Hospital Forms - South Austin Hospital

Austin Surgical Hospital has forms that must be completed prior to receiving surgical services. The information obtained will be utilized to help hospital staff understand the patients' health history and personal information. The information on the form(s) is kept confidential and can be completed by the patient or by hospital staff. Completed forms can be returned via fax, mail, or in person prior to the scheduled Pre-Admission Testing appointment.

Forms

• Authorization to Release Medical Information [81.66 KB PDF]
  This form is to authorize Austin Surgical Hospital to either release or obtain patient medical information.
• Austin Surgical Dictation Quick Ref Guide [172.78 KB PDF]
  Quick reference guide on the dictation system at ASH.
• ASH Webconsole Review and Release QRG [198.25 KB PDF]
  Quick reference guide on using the online dictation/transcription service with ASH. Note: This system requires Internet Explorer to function.
• Online Pre-Surgical Assessment at Austin Surgical Hospital
  To start the pre-surgical assessment process, Austin Surgical Hospital requests that you fill out your medical history online with One Medical Passport. Online registration is a helpful way to curb healthcare costs, and our online form will expedite your visit.
• Patient Registration Form [87.24 KB PDF]
  To expedite your visit to Austin Surgical Hospital please complete this form and bring it with you to our South Austin hospital.
• Adult History Questionnaire [47.95 KB PDF]
  To expedite your visit to Austin Surgical Hospital, please print, fill out, and fax this form to 512-314-3867. Alternatively you may bring it in or have it handy during your phone interview.
• Imaging Patient Record [83.31 KB PDF]
  To expedite your visit to Austin Surgical Hospital please complete this form and bring it with you to the hospital.
• Patient Guide [2.06 MB PDF]
  Any time somebody is a new patient at any health care center, knowing what to expect greatly enhances the patient experience. This document outlines exactly what to expect on your visit to Austin Surgical Hospital, with resources valuable to the patient. We provide this as a service to you, the patient. Austin Surgical Hospital - leading the way in Austin area health care clinics!
• Magnetic Resonance Screening Form [152.88 KB PDF]
  To expedite your visit to Austin Surgical Hospital please complete this form and bring it with you to the hospital.
• Joint University Presentation [521.03 KB PDF]
  Presentation given to prospective joint patients as they consider Austin Surgical Hospital for their surgery. PDF format.
• Sleep Study Patient Packet [211.45 KB PDF]
  To expedite your visit to Austin Surgical Hospital please complete this form and bring it with you to the hospital.
• MRSA Shower Instructions [1.31 MB PDF]
  Please follow these shower instructions before your surgery to reduce the number of germs on your skin. Any drug store will carry chlorhexidine body wash designed to reduce the bacteria on your skin.
• Fall Prevention Instructions [922.07 KB PDF]
  Falls are the top cause of accidents in people over the age of 65. Falls are also the main cause of serious injuries and accidental deaths in older people. Review the attached document to learn how to prevent falls.
• MRSA Patient Education Form [82.13 KB PDF]
  What You Need to Know About Staph/MRSA Skin Infections.