Patient Info

Financial Assistance

Availability of Financial Assistance
Purcell Municipal Hospital is committed to providing financial assistance to persons who have healthcare needs and are uninsured or underinsured.  Services eligible for discount are limited to emergency and medically necessary care, including inpatient hospital stays. 

The granting of financial assistance is based on an individualized determination for financial need, and shall not take into account age, gender, race, social or immigrant status, sexual orientation or religious affiliation.  A determination of financial assistance will be effective for a period of up to 6 months from the date the application was approved and will include outstanding account balances for covered services up to 3 months prior to approval date.

Eligibility Requirements
Financial assistance is determined by analyzing the household gross income with the most current Federal Poverty Level (FPL) guidelines.  No person eligible for financial assistance will be charged more for emergency or other medically necessary care than Amounts Generally Billed (AGB) to individuals who have Medicare or other insurance covering such care. 

Where to Find Information
To apply for Financial Assistance, please choose one of the following options:

Click the link below labeled “Financial Policy and Application

Request the information by mail

Paper applications and Policy are available at the PMH Business Office or ER Registration Desk
1500 North Green Avenue, Purcell, OK  73080

Call the Business Office Monday – Friday, 8am – 4:30pm at (405) 527-2216

Financial Assistance Policy and Application Revised June 2019

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How to Apply
The application process involves filling out the financial assistance application and submitting the form and all the supporting documents to the Business Office Manager at Purcell Municipal Hospital.   

  • Completed financial assistance applications can be submitted in person or mailed to:
    Purcell Municipal Hospital
    Attn:  Business Office Manager
    PO Box 511
    Purcell, OK  73080
  • Applicants may request assistance with completing application in person.  Call (405) 527-2216 for an appointment.
  • Applications may also be faxed to the Attention of Business Office Manager at (405) 527-6963

Payment  –  Patients/Guarantors are expected to pay the amount of their account that is not eligible for assistance under the Financial Assistance Policy.  After application is approved, payment in full is expected, or a payment plan must be established.  Patients/Guarantors who fail to pay their balance within 90 days after discounts being applied will be subject to normal collection procedures.

Assistance with English/Spanish language translation is available upon request.

Health Information Management Department

The Health Information Management Department, formerly called Medical Records, oversees the management of all medical records for care provided to patients at Purcell Municipal Hospital.

H.I.M. Department Hours

Monday-Friday 8:00am – 4:30pm.
HIM Department Phone number (405) 527-2230
Fax number (405) 527-4731

Mailing Address

Health Information Management Dept.
Purcell Municipal Hospital
PO Box 511
Purcell, Oklahoma 73080

The Health Information Management Department is also responsible for the release of medical information and can assist patients in obtaining their medical record for care provided at Purcell Municipal Hospital.

The Authorization for release of Health Information can be mailed, faxed or you can personally deliver the request to the Health Information Management Department at PMH. If you do not want the records mailed to you, please indicate on your authorization that you wish to pick up the records and indicate a daytime phone number to contact once the request has been completed.

The HIM Department releases copies of patient records upon request, provided we receive a valid authorization signed by the patient or legal representative. Children over the age of 18 or under the age of 18 but considered an emancipated minor have the authority to release medical information on his/her own.

Upon request of records, please include one of the following forms of identification and necessary documents (if applicable) to validate the release of information:

Acceptable Photo IDs Include:

  • Drivers License
  • Employment ID
  • State Issue ID
  • Current School ID
  • Military ID
  • VA ID
  • Valid, Current Passport

Other Necessary Documents As Applicable:

  • Power of Attorney
  • Legal Guardianship Papers
  • Divorce Decree
  • Death Certificate
  • Executor of Estate

In some cases, you may need to allow 30 days from the date of discharge for record processing before requested copies will be available.

If you have any questions, please contact the Health Information Management Department at (405) 527-2230.