Below are a few commonly used medical forms. Please print off the ones requested by your physician's office and bring the completed forms to your next appointment unless otherwise directed.
- Authorization for Emergency Care to Minor(s) - This form is authorization by the parent/legal guardian for any medical facility to provide health services to the minor in the absence of a parent/legal guardian. This form should be left with the temporary caregiver of your child. The temporary caregiver will be required to present this form at the time medical care is received.
- Authorization to Release Facility's Protected Health Information (PHI) | Autorización Para Divulgar Información De Salud Protegida (PHI) Del Centro
- Advance Directive | Directiva Avanzada - This form is provided to serve as a framework for individuals who wish to complete an Advance Directive, also known as a living will. In order for doctors or hospital workers to be legally required to follow an Advance Directive, it must meet the following requirements:
- Individuals must be at least 18 when signing an Advance Directive and of sound mind.
- It must be signed by the individual and the signature witnessed by two persons. Heirs, legatees or devisees (persons with an interest in the estate of the individual) are not permitted to be witnesses.
- The instructions or directives in an Advance Directive should be followed by the doctors, hospital workers and family when the individual is certified to have reached the specified medical condition.
- Please note: As a Catholic healthcare provider, Saint Francis Health System facilities will honor the Advance Directive unless it conflicts with Catholic Ethical and Religious Directives. For instance, our hospitals may not be able to participate in directives that include dehydration or starvation for the ending of life. Transfer to another facility can be arranged as needed.
- Patient Information Card - The Patient Information Card can be printed, filled out and carried with you in your purse or wallet. This card is designed for recording information about you that is helpful when you go to the hospital or a doctor's office. It is provided to help you and your family members keep track of your allergies, medications, immunizations and history of illnesses or surgeries. Be sure to include all medications on this list, including over-the-counter and herbal medications. You may update your copy or print a new copy and fill it out when any changes are experienced.