Please fill out the PDF form below to request more information about Johnson County Community Health Services – Home Healthcare programs and services. The information you provide will be sent to our home healthcare team, who will respond to your request and address your questions/concerns. Do not use this form in a medical emergency of any kind.

Authorization to Disclose Health Information to JCCHS (PDF Download)

If you are requesting home healthcare services for either yourself or a loved one, please note that submitting this form does not mean care will automatically begin. Specific criteria must be met for home health care services to start, and a physician authorization is required.

If you are a physician or are from a physician’s office and are seeking care for a patient, please call us at (660) 747-6121.