Patient Forms and Pre-Registration

Patients with appointments at a USA Physicians Group office or the Mitchell Cancer Institute can select their clinic below to complete some forms in advance of their visit. Please download the available forms, complete them, print them, and bring them to your visit. This will help you save time on the day of your actual appointment. Additional forms may be provided in our physicians office locations. 

What Should You Bring With You?

• Insurance card(s)
• Referrals/ Authorizations (Approvals)
• Driver's license or photo identification
• Co-pays

Patient Access at University Hospital is located in our main lobby, just past the Information Desk. Pre-registration is available to all scheduled patients prior to the date of service. After your test or exam has been scheduled by your physician, you may receive a call from our Patient Access department to pre-register you for your upcoming visit. You also may call Patient Access to pre-register at (251) 471-7250.

You will be asked to provide your personal information, including name and address, insurance coverage, emergency contact, and employment information. If your visit is the result of an accident, we will also need accident information.

What Should You Bring With You?

• Insurance card(s)
• Referrals/ Authorizations (Approvals)
• Driver's license or photo identification
• Doctor's order
• Claim form(s)
• Co-pays

Outpatient Registration

Patients who are scheduled for outpatient exams or tests must first be registered by our Patient Access department. If you are scheduled for an outpatient test in the Heart Center, MRI, Nuclear Medicine, Pulmonary Lab, or Cardiac Catherization Lab, you will receive a call from Patient Access with directions. It is important that you arrive on time, or even a little early, so that you won't be rushed as you park and come inside.

You will be asked to sign a consent form for admission and for medical treatment. An identification bracelet for your wrist will also be prepared. At this time you will be directed to your testing area and placed in the capable hands of our health professionals.

Inpatient Registration

If your physician determines that you will be staying with us overnight or longer, he/she will arrange this with our Patient Access department. You will be contacted by our office to obtain your personal information, emergency contact, insurance coverage, and employment information.

Financial Responsibility

Patients are responsible for payment on the date of service. This includes deductibles, co-payments and co-insurance. Payment can be made in the Patient Access department. If you qualify and need assistance, a financial counselor can help with payment plans, allowing you to pay your bill over a period of time. For more information, please call (251) 470-5882.

Insurance Approvals

Health insurance is a contract between you and your insurance company. Many insurance companies must approve certain tests or exams before you can have them. Your physician is responsible for getting this approval, if it is required. If approval has not been obtained when you arrive for your appointment, you may be asked to reschedule. Without approval, your insurance company will deny payment in most instances.

Please note: The Patient Access department does not obtain approvals, and does not set appointments. This should be taken care of by your physician.

Patient Access at USA Children's & Women's Hospital has six points of entry. All Patient Access locations are inside the main hospital, with the exception of Therapy Services:

• Therapy Services is located in the Center for Child Development at 1610 Center St., southeast of the hospital. The telephone number is (251) 415-1670
• Emergency Services are registered in the Evaluation Center, at the east side entrance of the hospital. The telephone number is (251) 415-1620
• The Imaging Center, where all radiological services are performed is located at the same east side entrance. Upon entering, please sign in. The Registration staff are available at the front desk for your convenience. The telephone number is (251) 415-8649
• OB patients who are not scheduled or sent from your physician's office will report first to the Evaluation Center located at the east side entrance unless specifically told by your physician to report to another location
• Outpatient Surgery and Day of Surgery patients should report to the main Patient Access department between 5 a.m. and 7:30 a.m. on the day of surgery. After 7:30 a.m., patients should report to Pre-Admit Registration, located straight through the main lobby in the Surgery department. The telephone number is (251) 415-1629
• The main Patient Access department is located just to the right of the Lobby upon entering the hospital. All inpatients and other outpatients should report to this area. The telephone number is (251) 415-1617, and the fax number is (251) 415-1002

Pre-Registration

Pre-registration is available to all scheduled patients prior to the date of service to expedite the check-in process. During the pre-registration process, all registration information is obtained over the telephone. When you arrive, you will be required to provide your insurance cards and sign the required forms before going to the department. Patients can pre-register for services by calling (251) 415-1629.

Requirements for All Registrations

Upon arrival for registration, you will be asked to verify all demographic and insurance information, and you will be required to provide the following information:

• Health insurance cards and information including address, telephone number and policy number
• Photographic identification card
• A valid prescription or physician order for all tests
• Referral or authorization numbers, if required by your insurance
• A note giving "permission to treat" from a parent or legal guardian if the minor will be unaccompanied by the responsible party
• You also will be required to sign the Conditions and Consent for Treatment form at the time of registration

Advance Directives

Upon admission to USA Children's & Women's Hospital, each patient is given a brochure regarding medical advance directives. If you would like this information before you arrive, please contact the Patient Access department during regular business hours.

Deposits/Co-Payments

Patients are responsible for all financial liabilities including co-payments, deductibles and out-of-pocket expenses at the time of registration or at the time of discharge for emergency admissions. If the exact dollar amount has not been determined, you will be asked to pay the estimated amount and will be billed for the remainder.