Get In01 Registration - Saint Francis Health System

Completing the IN01 Registration form for Saint Francis Health System is essential for ensuring accurate patient information and seamless medical care. This guide provides straightforward, step-by-step instructions to help you fill out the form online with confidence.

Follow the steps to properly complete the registration form.

1. Click ‘Get Form’ button to access the IN01 registration form and open it in your preferred online editor.
2. Begin filling in the patient information section. Enter the patient's name as it appears on legal documents, including last, first, and middle name. Then, provide the date of birth and race from the provided options.
3. Input the patient's contact details, including their telephone number, email address, and physical address. Make sure to include the city, state, and zip code.
4. Specify the patient's marital status by selecting the appropriate option. Include the patient's social security number for identification.
5. Provide information about the primary care physician, including their name and telephone number. Also, fill out the patient's employment details and occupation.
6. Enter the guarantor's information if it differs from the patient. This includes the guarantor's name, social security number, and relationship to the patient.
7. Complete the emergency contact information, detailing the name, relationship, and contact number for the individual to reach in case of emergencies.
8. Fill in the primary and secondary insurance details. Include the insurance company name, address, and relevant contact numbers, along with the group and certificate numbers.
9. Read and acknowledge the notice of privacy practices. This is crucial for understanding how your medical information will be handled.
10. Finally, review all entries for accuracy, then sign and date the form. Save your changes, and choose to download, print, or share the completed registration form as needed.

Complete your IN01 registration form online today to ensure a smooth health care experience!