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Patient Forms

Below are several public documents regarding various policies and practices at Grays Harbor Community Hospital. If you have any questions about these forms, please contact patient advocacy at 360.537.5134.

Advance directive

An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to Grays Harbor Community Hospital, our staff will talk to you about advance directives. The directives describe what kind of care you want if you have an illness that you are unlikely to recover from or if you are permanently unconscious. Advance directives tell your doctor that you don't want certain kinds of treatment.

Download the advance directive policy for patient rights for end-of-life treatment.

Patient admission

The admitting policy for patients of Grays Harbor Community Hospital: Hospital services shall be made available to all persons, without prejudice, and shall be limited only by bed availability. The admission of patients when there are limited beds available in the community shall be based on a system which gives priority to critically ill patients.

View the admitting policy for patients of Grays Harbor Community Hospital.

Reproductive healthcare for women

Within the framework of the World Health Organization's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, Grays Harbor Community Hospital supports the sexual rights of all persons, which must be respected, protected and fulfilled.

View our policy on reproductive healthcare for women.

View the DOH Hospital Reproductive Services Form Reproductive Services Form

Financial assistance

If you were low-income at the time you or your dependent received service(s) from Grays Harbor Community Hospital and/or its partners, you may be eligible for reduction or forgiveness of your medical bill(s). This form must be printed, completed and returned.

Charity Care information English

Charity Care Schedule English
Charity Care information - Spanish
Charity Care schedule - Spanish

Financial Assistance Application Form
Financial Assistance Application Form - Spanish

Tort claims

Instructions for completing a tort claim form.
Download the standard tort claim packet.

Release of information

Complete this form to release your protected healthcare information to our quality, risk and compliance department when filing a tort claim.

Download our release of information form.

Vehicle collision form

Attach this form to your standard claim form if the claim involves a vehicle collision.

Download the vehicle collision form.

HIPAA Privacy Notice

Your information, your rights, our responsibility - This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Download the HIPAA Privacy Notice

Tax Credit Policy

Download the Tax Credit Policy

Download the Tax Credit Application


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Aberdeen, WA 98520