Kansas Health Information Exchange
KDH participates in the electronic exchange of health information with other health care providers and health plans in the State of Kansas through an approved health information organization. Unless you direct otherwise, your electronic health records will be accessible through the exchange to properly authorized users for purposes of treatment, payment, and health care operations only.
If you want to restrict access to your records through the exchange, you must submit a request for restriction through the Kansas Health Information Exchange, Inc. Contact the KHIE Support Center at (785)783-8984 or visit for more information.
Even if you restrict access, your information still will be available through the exchange by a properly authorized individual as necessary to report specific information to a government agency as required by law (for example, reporting of certain communicable diseases or suspected incidents of abuse)
For your protection, each request for restrictions is subject to verification procedures. Please allow sufficient time for your request to be processed. Your failure to provide all information required for verification may result in additional delay or denial of your request.
If you would like to request copies of your medical records please download the file and fill it out completely.
The form is to be signed and dated by the patient or legal representative. You can then fax or mail the completed form and someone from our HIM Department will contact you.
Fax Number: (620)825-4667
Mail To: Kiowa District Hospital
1002 S. 4th, PO Box 184
Kiowa, KS 67070-1825
Return To: Clinic Front Desk