My Chart Donate HOME BUILDING PROJECT HOSPITAL GCCC PARK PLACE ASSISTED LIVING FOUNDATION ABOUT US ABOUT US Patient Resources Explore our resources Medical Records Request Community Care Community Health Needs Assessment The DAISY Award Medical Records Request In order for our Medical Records Department to process your request for medical records please print, fill out, and sign, then either mail, fax, or hand deliver the form below. If a form is not filled out completely it will be denied. Signature of the requesting patient is required by law. If you are a Durable Medical Power of Attorney for a patient, a copy of the Power of Attorney papers must accompany this form. The standard processing time for records request is 7-10 business days. If you are requesting records be sent to you, (in accordance with N.D. Century Code Section 23-12-14) the following fee scale will apply. 10 pages or less, no charge 11-25 pages, flat fee of $20.00 $0.75 per page after the 25th page This charge includes any administration fee, retrieval fee, and postage expense. **The only exception for these charges is for Continuation of Care sent directly to another facility** If you have any questions, please contact our Medical Records Department at 701-797-2221 ext 7134 The medical records fax number is 701-797-2457 REQUEST FOR INFORMATION Below is information for North Dakotans on advanced health care planning. This document explains what an advanced directive is and how to fill out the legal paperwork, which is included. ADVANCED DIRECTIVE Community Health Needs Assessment What is a Community Health Needs Assessment? A community health needs assessment is a way for communities to identifiy, and analyze the specific health needs of their community. This assessment allows communities to prioritize their health needs, make a plan to meet those needs, and then execute the plan. Cooperstown Medical Center completes the Comminity Health Needs Assessment because it is a Critical Access Hospital (CAH) and completion of the assessment is mandated by the Affordable Care Act. All CAHs are required to complete this assessment every three years. There are mulitple ways to asses community health needs, here are a few ways: Stakeholder meetings Community focus groups Surveys Interviews with community leaders Population health and other health-related data Information taken from Center for Rural Health; University of North Dakota; School of Medicine and Health Sciences Our 2019 assessment is available to the right by clicking on the link. Also provided for your convenience are our 2016 Community Needs Assessment Implementation Plan, as well as the 2016 and 2012 Community Needs Health Assessment. 2019 Community Health Needs Assessment 2019 CMC Implementation Plan 2016 CMC Implementation Plan 2016 Community Health Needs Assessment 2012 Community Health Needs Assessment Community Care Program CMC offers assistance to help cover your facility medical costs. To apply for Cooperstown Medical Center’s Community Care program, please download the form below and return to Annie Dewald, HIM Manager/Corporate Compliance, or to the Business Office. The application for Community Care is now available to be filled out below as well. Please be aware that more information may/will be requested before approval of your application. This is a sliding scale fee policy. Download the Community Care Application or fill it out online below. ONLINE COMMUNITY CARE APPLICATION DAISY Award The DAISY Award was established by the DAISY Foundation in memory of J. Patrick Barnes who died at 33 of ITP, an auto-immune disease. The Barnes Family was awestruck by the clinical skills, caring and compassion of the nurses who cared for Patrick, so they created this national award to say thank you to nurses everywhere. SHARE YOUR STORY Phone Numbers: Main Line- (701) 797-2221 Clinic Line- (701) 797-2128 Release of Information Fax: (701) 797-2457 Address: 1200 Roberts Ave NE Cooperstown, ND 58425 Cooperstown Medical Facebook Payments My Chart PLEDGE Website design and development by Firespring