Campbell County Health is dedicated to providing prompt processing of all
medical record requests while ensuring that all medical information is
disclosed in accordance with federal and state laws in Gillette, Wyoming.
Patient Forms
For your convenience, please print and fill out all applicable forms and
present them when you arrive for your visit.
Learn more
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.
You have the right to give instructions about your own healthcare. You
also have the right to name someone else to make healthcare decisions
for you. The Advance Healthcare Directive form lets you do either or both
of these things.
Learn more about an advance directive and download a form (directions included)
Online Medical Record: My Health Home
CCH's My Health Home allows you to access your medical record online for free.
My Health Home offers Campbell County Memorial Hospital and Campbell County
Medical Group patients quick and private 24-hour access to their inpatient
hospital personal health information. From any device with internet access,
you can view your hospital records on this secure, password-protected website.
Learn more about My Health Home
All staff will maintain the individual’s right to confidentiality
when processing and releasing Protected Health Information (PHI). Medical
records maintained by CCMG clinics are confidential and legal documents
that cannot be disclosed to anyone without the consent of the patient
with the exception of the required reporting of certain information to
state and federal agencies. As a patient you have a right to obtain a
copy of his or her medical record, or ask that a copy be sent to a new doctor.
Below is information on how to receive your medical record in print.
Complete the Release of Information Form in its entirety.
Download form
Photo ID is required to release records.
With appropriate authorization Individuals will be allowed to pick up records
for their spouse or adult children over age 18
Printed CCMH medical records
All staff will maintain the individual’s right to confidentiality
when processing and releasing Protected Health Information (PHI). Medical
records maintained by the hospital are confidential and legal documents
that cannot be disclosed to anyone without the consent of the patient
with the exception of the required reporting of certain information to
state and federal agencies. The Medical Practice Act allows for a patient
to obtain a copy of his or her medical record, or ask that a copy be sent
to a new doctor. A written consent from the patient or the minor patient’s
parent or legal guardian must specify the information needed, the purpose
for the release, and the name of the person the information is to be released to.
Below is information on how to receive your medical record in print.
Fee for release of information is $.015 per page.
Release of records requires a 48-hour notice. Call 307-688-1300 Monday-Friday
from 8 am-4 pm to request release of information. Saturday-Sunday the
office is closed.
Photo ID is required to release records.
Notice to copy lengthy records requires up to 5 days.
Individuals may not pick up records for their spouse or adult children
over age 18.
Find Health Information Services / Medical Records at:
Campbell County Memorial Hospital
501 S. Burma Avenue, First Floor
Gillette, Wyoming 82716
Phone: 307.688.1300
