At-Large Health Management / Insurance Program Application PacketA blank At-Large Health Management/Insurance Program (ALHM/IP) application and a
release of information form to be completed and returned.
Food Distribution ApplicationApplication for the Food Distribution Program on Indian Reservations (FDPIR)
Patient Complaint FormIf you have a concern about the services you received through the Ho-Chunk Nation Health
Care facilities, please complete this form and return to Quality Improvement Director.
Purchased / Referred Care ApplicationThe Purchased / Referred Care Application and a Medical Release form. The application requires a yearly update and also an update whenever reported information changes.