Your physician, who is a member of the hospital’s medical staff, requested your admission to the medical center. When you arrive, unless otherwise directed, please go directly to the Admissions Window. The admissions representative will help you complete the forms we need, answer your questions, and make sure you are directed to the proper location.

You will be asked to sign some papers giving us permission to care for you. They are perfectly routine and we need to have your approval in case something comes up during your stay.

You may be asked to sign documents dealing with:

• Consent for care of surgery

• Release of information to your insurance carrier

• Responsibility for your hospital charges

• Assignment of insurance benefits

• Specific services you’ll need for your diagnosis

THE ADMISSION PROCESS
For non-emergency situations and out-patient visits, please report to the admission window in the front lobby. The patient will be asked:

• To fill out a patient information sheet (This contains basic information, such as Name, Address, Date of Birth, Social Security Number, Emergency contacts, etc.)

• If the service is related to an accident or injury

• For insurance cards or records:
  – If the service is related to an auto accident you will need your personal auto insurance information.
  – If the service is related to an accident on someone's property, you will need the insurance from the homeowner or business where the accident occurred.

• To complete a Medicare questionnaire (if applicable) to determine if another insurance should be billed.

For Admissions through the Emergency Room, only the patient's name and date of birth are required until the patient is stabilized and placed in a room. At an appropriate time, a representative from the business office will gather additional information from the patient, relative or legally designated representative.

Please bring medical insurance cards or insurance coverage information. If you have a Living Will or a Durable Power of Attorney for Health Care Decisions bring a copy if you are not sure that it is already on file at the hospital.

CONFIDENTIALITY
Clay County Medical Center personnel are required to respect your privacy and maintain confidentiality. Information in your patient record is limited to the staff providing your care. We ask your assistance in respecting the privacy of other patients as well.