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  • Home
  • About
    • About
    • Events
    • Leadership
    • Newsroom
    • Community Health
    • Contact Us
  • Hospital
    • Hospital Care
    • Outpatient Care
    • Specialty Care
    • Our Specialty Doctors and Providers
    • Wound Clinic
    • Visitor Information
    • Patient Disclosures
    • Patient Financial Assistance Information
    • Hospital Pricing & Charges
  • Family Medicine
    • Holton Family Medicine
    • Behavioral Health Services
    • Hoyt Family Medicine
    • Wetmore Family Medicine
    • Providers
    • Patient Forms
  • Weight Loss Management
  • Home Health
  • Hospice
  • Careers
    • Careers
    • Volunteer Program
  • Online Bill Pay
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Menu
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  • About
    • About
    • Events
    • Leadership
    • Newsroom
    • Community Health
    • Contact Us
  • Hospital
    • Hospital Care
    • Outpatient Care
    • Specialty Care
    • Our Specialty Doctors and Providers
    • Wound Clinic
    • Visitor Information
    • Patient Disclosures
    • Patient Financial Assistance Information
    • Hospital Pricing & Charges
  • Family Medicine
    • Holton Family Medicine
    • Behavioral Health Services
    • Hoyt Family Medicine
    • Wetmore Family Medicine
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Release of Information Authorization

Patient Registration Form

Confidential Health History Form

Confidential Health History Form Spanish


Pediatric Health History


Pediatric Health History Spanish

No Show Policy Holton

2021 Family Medicine Treatment Authorization

Meeting with Patient

1110 Columbine Drive
Holton, KS 66436
785-364-2116 

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About Us

  • History
  • Mission
  • Values
  • Newsroom
  • HCH Leadership
  • HCH Auxiliary
  • HCH Board of Directors
  • HCH Foundation
  • Patient and Family Advisory Council (PFAC)
  • History
  • Mission
  • Values
  • Newsroom
  • HCH Leadership
  • HCH Auxiliary
  • HCH Board of Directors
  • HCH Foundation
  • Patient and Family Advisory Council (PFAC)

Services

  • Advanced Wound Healing Clinic
  • Cardiovascular Services
  • Emergency
  • Home Health
  • Hospice
  • Imaging Services ​
  • Laboratory Services
  • Medication Infusions and Injections​
  • Outpatient Infusion Therapy ​
  • Radiology Services
  • Rehabilitation Services
  • Senior Life Solutions
  • Specialty Clinics
  • Swing Bed And Skilled Nursing Services
  • Weight Loss Management
  • Advanced Wound Healing Clinic
  • Cardiovascular Services
  • Emergency
  • Home Health
  • Hospice
  • Imaging Services ​
  • Laboratory Services
  • Medication Infusions and Injections​
  • Outpatient Infusion Therapy ​
  • Radiology Services
  • Rehabilitation Services
  • Senior Life Solutions
  • Specialty Clinics
  • Swing Bed And Skilled Nursing Services
  • Weight Loss Management

Patient Info

  • Financial Assistance Policy Plan
  • Financial Policy
  • Hospital Pricing and Charges
  • Kansas Health Information Technology Sharing
  • Non-Discrimination Policy
  • Notice of Privacy Practice
  • Release of Information
  • Visitor Information
  • Patient Forms
  • Financial Assistance Policy Plan
  • Financial Policy
  • Hospital Pricing and Charges
  • Kansas Health Information Technology Sharing
  • Non-Discrimination Policy
  • Notice of Privacy Practice
  • Release of Information
  • Visitor Information
  • Patient Forms

Locations

  • Holton Community Hospital
  • Holton Family Medicine
  • Hoyt Family Medicine
  • Wetmore Family Medicine
  • Holton Community Hospital
  • Holton Family Medicine
  • Hoyt Family Medicine
  • Wetmore Family Medicine

Newsroom

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  • COVID-19 Update
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