病人形式
Before receiving care as a patient at NYU Langone, we ask that you complete several forms to make sure that you understand your rights and responsibilities. We encourage you to read and understand the forms before your visit. You will sign the forms at your appointment, so you do not need to print or sign them in advance.
Review the patient forms for the following 类型的访问:
我们还提供 doctor’s office forms in other languages, 包括阿拉伯语, 孟加拉语, 中国人, 法国, 希腊, 希伯来语, 日本, 朝鲜文, 波兰的, 俄罗斯, 和西班牙语.
类型的访问
You may be coming to NYU Langone for a doctor’s office appointment or for a hospital stay as an inpatient, outpatient, or for observation. The forms you need to fill out vary depending on the type of visit, which include the following:
- 住院病人在医院里的住院病人, which usually lasts at least two nights, 经常做手术, 医学治疗, or to stabilize a serious illness or injury.
- 门诊呆, which may take place at a hospital or one of our outpatient care centers, 你可以在哪里进行测试, 多种治疗方法, 或小手术. The stay is typically a few hours.
- Observation, which is a specific kind of outpatient care. People under observation remain in a hospital bed while being monitored for a serious change in their medical condition, 通常不超过24小时. During that time, a healthcare team decides if the patient needs to be admitted to the hospital.
- A visit to a doctor’s office to receive care from a physician or another medical professional.
第一次到访表格
During your first visit to an NYU Langone facility, 包括一个医院, 护理的位置, or doctor’s office where the NYU Langone logo is displayed, 你需要阅读并签字 病人 Privacy and HIPAA Rights forms. 了解更多关于 HIPAA patient privacy information.
For your safety, we use the 病人Secure® 系统. 与生物技术, the 系统 scans a unique feature of your hand to simplify patient registration and provide the most accurate form of patient identification for future visits to NYU Langone.
We encourage you to review these forms as well:
- Acknowledgment of Admission and Financial Information
- 承认病人权利
- 医疗保健代理信息
- 私隐实务须知 Acknowledgment
- 病人s’ Bill of Rights Information
- Parents’ Bill of Rights Information
住院治疗表格
People coming for an inpatient stay need these forms and information:
- Acknowledgment of Admission and Financial Information
- 承认病人权利
- Acute Inpatient Rehabilitation (if you are admitted to Rusk Rehabilitation)
- Advance Care Planning Information
- Efficiency and Quality Improvement Program
- 医疗保健代理信息
- Health Information Exchange (HIE) Fact Sheet and Consent Form
- 医院信息披露形式
- Inpatient, Outpatient, Observation Visit Information
- Important Information for Medicare 病人s
- 不歧视政策
- 私隐实务须知
- 私隐实务须知 Acknowledgment
- Release of Records for External Appeal
- Statement of 病人 Responsibilities
- 你作为医院病人的权利
门诊就诊表格
People coming for an outpatient visit need the following forms and information:
- Acknowledgment of Admission and Financial Information
- 承认病人权利
- Advance Care Planning Information
- 关于医疗保健的决定
- 医疗保健代理信息
- Health Information Exchange (HIE) Fact Sheet and Consent Form
- 医院信息披露形式
- Inpatient, Outpatient, Observation Visit Information
- 不歧视政策
- 私隐实务须知
- 私隐实务须知 Acknowledgment
- 病人s’ Bill of Rights Information
- Release of Records for External Appeal
- Statement of 病人 Responsibilities
您的观察访问表格
People coming for an observation visit need the following form:
Forms for Visits to a Doctor’s Office
If you are a patient who has not yet been to an NYU Langone doctor’s office, you can review the registration forms below in advance of your first office visit to help expedite the initial registration process.
Please call your doctor’s office if you have questions about the forms.
- FGP Financial Acknowledgment Form
- Health Information Exchange (HIE) Fact Sheet and Consent Form
- 私隐实务须知
- 私隐实务须知 Acknowledgment
- Summary of Faculty Group Practice (FGP) Financial 政策
Additional Forms for Doctor’s Office Visits
Review these additional forms that you may need during the course of your treatment at NYU Langone:
- Authorization for the Use and Disclosure PHI (release of information and instructions)
- Credit Card Storage and Authorization Form
- Deaf and Hard of Hearing Questionnaire
- 金融援助的应用程序
- 金融援助的应用程序 (Spanish)
- 医疗补助非par豁免
- 医疗保险选择退出放弃
- New York State Assignment of Benefit
- Non-Par Financial Acknowledgment Form
- NYU Langone Health MyChart Adolescent Proxy Access
- NYU Langone Health MyChart Adult Proxy Access
- 病人 Consent Form for Interpreter Services
- 病人评估形式
- 病人 Information Change/Verification Form
- Proxy Access to the Online Medical Record of a Child Under 12 Years Old
- Workers Compensation/No Fault 保险 Registration Form
私隐实务须知 in Other Languages
- 阿拉伯语(العربية)
- 孟加拉(বাংলা)
- 中文(中文)
- 克里奥尔语(kreol)
- 法语(法语)
- 希腊(ελληνικά)
- 意大利(意大利语)
- 韩国(한국의)
- 波兰(波兰语)
- 葡萄牙语(葡萄牙)
- 俄罗斯(Pусский)
- 西班牙语(西班牙语)