Patient Forms and Documents
We realize a hospital stay can be stressful and overwhelming. Our dedicated team work collaboratively (physicians, nurses, technicians, dietitians, volunteers, administration and members of the support staff) to help make your stay as comfortable as possible.
The following forms and documents will be beneficial to you, should you need to get information from your medical record or wish to provide care information to your family and medical caregivers.
Want to email a patient? See here for an electronic e-card you can send to friends and family.
Authorization for Release of Medical Information
To request copies of your medical records, please fill out the Patient Request for Access to Protected Health Information form. Download a form HERE. Completed forms can then be faxed to Benefis Medical Records at 406.455.4998 or mailed to:
Benefis Health System
Medical Records Department
1101 26th Street South
Great Falls, MT 59405
For more information, please call Benefis Medical Records Department at 406.455.5642. Fax us at 406.455.4998.
No one likes to think about the end of life, but having the discussions with a spouse, significant other or relatives can help you plan so that end of life occurs according to your wishes. This planning should include putting your wishes in writing and assigning a specific person or persons to make healthcare or final decisions for you when or if you are not able to make such decisions yourself.
Providers Orders For Life-Sustaining Treatment (POLST) are instructions (orders) from your provider to emergency responders concerning the level of care you prefer if the emergency responders find you unable to guide them. The POLST form should go with you wherever you go for medical treatment. Many people with POLST forms pin them to their refrigerator doors with a magnet when they are at home, in case they are unable to give them to emergency responders themselves. One should attach to the back of your POLST form a copy of your durable power of attorney and directive to providers, (also called a “living will, 5 Wishes document”).
Five Wishes Document
Five Wishes is the first living will that discusses your personal, emotional and spiritual needs as well as your medical wishes. It lets you choose the person you want to make healthcare decisions for you if you are not able to make them for yourself. Five Wishes lets you say exactly how you want to be treated if you get seriously ill. This easy to use document can be completed online and once it is filled out and properly signed it is valid under the laws of Montana. Click Here to complete an online version.
Our web partner HEALTHWISE provides a wealth of information on advance directives, such as:
- Writing an Advance Directive
- Care at the End of Life
- Choosing a Health Care Agent
- Should I receive Artificial Hydration and Nutrition?
- Should I receive Cardiopulmonary Resuscitation (CPR) and Artificial Ventilation?
- Should I stop Kidney Dialysis?
- Should I stop Life-Prolonging Treatment?
Benefis Hospitals honors any advance directive that is properly written and signed.