Huntington is pleased to provide some documents to help with your
hospital admission. Please click the links below for forms with
pre-hospital and surgery information. For information and forms related to Birth at Huntington Hospital, please go to Maternity Orientation and Tour.
Download, print and complete, then fax or bring to the hospital with your insurance card. Please print the form, complete the information and return it to:
Huntington Memorial Hospital
Attention: Call Center
100 W. California Blvd.
Pasadena, CA 91109-7013
You may also fax it to: (626) 397-2160
If you have any questions regarding pre-registration or conservatorship/guardianship, please contact the call center at (626) 397-5600 Mon-Fri 7am-5pm.
They will assist you in connecting with the appropriate person to answer questions and obtain signatures for various documents in preparation for a test/procedure in advance or on the day of the appointment.
Medication Form: A handy form that anyone can use to list medications you are taking.
PREPARATION FOR SURGERY
Pre-Hospital To-Do List: A basic checklist of requirements for surgery.
Information Sheet: Information sheet for Informed Consent for Anesthesia Services- explains different types of anesthesia (for Spanish version click here).
Patient Instructions for Surgery: Detailed preoperative and day of surgery instructions.
Authorization and Consent for Surgery: A sample of the surgery/procedure consent required for all patients having surgery (for Spanish version click here).
Consent for Transfusion of Blood or Blood Components:
A sample of the authorization used for all patients who may require a
transfusion during their hospital stay (for Spanish version click here).
Hysterectomy Consent: A sample of the informed consent for the hysterectomy procedure.
Pre Anesthesia Evaluation: Please print, fill-out and bring with you to the hospital on the day of your surgery.
PLANNING YOUR CARE FOR WHEN YOU LEAVE THE HOSPITAL
One of the important things to think about any hospitalization is how to get the care you need after you are done with your hospital care. While you are at Huntington, your healthcare team will give you the care you need, and will help you plan for your care needs after the time in the hospital. Many people need some help when they are ready to leave the hospital. If you prepare for your care needs beforehand you can make it easier for yourself, and think through your best options for care. We can help. By clicking on the link below, you can find a tool to help you in this process.
Discharge Planning Form:
Please print the form, fill it out and bring with you when you are admitted. This will help facilitate your discharge from the hospital.