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 307.688.1301 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).
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.
State of Wyoming Vital Statistics Services: To order a birth certificate
if you were born in the state of Wyoming, visit:
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
Need Adobe Reader?
Click here to download it for free.