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Patient Policies & Forms

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Download Patient Policies & Forms (PDF downloads)

  • Financial Assistance Info - English
  • Financial Assistance Info - Spanish
  • Financial Assistance Application - English
  • Financial Assistance Application - Spanish
  • Financial Assistance Summary - English
  • Financial Assistance Summary - Spanish
  • Financial Assistance Policy
  • Acknowledgment of Receipt of Privacy Practices - English
  • Acknowledgment of Receipt of Privacy Practices Spanish
  • Patient Grievance Form - English
  • Patient Grievance Form - Spanish
  • Breastfeeding Bill of Rights - English
  • Breastfeeding Bill of Rights - Spanish
  • Health Care Proxy Instructions - English
  • Health Care Proxy Instructions - Spanish
  • Notice of Privacy Practices
  • Patient Bill of Rights - English
  • Patient Bill of Rights - Spanish
  • NYS Patient's Rights Booklet - English
  • NYS Patient's Rights Booklet - Spanish
  • Interpreter Services Brochure - English
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AUBURN COMMUNITY HOSPITAL 17 Lansing Street, Auburn, NY 13021 315-255-7011

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