Get Admission Form For Patients - Usz

Completing the Admission Form for Patients - Usz is an essential step in securing your treatment. This guide provides clear and detailed instructions to help you efficiently fill out the form online, ensuring that all necessary information is submitted accurately.

Follow the steps to complete your admission form easily.

1. Press the ‘Get Form’ button to access the Admission Form for Patients - Usz and open it in the editor.
2. Select the type of admission that applies to you: Out-patient, In-patient, or Out-patient day clinic. Make sure to check the relevant option.
3. Provide the notification details by specifying which clinic you are being admitted to and your expected admission/treatment time and date.
4. In the general details section, fill out your personal information including your social security number, insurance card number, surname, first name, maiden name, date of birth, gender, occupation, language, religion, marital status, and nationality.
5. Enter your current address information, including your domicile/residential address for tax purposes. Make sure to include your street number, postcode, town or village, canton or state, and contact numbers.
6. If applicable, provide details for other domicile or weekly commuter arrangements. Fill in the necessary contact information of the person who will be responsible for your admission.
7. Indicate your consent for the University Hospital of Zurich to collect medical information from previous doctors and medical staff by selecting 'Yes' or 'No'.
8. Provide information about your admission reason, such as illness, accident, or other specified conditions.
9. Fill in your insurance details, including the type of cover and the name of your insurance company. Include any policy numbers and exclusions relevant to your case.
10. Ensure that you have the necessary documents available, such as your identification, insurance cards, and signed admission form.
11. Review all the provided information to confirm its accuracy. Finally, you can save your changes, download, print, or share the completed form as needed.

Take the first step towards your treatment by completing the Admission Form online today.