Patient Forms

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

Campbell County Medical Group Forms

CCMH Department Forms

CCMH Medical Records Forms

If you have any questions call 307-688-1300 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).

Advance Healthcare Directive

All adults can benefit from thinking about what their healthcare choices would be if they are unable to speak for themselves. It’s not an easy conversation to have, but your decisions can be written in a document called an advance directive so others know what they are. Learn more

Birth Certificate

State of Wyoming Vital Statistics Services: To order a birth certificate if you were born in the state of Wyoming, visit:
https://health.wyo.gov/admin/vitalstatistics/
Other state certificates: 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

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