Below you will find a library of helpful forms. Each of these is available in Adobe Acrobat PDF format. If you need the free Adobe Acrobat Reader software, you can access it here: https://get.adobe.com/reader/

Financial Forms

Medical Forms

Scholarship Application

Find My Cost Worksheet
LRGH Financial Assistance Policy
Financial Assistance Application
Employee Verification Form
Provider Listing
Plain Language Summary
Authorization to Disclose Protected Health Information
Authorization to Obtain Protected Health Information
Designation of Personal Representative
Patient Requests To Amend Protected Health Information
2020 LRGH Auxiliary Scholarship Application