When a new patient walks into a hospital or to a health care organization to get some treatment about their condition, there will be a new patient registration form that they need to fill out. This kind of form will provide the healthcare organization not only about their new patient personal detailed information such as name and address but it also can help the medical staff in there to make a quick assessment of the patient condition based on the information that the patient provides in the form.

Some information that they need to fill out are their name, address, email, sex, weight, height, date of birth, emergency contact and health history. While the first part of the form was a standard thing that almost every form for any purpose must be filled out, there are several items that make it different from any other form. Emergency contact for example, it will allow the hospital to contact the closest person just in case something happen to the patient.

Another important part that must be present in the form is about the patient health history. It was critical aspect that must be provided by the patient where the medical staff will have a foundation on choosing the best treatment type for the patient. The new patient registration form template just like the one that people can find here already covered all basic things that the healthcare organization need so it will be far more convenient to the healthcare administration for download it and use it for their new patient without have to bother to make it on their own. Other common information needed in this form is insurance information.

This template below is a reference to create your own form. Different hospital or clinic requires different information that needs to be filled, especially if there are some specific information needed for specific diseases.

  Patient Registration Form (19.6 KiB, 1,046 hits)