Forms

Financial Assistance Forms

English:

• Introduction Letter
• Instructions - Financial Assistance Program
• Application - Financial Assistance
• Patient Profile Questionnaire

Spanish:

• Una carta de presentacion
• Instrucciones del Programa de Asistencia Financiera
• Uso De la Ayuda Financiera Del Uniforme
• Cuestionario de Perfil del Paciente

General Hospital Forms

• Advance Directive Information and Forms
• Patient Request for Release of Information Form
  (request for records by patient or patient rep)
• Authorization for Release of Health Information
  (request for record by someone other than the patient or patient rep)
• Request To Amend My Protected Health Information
• Pre-Anesthesia Form

Howard Hospital Foundation Forms

Pre-Registration Forms

• Printable OB Pre-Registration Form
• Formulario de registro previo para obstetricia

Volunteer Services Forms

• Guidance Counselor Form
• Volunteer Application

Additional Patient & Hospital Information

• Patient Rights & Responsibilities
• HCGH Campus Map
• Medication Tracker
• Patient Menu