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  • Home
  • Your Hospital District
    • Volunteer Services
      • Grand River Hospital District Volunteer Association (GRHDVA)
      • Meals on Wheels
        • March for Meals
        • Blizzard Bags for Grand River Meals on Wheels Recipients
    • Report to Our Communities
    • Giving Opportunities
    • Grand River Hospital District Map
    • Community Information
    • Board of Directors
      • Board of Director’s Meeting Agendas
      • Board Meetings Schedule
    • Administrative Directors
    • News
    • Videos
  • Services
    • Grand River Health – Rifle
    • Grand River Health – Battlement Mesa\Parachute
  • Care Center
  • Provider Search
  • Patients and Visitors
    • Billing and Insurance
      • Commitment to Charity Care
      • Costs of Common Healthcare Needs
      • Discounts and Options
    • Colorado End-of-Life Options Act
    • Facility Maps
    • Forms
    • Grand River Health Patient Portal
    • Local Resources
    • Patient-Centered Medical Home
    • Release My Health Records
    • Rights & Privacy
      • How to File a Complaint
      • Non Discrimination Statement
      • Patient Rights and Responsibilities
    • Visitation by Support Persons, Family Members and Visitors
    • 2022 Community Health Needs Assessment
    • Household Medication And Sharps Takeback Program
  • Careers
    • Jobs
    • Living In Rifle
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Forms

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All forms are in Downloadable Printable PDF format.

Grand River Health Medical Records
(Health Information Management)
Release of Medical Information

Fax to 970.625.2752

Phone: 970.625.6412

English
Spanish
English
  1. Clinic New Patient Form
  2. HIPAA Form
  3. Clinic Medical Records Release
  4. Neurosurgery New Patient Forms English
  5. General Surgery New Patient Form
  6. Child History Questionnaire English
  7. Orthopaedic New Patient Forms
  8. Women’s Health Questionnaire
  9. Consent to Treat a Minor
  10. Mens Health Questionnaire
  11. CIIS questions
  12. Wound Care Intake Form
  13. Podiatric New Patient Form
  14. Sports Clearance Exam Form
  15. Rehab Balance Confidence Scale Form
  16. Rehab Dizziness Handicap Inventory
  17. Rehab LEFS Form
  18. Rehab Low Back Pain Form
  19. Rehab Neck Disability Form
  20. Rehab Pain Sheet
  21. Rehab QuickDash Form
Spanish
  1. Formularios para pacientes nuevos en la clínica
  2. Formularios para HIPAA
  3. Divulgación de expdientes médicos de la clínica
  4. Formularios para pacientes nuevos del Neurosurgery
  5. Pacientes nuevos de cirugía general
  6. Cuestionario del historial del niños
  7. Formularios para pacientes nuevos de ortopedia
  8. Cuestionario de salud femenina
  9. Consentimiento para tratamiento de menores
  10. Cuestionario de salud masculina
  11. Preguntas del SIIC
  12. Tratamiento de heridas
  13. Cuestionario de la Escala de Equilibrio
  14. IDM
  15. Cuestionario del Dolor de Cabeza
  16. Cuestionario de las Extremidades Inferiores
  17. Cuestionario del Dolor Lumbar
  18. Cuestionario del Discapacidad de Cuello
  19. Cuestionario del Dolor
  20. Cuestionario de QuickDash
  21. Formularios De Evaluacion Física
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  • Hospital: 970.625.1510
  • Appointments: 970.625.1100
  • 501 Airport Rd. Rifle, CO 81650
  • Contact Directory

Heart Health

July 9, 2024

Connecting our Communities Heart Health Heart health is a popular topic these days, but it’s complex and can be difficult to understand. Ask anyone if they’re interested in keeping their

Read More »

Nourishing Insights: Understanding Eating Disorders

February 8, 2024

Connecting our Communities Nourishing Insights: Understanding Eating Disorders . Join Drew Schelling and Sabina Cotter from Grand River Health’s Changing Lifestyles department to learn about the various types of eating

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Antibiotic Stewardship Program

July 11, 2023

Connecting our Communities Understanding Antibiotic Stewardship Antibiotics revolutionized modern medicine, transforming the treatment of bacterial infections and saving countless lives. However, their misuse and overuse have led to a rise

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COVID-19 Vaccination Information
Events Calendar
35 events found.
  • July 2025

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Grief Support Group
Grief Support Group
July 1 @ 8:00 am - 5:00 pm
Grief Support Group

Grand River Health offers on-going grief support for individuals who are dealing with the loss of a loved one. We offer a way to connect those who are going through […]

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Grief Support Group
heart in the trees
July 15 @ 5:30 pm - 6:30 pm
Grief Support Group

Grand River Health offers on-going grief support for individuals who are dealing with the loss of a loved one. We offer a way to connect those who are going through […]

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July 1 @ 8:00 am - 5:00 pm

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July 15 @ 5:30 pm - 6:30 pm

Grief Support Group

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View Calendar

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