Patient Forms & Policies

Day Kimball Hospital | Forms & Policies

Inpatient Admissions Packet 

Day Kimball Hospital Authorization to Release Medical Records Form 
This form must be presented at the Day Kimball Hospital Medical Records Office along with proof of identification in order to obtain records.

Notice of Privacy Practices


Day Kimball Medical Group | Forms & Policies

No Show Policy

Notice of Privacy Practices

Receipt of Privacy Notice

Consent for Basic Treatment

Authorization for Release of Information

Permission to Share

Day Kimball Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, are deaf or hard of hearing, language assistance services are provided free of charge. Call (860) 928-6541 ext. 2342 or ext. 2229; for TTY, dial 711 and ask to be connected to (860) 928-6541 ext. 2342 or ext. 2229.