Updated
6/7/2024
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| Birth Certificate Request | |
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Description
Instructions on how to obtain a copy of a birth certificate.
Last Updated
3/18/2019
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| Consent to Treat Form | |
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Last Updated
3/18/2019
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| Consent to Treatment of Minors | |
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Description
Complete for patients under 18 years old.
Last Updated
6/7/2024
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| Consentimiento Para Tratamiento (Spanish) | |
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Description
Estoy bajo el cuidado y la supervisión de mi médico responsable o designado y es responsabilidad de LMH y su personal llevar a cabo las instrucciones de estos médicos, dentistas u otros profesionales de la salud aliados.
Owner
Health Information Management Systems (HIMS)
Last Updated
10/14/2019
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| Consumer Civil Rights | |
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Last Updated
10/21/2016
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| Daisy Award for Extraordinary Nurses | |
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Description
The DAISY award rewards and celebrates extraordinary clinical skill and compassionate care given by nurses everyday.
Last Updated
4/8/2013
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| Ethnicity Questionnaire | |
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Description
Ethnicity Questionnaire
Last Updated
3/18/2019
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| Financial Assistance Application - English | |
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Last Updated
12/1/2020
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| Financial Assistance Application - Spanish | |
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Owner
Patient Accounts
Last Updated
12/1/2020
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| Interpretive Services Notification | |
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Owner
Compliance
Last Updated
10/17/2016
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| LMH Advance Directives | |
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Description
Advance Directive forms that help patients make informed health care choices.
Last Updated
6/25/2014
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| Medical Records Release - English | |
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Owner
Health Information Management (HIMS)
Last Updated
4/12/2023
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| Medical Records Release - Spanish | |
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Owner
Health Information Management (HIMS)
Last Updated
4/12/2023
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| Notice of Privacy Practices | |
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Description
LMH Notice of Privacy Practices
Last Updated
7/19/2019
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| Patient Bill of Rights | |
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Description
LMH Patient Bill of Rights
Last Updated
7/15/2013
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| Patient Registration Form | |
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Last Updated
3/18/2019
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| Reconocimiento de Recibo de Aviso de Prácticas de Privacidad de LMH | |
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Description
La notificación del LMH Health de prácticas de privacidad proporciona información acerca de cómo podemos utilizar y divulgar su información protegida de salud.
Owner
Health Information Management Systems (HIMS)
Last Updated
10/11/2019
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| Request to Amend Medical Record | |
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Description
Download this form to update your medical record at LMH Health.
Owner
Health Information Management Systems (HIMS)
Last Updated
5/7/2021
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| Care Coordination Resource Guide | |
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Description
Download this helpful guide for community resources.
Last Updated
10/15/2019
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| Code of Conduct | |
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Owner
Compliance
Last Updated
2/28/2023
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| Consumer Civil Rights | |
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Last Updated
10/21/2016
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| Gifts, Gratuities, Business Courtesies Policy | |
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Description
This document explains the Gifts, Gratuities, Business Courtesies Policy at Lawrence Memorial Hospital
Last Updated
2/24/2015
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| Interpretive Services Notification | |
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Owner
Compliance
Last Updated
10/17/2016
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| Notice of Privacy Practices | |
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Description
LMH Notice of Privacy Practices
Last Updated
7/19/2019
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| Patient Bill of Rights | |
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Description
LMH Patient Bill of Rights
Last Updated
7/15/2013
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| Requesting Public Records | |
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Last Updated
2/11/2020
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| Terms of Use | |
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Last Updated
4/9/2013
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| Visitor Policy | |
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Last Updated
4/9/2013
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