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Admission Forms
The following forms* may be used when admitting a patient to Hartford Hospital.
 
Admission Forms:
Form Name Rev. Posted
Ambulatory Record 11/06 01/17/08
Cardiology PC - Consultation/ Admission Report 05/08 09/23/08
Elective Admission/Surgery H&P Form 11/06 12/11/06
Informed Consent (English) 02/08 03/13/08
Informed Consent (Spanish) 07/07 01/17/08
Open Heart Surgery Consent (English) 02/08 02/28/08
Open Heart Surgery Consent (Spanish) 02/08 02/28/08
Patient Pre-Admission Questionnaire 11/06 12/21/06
Physician's Order Forms:
Form Name Rev. Posted
C8 Admission Orders 03/06 12/01/06
Imaging Center Requisition 02/08 02/26/08
Pre-Op Ambulatory Surgery 03/06 12/01/06
Pre-Op Laproscopic Cholecystectomy 05/05 12/01/06
Pre-Op Bowel 10/05 12/01/06
Pre-Op Lumbar Fusion 05/04 12/01/06
Pre-Op Total Joint 03/08 04/22/08
Pre-Op Open Heart 06/07 08/13/07
 
Helpful Documents:
Form Name Rev. Posted
A Guide to Parking at Hartford Hospital 01/08 01/17/08
Patient Guide to Surgery 03/05 12/01/06
Patient Guide to Diabetes Medications Before Surgery (English) 12/07 02/12/08
Patient Guide to Diabetes Medications Before Surgery (Spanish) 12/07 02/12/08
 
* These forms are provided in PDF format. When printing these forms, we suggest using a laser or other high-quality printer. In addition, please utilize the ORIGINALS, not copies. These steps will ensure bar codes are correctly interpreted by our document archival system.

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