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Attention: Stormont Vail Health is dedicated to ensuring timely medical care to our communities. With the expected inclement weather this weekend, please visit the Extreme Weather Updates page to ensure we can best serve you.

Patient Forms

Influenza Vaccine

Consent for Flu Vaccine English | Spanish

Flu Vaccine Information English | Spanish

Other Forms

Birthplace Pre-Registration | Español

Authorization to Disclose-Obtain Health Information | Español

Living Will

Durable Power of Attorney

Patient Accommodation Request Form

Patient Amendment Request Form

Patient Restriction Request Form

Patient Audit Request Form

Pre-Hospital Do Not Resuscitate (DNR) Forms

Parental Authorization for Medical Treatment | Español

MyChart Diminished Capacity | Español

Notice of Privacy Practices | Aviso de Normas de Privacidad

Care Everywhere Notice and Opt-Out_Opt-In Request Form

Special Contact: Minor (English)

Special Contact: Minor (Spanish)

Special Contact: Adult (English)

Special Contact: Adult (Spanish)

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1500 SW 10th Ave.
Topeka, KS 66604
(785) 354-6000

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