Patient Forms

Advance Directives

Advance Directives are documents written in advance of serious illness that state your choices for health care, or name someone to make those choices, if you become unable to make decisions. Through advance directive, such as living wills and durable powers of attorney for health care, you can make legally valid decisions about your future medical treatment. Examples of Advance Directives are available at the Admission Desk.

Privacy Notice

The Notice of Privacy Rights and Practices is provided to inform you of how your confidential health information may be used and shared, and how you can obtain access to this information.  The Notice of Privacy Rights and Practices also provides you with information regarding your privacy rights. 

Admission Forms

If you come in for an inpatient procedure, our Admission staff will have these forms available to you. They are also here for you to look at in advance. You may view and print off these pdf versions.

Charity Care Guidelines

The Business Office Manager will assume overall responsibility for the administration of the charity care program of Johnson County Hospital. All formal requests by patients with outstanding accounts will be forwarded to the Business Office Manager for determination.

Patient Satisfaction Survey

Our Inpatient Satisfaction Survey is a tool we use to identify the positives and negatives of your hospital stay with us. We strive to give you the best patient care we can and appreciate your honest feedback.

Limited English Proficiency (LEP) Policy

Nondiscrimination Policy

Johnson County Hospital does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy, contact:

Section 504 Coordinator: Mary Kent, Johnson County Hospital Administrator
Phone Number: (402) 335-3361
TDD/State Relay Number: (800) 833-7352