Hardin County General Hospital
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Hardin County General Hospital

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filler@godaddy.com

  • Home
  • Patient Portal
  • Current Prices
  • Job Openings
  • About Us
  • Contact Us
  • Financial Assistance
  • CHNA
  • Medical Staff
  • Clinic
  • Hospital Services
  • Hospital News
  • Quality Improvement
  • Compliance
  • Employee Portal

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  • My Account

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Forms

Hospital Wide Table of Contents (pdf)Download
Absenteeism Form (pdf)Download
Application for Employment (pdf)Download
Bomb Threat (pdf)Download
Confidentiality Agreement (pdf)Download
Continuing Education/In-service Form (pdf)Download
Delay of Service Form (pdf)Download
Disciplinary Form (pdf)Download
Education Referral Form (pdf)Download
Employee Counseling Form (pdf)Download
Employee Incident (pdf)Download
Employee Physical (pdf)Download
Employee’s Request for Days off (Vacation/Personal) (pdf)Download
Employee’s Request for Leave of Absence (pdf)Download
Fall Incident (pdf)Download
Health Status Form (pdf)Download
Important Message from Medicare Form (pdf)Download
Important Message Letter (pdf)Download
Independent Contractors Orientation Check List (pdf)Download
Independent Contractors - Orientation Packet (pdf)Download
Internet Access Agreement (pdf)Download
Interrupted Lunch Form (pdf)Download
Letterhead (doc)Download
Miscellaneous Incident (pdf)Download
Missed Punch Form (pdf)Download
Medication Incident (pdf)Download
New Hire Physical (pdf)Download
Notice of Privacy Practices (pdf)Download
Orientation Form (pdf)Download
Outdate Logs (pdf)Download
Good Faith Estimate manual form (docx)Download
Grievance Policy (doc)Download
Grievance Report (docx)Download

Patient Referral Form

Outpatient Treatment Record (pdf)Download
Outpatient Procedure Follow-up Report (pdf)Download
Patient Complaint Form (pdf)Download
Patient Referral Form (pdf)Download
Policy Changes Form (pdf)Download
QI Process Idea Form (pdf)Download
Record Of Warning (pdf)Download
Release Of Information (pdf)Download
Reference Reply Form (pdf)Download
Supply/Equipment Request (pdf)Download
VESSA Leave Of Absence (pdf)Download
Work Order Request (pdf)Download

Annual Review For CAPR

Download PDF

 

Hardin County General Hospital

P.O. Box 2467

6 Ferrell Rd

Rosiclare, IL 62982

Phone: 618-285-6634

Fax: 618-285-3564

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