Patient Info

     

Services Provided

Preadmission

Patient Forms

Pain Management

Safety Tips For Patients

Understanding Billing,
Payment & Insurance

American Hospital Association's
Put It In Writing
(An advance directive is your life on your terms.)

• Preadmission
Forms on this page can be completed and printed or printed and filled in by hand.

      Form #1:  Registration Form

Thank you for choosing Phelps Memorial Health Center for your health care needs. We want your visit to be as pleasant as possible. Please complete the pre-registration form and bring with you or return to our office prior to your admission. This will expedite the admission process on the day you arrive. If time does not allow you to mail this form, you may call our Business Office with the information. Remember to bring your insurance cards at the time of admission. Before your admission please verify your health insurance coverage and hospitalization or outpatient requirements, as well as complete all your pre-certification notices. If you have any questions regarding our admission process, please contact our Business Office at (308) 995-2871.

Helping You Understand Billing, Payment & Insurance

When coming to Phelps Memorial Health Center for a procedure or surgery, whether you're going home the same day or staying in the hospital over night, there are some things that you need to know and that we need to know about you. You will find links below to download forms that can be filled out and brought with you when you come in to do your pre-admission. You can also fill out before day of procedure and mail to the hospital.

• Preoperative Information
    * Form #2 & Form #3 can be filled out on your computer and then printed.

All forms are in Adobe Acrobat format. If you do not have adobe you can download free from: http://www.adobe.com/products/acrobat/readstep.html