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Preregistration

 

Download and complete the forms

Maternity Other
Medicare Self Pay CHAMPUS Other Medicare Self Pay CHAMPUS Other
General Conditions of Admission • • • • • • • •
Preregistration Form • • • • • • • •
TB Screening/Latex Allergy Screening • • • • • • • •
Birth Announcement • • • •
Message from Medicare • •
Medicare Secondary Payer Questionnaire • •
DSH Application • •
Message from CHAMPUS • •

Please fill out the forms as completely as possible. If you are unable to answer a question, call us at (270) 745-1398 and a Preregistration Representative can help you. Or, leave it blank and we will assist you when you arrive at The Medical Center.

In order to complete these forms, you will need to review the Patient Handbook (pages 5 through 16) for the following information: Patient's Rights and Responsibilities, Patient and Family Education for Pain, Advance Directives and AIDS Education and Awareness.

 

Submit your preregistration forms

To complete the preregistration process, you can either:

  1. Mail completed forms to:
    The Medical Center
    ATTN: Patient Registration
    250 Park Street
    PO Box 90010
    Bowling Green, KY 42102-8907
  2. Call (270) 745-1398 and a Preregistration Representative will take your information.
  3. Bring them with you the day of your procedure.

The day of your procedure

While the preregistration process cuts down on the registration time, there is still some important information you will need to bring with you the day of your procedure to complete registration.

  1. Identification (such as a driver's license)
  2. All health insurance cards
  3. Certifications and claim forms
  4. Any physician's orders
  5. Test results given to you by your physician's office