---
title: Yoakum County Hospital | Forms & Additional Information
description: Download forms & get more information about Yoakum County Hospital's team, proudly serving West Texas and Eastern New Mexico with five trusted facilities.
image: https://opengraph.b-cdn.net/production/images/606ed075-2625-4ce6-b016-8a13ff8bb941.png?token=GYy4Sbq5pUJhmCJFP5ViOb6M4EZMZHNNOY1nPMWVudA&height=628&width=1200&expires=33267425229
---

[![YCH Header Logo](https://ych.us/hubfs/raw_assets/public/website-theme/images/ych-full-color-logo.png) ![YCH Header Logo Transparent](https://ych.us/hubfs/b156a901d2bdec0fe41ef962000ffef491ad4f82.png)](https://ych.us/?hsLang=es-us)

- [About Us](https://ych.us/about?hsLang=es-us)
- [Our People](https://ych.us/our-people?hsLang=es-us)
- [Our Facilities](https://ych.us/facilities?hsLang=es-us)
- [Patient Forms](https://ych.us/patient-forms?hsLang=es-us)
- [Price Transparency](https://us.flow-prod.boomi.com/f2a4d421-8a52-4b09-8a4c-8476aae2d651/play/ptt?flow-id=55c677ad-57f7-4e47-b22f-19d1bb1871bd&flow-version-id=1c9a934c-0b86-4339-84c3-2e713f995ea6&hospital-id=52)

[Contact Us](https://ych.us/contact-us?hsLang=es-us)

- [About Us](https://ych.us/about?hsLang=es-us)
- [Our People](https://ych.us/our-people?hsLang=es-us)
- [Our Facilities](https://ych.us/facilities?hsLang=es-us)
- [Patient Forms](https://ych.us/patient-forms?hsLang=es-us)
- [Price Transparency](https://us.flow-prod.boomi.com/f2a4d421-8a52-4b09-8a4c-8476aae2d651/play/ptt?flow-id=55c677ad-57f7-4e47-b22f-19d1bb1871bd&flow-version-id=1c9a934c-0b86-4339-84c3-2e713f995ea6&hospital-id=52)

[Contact Us](https://ych.us/contact-us?hsLang=es-us)

![](https://ych.us/hubfs/contact-us-pattern.png)

# Forms & Additional Information

##### Main Forms

[![Vector](https://ych.us/hubfs/Vector.svg) Price Transparency](https://us.flow-prod.boomi.com/f2a4d421-8a52-4b09-8a4c-8476aae2d651/play/ptt?flow-id=a91f6d2f-a3ad-4257-9185-99463fe7c6a3&flow-version-id=691a537c-ea37-41a1-96ba-24e7272b0047&hospital-id=103) [![Vector (1)](https://ych.us/hubfs/Vector%20(1).svg) Standard Charges](https://ych.us/hubfs/Standard-Charges-List-Yoakum-County-Hospital.xlsx?hsLang=es-us) [![Vector (2)](https://ych.us/hubfs/Vector%20(2).svg) No Surprise Act](https://ych.us/hubfs/Disclosure-Notice-Regarding-Patient-Protections-Against-Surprise-Medical-Billing.pdf?hsLang=es-us)

##### Additional Forms

[Hospital Charges Transparency 2019](https://ych.us/hubfs/Hospital-Charges-Transparency-2019.xlsx?hsLang=es-us) [YCH Survey Questions](https://ych.us/hubfs/survey.pdf?hsLang=es-us) [Community Health Needs Assessment](https://ych.us/hubfs/YOAKUM-COUNTY-HOSPITAL-CHNA-2022%20(1).pdf?hsLang=es-us) [Universal Medications Forms (English)](https://ych.us/hubfs/universalmed.pdf?hsLang=es-us) [Universal Medications Forms (Spanish)](https://ych.us/hubfs/universalSpanish.pdf?hsLang=es-us) [Laboratory Wellness Program (English)](https://ych.us/hubfs/WP-ad-english-May-17-2023-1.docx?hsLang=es-us) [Laboratory Wellness Program (Spanish)](https://ych.us/hubfs/WP-May-17th-SPANISH.docx?hsLang=es-us) [Hospital Charges Disclaimer](https://ych.us/hubfs/Hospital-Charges-Disclaimer.pdf?hsLang=es-us) [Charity Care Application](https://ych.us/hubfs/Charity-Care-Application-1.pdf?hsLang=es-us) [Charity Care Policy + Procedure](https://ych.us/hubfs/Charity-Policy-Yoakum-County-Hospital-Policy-Procedure-2024-1.pdf?hsLang=es-us) [AblePay - Simple Health Savings](https://ablepayhealth.com/yoakumweb/)

#### Our rural hospital specializes in going the extra mile.

### How Can We Help You?

[Contact Us](https://ych.us/contact-us?hsLang=es-us)

[![Footer Logo](https://ych.us/hubfs/raw_assets/public/website-theme/images/ych-full-color-logo.png)](https://ych.us/?hsLang=es-us)

[Careers](https://ych.us/careers?hsLang=es-us) [Facilities](https://ych.us/facilities?hsLang=es-us) [Contact](https://ych.us/contact-us?hsLang=es-us) [Price Transparency](https://us.flow-prod.boomi.com/f2a4d421-8a52-4b09-8a4c-8476aae2d651/play/ptt?flow-id=a91f6d2f-a3ad-4257-9185-99463fe7c6a3&flow-version-id=1c1ee65c-1ada-473e-bde2-3aa7100683ac&hospital-id=52)

[![Facebook Link](https://ych.us/hubfs/raw_assets/public/website-theme/images/Facebook.png)](https://www.facebook.com/yoakumcountyhospital/)

 Copyright © 2025 Yoakum County Hospital | All Rights Reserved | [Privacy Policy](https://ych.us/hubfs/YCH-Code-of-Conduct.pdf?hsLang=es-us) | Crafted by [Primitive](https://www.leadwithprimitive.com)

```json
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  "@type" : "Organization",
  "address" : {
    "@type" : "PostalAddress",
    "addressCountry" : "",
    "addressLocality" : "",
    "postalCode" : "",
    "streetAddress" : ""
  },
  "description" : "",
  "logo" : "",
  "name" : "",
  "sameAs" : [ "", "", "" ],
  "url" : ""
}
```