Forms

Below is a list of the most common forms are used at Campbell County Memorial Hospital. Please complete and print them, then bring with you for your visit.

If you have any questions call 307.688.1301 or fax 307.688.1390. Please note that CCMH maintains records for 10 years from date of service for adults. CCMH maintains records until the child reaches age of majority plus 10 years.

Release of Information Form
The Release of Information Form must be completed in its entirety before any medical records can be released. (All highlighted areas, if filling release out online). The patient's signature and a copy of their photo ID is also required, along with a witness signature. (It can be anybody over the age of 18).
Birth Certificate - VitalCheck.com
If you have any questions concerning Vital Records/Birth Certificates please contact Vital Records at 307.777.7591 or visit them at www.vitalcheck.com
Wyoming Advance Healthcare Directive Form

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