Forms

Adult

The two forms that can be printed and faxed are:

• Admission Procedure Financial Information
• Physician Order to Admit

Copies of the remaining forms may be hand-carried by the patient or faxed to the PATS in time for the PATS appointment (fax chart prep 909-558-3626). Originals of the documents must be at the OR site by time of surgery.

Children's

The two forms that can be printed and faxed are:

• Admission Procedure Financial Information
• Physician Order to Admit

Copies of the remaining forms may be hand-carried by the patient or faxed to the PATS in time for the PATS appointment (fax chart prep 909-558-3626). Originals of the documents must be at the OR site by time of surgery.

To Order Forms, PATS brochures, appointment reminder cards, etc.

Please contact Porscha Schuler by email at PorschaSchuler@llu.edu.

• Children's Hospital
• Medical Center