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Medical Records Request
Community Care
Community Health Needs Assessment
The DAISY Award
Medical Records Request
- 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
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 2022 assessment is available to the right by clicking on the link. Also provided for your convenience are our 2019 and 2016 Community Health Needs Assessment Implementation Plan, as well as the 2019, 2016 and 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 it 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.
| 2022 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA | |
| Persons in family/household | Poverty guideline |
| 1 | $13,590 |
| 2 | $18,310 |
| 3 | $23,030 |
| 4 | $27,750 |
| 5 | $32,470 |
| 6 | $37,190 |
| 7 | $41,910 |
| 8 | $46,630 |
| For families/households with more than 8 persons, add $4,720 for each additional person. | |
Online Community Care Application
The discount will apply to all services received at the clinic and hospital, but not those services or equipment that are purchased from outside, including reference laboratory testing, medications, and x-ray interpretation by a consulting radiologist, and other such services. This form must be competed every 12 months or if your financial situation changes.
DAISY Award
