Get Online Pre-registration Available At Wwwnorthsidebcomb

This guide provides step-by-step instructions for completing the online pre-registration form required for your upcoming hospital admission. By following these instructions, you can ensure a smooth and efficient pre-registration process tailored to your needs.

Follow the steps to successfully complete your online pre-registration form.

1. Click 'Get Form' button to obtain the form and open it in the designated editor.
2. Fill in the patient information section. Provide the patient's full name as it appears on their government-issued identification, along with their middle name if applicable, Social Security number, birthdate, race, and ethnicity.
3. Indicate the expected date of delivery and the last menstrual period. This information is essential for scheduling and preparing for the patient’s care.
4. Complete the family contact information. List a contact person's name, their relationship to the patient, and their contact details.
5. In the financial responsibility section, ensure you provide accurate information regarding the policy holder, including their name, employer, and employment status.
6. Provide the admitting physician’s name, as well as the primary care physician’s and pediatrician’s names and phone numbers.
7. Fill in the language preference section to inform the hospital of your preferred language for medical communication. If you need an interpreter, indicate 'yes' or 'no'.
8. Review the acknowledgment of financial responsibility and privacy practices. You may need to sign the declaration at the bottom of the form.
9. Once all sections are completed, save any changes made to the form. You may also download, print, or share the form as needed.

Complete your pre-registration form online today to ensure a timely and organized admission process at Northside Hospital.