Registration

At our hospital, we understand your time is valuable. That’s why we offer Online Pre-Registration and Scheduling. Simply, complete the 10-20 minute Online Pre-Registration Scheduling forms at least two business days prior to your scheduled appointment. Before you begin, be sure you have all of the information listed below:

• Social Security number
• Name of ordering physician
• Date of your scheduled procedure
• All insurance cards
• Employer information.

For privacy reasons, if you leave your computer idle for more than 20 minutes, your form will not be saved and you will have to begin again.

Check-in with our registration staff on the date of your scheduled service to complete the registration process. Please be advised that you will sign all consent forms during your visit.

What to Bring With You

To avoid delays at check-in, please bring the following with you on the day of your appointment:

• Your picture ID or driver’s license
• All insurance cards
• Prescription for services from your physician’s office
• List of current medications and allergies
• When appropriate, please bring with you copies of any medical notes, lab results, biopsies, X-ray results, etc.
• Your authorization or referral from your physician’s office
• If you arrive without your necessary authorization and/or referral, you will be expected to pay for your visit prior to receiving services or opt to reschedule your appointment.
• Anticipate a call from the pre-registration area to collect your required estimated financial responsibility. Unpaid co-payments and deductibles are expected to be paid at the time of your visit.

Personal Belongings

Please bring minimal personal belongings with you. You will want to leave valuables at home. The hospital is not responsible for lost or damaged personal property.

Payment

As a courtesy to you, we will file your insurance after discharge. Upon admission, you will be asked to pay a deposit to cover any estimated deductible, co-insurance or non-covered charges. If you need to make financial arrangements, please let the Pre-registration office know prior to service so as to avoid any delays on the day of service.

At the Time of Arrival

You will be asked to sign a consent for treatment and authorization to bill your insurance. We will make a copy of your insurance card and your driver’s license or photo ID. If you have an Advance Directive or living will, we will make a copy of that. You will be given a copy of our Privacy Practices. If you have pre-registered, you will be given a copy of your demographic and insurance information to review and approve.

Medicare Patients

We are required by federal law to ask you questions regarding other payment sources. Although you may have answered these in the past on other visits, we have to ask the questions each time you come for treatment except for recurring treatments 90 days. For patients spending the night, you will also be given a copy of your Medicare Rights.

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Please Note: This is a general contact inbox for HCA Midwest Health that is not monitored 24/7. If you need to contact your practice directly, please use the Patient Portal or call the clinic directly. General internet communication is inherently not secure. For this reason, we highly recommend that data considered confidential or private in nature not be submitted on this form (e.g., social security numbers, diagnosis information, credit card numbers, etc.).

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