Mt. Grant General Hospital Notice of Privacy Practices (revised 09/23/2013). This notice describes how medical information about you may be used, disclosed, and how you can get access to this information.
Patients wishing to share their patient or health information with another physician, attorney, company, or individual must complete an Authorization for Release of Patient Information form.
Patients may complete an application for financial assistance. Approval is based on annual household income and family size in accordance with the expanded Federal Poverty Guidelines established by the Centers for Medicare and Medicaid (CMS) specifically for the state of Colorado, Arizona, Wyoming, Nebraska, Nevada and California.
Division of Welfare and Supportive Services Application for Assistance. Please print, complete and return to the local welfare office.