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Admission Check List

For My Hospital Stay

Check-In Items

  • Photo Identification Card (i.e. Driver's License, Passport, etc.)
  • Insurance Card
  • Medicare or Medicaid card, if applicable
  • Authorization for Procedure, if applicable
  • Physician's Orders and other paperwork
  • Co-Pay/Deductible
  • Current medications

Personal Items

  • Eye glasses and case
  • Contact lenses, solution and case
  • Dentures and case
  • Hair brush/comb
  • Change of clothes
  • Other items

Please leave valuables (money, credit cards, etc.) at home.

Emergency Contacts

  • Contact Name
  • Phone Number
  • Relationship

Physician Information

  • Physician Name
  • Phone Number

How am I getting home

  • Written-out Instructions

Important Information

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