Forms & Information

Forms Instructions

Pre-Surgery Pediatric Health Status Summary Form

To make sure you get the best, safest care possible, we need some important information about you. Before your child comes to the hospital for surgery, please complete and bring with you a copy of this Pediatric Health Status Summary for children under the age of 13.

Personal Medication History Form

Your complete medication history is important to your physicians and to the hospital. Please fill out this form and bring it with you anytime you go to the doctor’s office or to the hospital. If you are scheduled for a Pre-Surgical Services appointment, make a trip to the Emergency Room, or are coming directly to the hospital, remember to bring this completed form!!

If for some reason you are unable to fill out this form, please bring in a bag all of the medications (in their original containers) that you are currently taking.

Speak Up and help prevent medical errors

Mistakes can happen during surgery. Hospitals and other medical facilities that are accredited by The Joint Commission must follow a procedure that helps surgeons avoid these mistakes.

Mistakes can also happen before or after surgery. A patient can take the wrong medicine. Or they don’t understand the instructions about how to take care of themselves. As a patient, you can make your care safer by being an active, involved and informed member of your health care team.

Five Simple Things You can Do to Prevent Infection

Infections are dangerous – especially for people who are hospitalized or are having surgery. Here are five simple things you can do to reduce your risk of infection.