CO Good Samaritan Hospital Pre-Registration Form 2015-2025 free printable template

Due Date: OB Doctor: Return form during your Center for Childbirth tour or mail to: Good Samaritan Medical Center, 200 Exemplar Circle, Lafayette, Colorado 80026 Attention: Patient Registration Department

How to fill out good samaritan hospital doctors

How to fill out CO Good Samaritan Hospital Pre-Registration Form

1. Visit the CO Good Samaritan Hospital website or obtain a physical copy of the Pre-Registration Form.
2. Provide your personal information including full name, date of birth, and contact details.
3. Fill out your insurance information, including the provider name and policy number.
4. List any allergies or medical conditions you have.
5. Include the name and contact information of your primary care physician.
6. Specify the reason for your visit or the procedure you are scheduled for.
7. Review the form for accuracy and completeness.
8. Submit the form online or return it to the hospital's admissions office, as instructed.

Who needs CO Good Samaritan Hospital Pre-Registration Form?

1. Patients who have scheduled procedures or appointments at CO Good Samaritan Hospital.
2. Individuals obtaining treatment requiring insurance processing.
3. Patients who want to expedite their admission process.

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What is CO Good Samaritan Hospital Pre-Registration Form?

The CO Good Samaritan Hospital Pre-Registration Form is a document that patients fill out prior to their medical visit to prepare for their treatment and streamline the registration process.

Who is required to file CO Good Samaritan Hospital Pre-Registration Form?

Patients who are planning to undergo a procedure, surgery, or any service at CO Good Samaritan Hospital are required to file the Pre-Registration Form.

How to fill out CO Good Samaritan Hospital Pre-Registration Form?

To fill out the CO Good Samaritan Hospital Pre-Registration Form, patients should provide personal information, insurance details, and any relevant medical history as required by the form.

What is the purpose of CO Good Samaritan Hospital Pre-Registration Form?

The purpose of the CO Good Samaritan Hospital Pre-Registration Form is to collect necessary information from patients in advance to expedite the registration process and ensure smooth admission for treatment.

What information must be reported on CO Good Samaritan Hospital Pre-Registration Form?

The information that must be reported on the CO Good Samaritan Hospital Pre-Registration Form includes the patient's personal details, insurance information, emergency contact, medical history, and any specific needs related to the planned treatment.