Client and Patient Forms
All Medicaid Recipients Accepted | Same-Day Admissions | Free Consultation
Please click on the forms below to print them out. If you have any questions or concerns about the form please call Kina’ole Case Management at (808) 396-1620 for more information.
B2B Hawaii Advance Directive Form
Download & Print
Physician's Order for Life-Sustaining Treatment Form
Download & Print
Written Declaration of Surrogate - Lack of Capacity Form
Download & Print
Request a Consultation
Fill out this short form and a Kina'ole Case Management representative will contact you within 2-3 business days. If you need immediate assistance, please call (808) 369-1620.