For questions or more information please contact our Health Information Management Department (HIM) at 618-443-2177, ext. 3336.

Click the buttons below to download your Patient Forms

Patient’s Toolkit for Diagnosis >>

The Patient’s Toolkit for Diagnosis can be picked up at your providers office.  It is created for people who are not feeling well or visiting their doctor or nurse with a health concern. It has a set of prompts and questions to help you participate and partner with your medical care team – doctors, nurses, and other health care professionals and support staff.

Adult Patient Form >>

The Patient Intake form provides Sparta Community Hospital with important personal information about your health history and individual healthcare needs.

NEW Pediatric Patient Form >>

The Pediatric Patient form provides Sparta Community Hospital with important personal information about your child’s health history and individual healthcare needs.

Authorization for Access >>

This form allows you to give an authorized representative access to your personal health information through the patient portal.

Non-Patient Portal Consent Form >>

This form is your request for access to your own health information via a patient portal account.

Hospital Authorization to Disclose Health Information >>

Complete this form to request Sparta Community Hospital to send your medical records to another person or organization.

Clinics Authorization to Disclose Health Information >>

Complete this form to request a Quality Health Care Clinic send your medical records to another person or organization.