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PRINTED 07/13/2017 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION X1 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER JAY COUNTY HOSPITAL X4 ID PREFIX TAG A. LABORATORY DIRECTOR S OR PROVIDER/SUPPLIER REPRESENTATIVE S SIGNATURE STATE FORM TITLE 5RPS11 X6 DATE If continuation sheet 1 of 1. BUILDING X3 DATE SURVEY COMPLETED B. WING 005029 NAME OF PROVIDER OR SUPPLIER X2 MULTIPLE CONSTRUCTION 04/13/2017 STREET ADDRESS CITY STATE ZIP CODE 500 W VOTAW...
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Jay County Hospital is a healthcare facility located in Jay County, Indiana.
Patients who receive treatment or services at Jay County Hospital may be required to file certain medical and insurance forms.
Patients can fill out Jay County Hospital forms either on paper or online through the hospital's patient portal.
The purpose of Jay County Hospital is to provide medical care and services to the community.
Information such as personal details, medical history, insurance information, and treatment received may need to be reported on Jay County Hospital forms.
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