Before receiving care as a patient at NYU Langone, we ask that you complete and sign several forms to make sure that you understand your rights and responsibilities. We encourage you to read and understand the forms prior to signing them at your visit. Learn more about forms for an inpatient visit, forms for an outpatient visit, and forms for visits to a doctor’s office.
If you have any questions when reading these forms and preparing for your hospital visit, please email firstname.lastname@example.org. Please contact your doctor’s office or the treatment location if you have questions about your scheduled doctor’s visit or test.
Types of Visits
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:
- An inpatient stay at a hospital, which usually lasts at least two nights, often for surgery, medical treatments, or to stabilize a serious illness or injury.
- An outpatient stay, which may take place at a hospital or one of our outpatient care centers, where you may have tests, a variety of treatments, or minor surgery. 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, usually for less than 24 hours. 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.
Learn more about the types of visits and possible cost differences.
Forms for Your First Visit
During your first visit to an NYU Langone facility, including a hospital, care location, or doctor’s office where the NYU Langone logo is displayed, you need to read and sign the Patient Privacy and HIPAA Rights forms.
For your safety, we use the PatientSecure® system. With biometric technology, the system 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:
Forms for Your Inpatient Visit
People coming for an inpatient stay need these forms:
- Inpatient Forms and Information
- Your Rights as a Hospital Patient
- For Medicare Inpatients
- Visitor Rights
- Private Rooms
- Acute Inpatient Rehabilitation (if you are admitted to Rusk Rehabilitation)
Forms for an Outpatient Procedure or Observation Visit
If you stay in a hospital room during your outpatient procedure or observation visit, consider reading these forms:
If you need hospital services at a location where NYU Langone has both a doctor’s office and provides hospital services, read our Faculty Group Practice (FGP) Financial Policies.
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 print and complete 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.
- Patient Demographic Form
- Pediatric Demographic Form
- Health Information Exchange (HIE) Fact Sheet and Consent Form
- Notice of Privacy Practices
- Notice of Privacy Practices Acknowledgement
- Summary of Faculty Group Practice (FGP) Financial Policies
- FGP Financial Acknowledgement Form
- Pharmacy and Laboratory Information
- Laboratory Letter
Additional Forms for Doctor’s Office Visits
Review these additional forms that you may need during the course of your treatment at NYU Langone:
- Credit Card Storage and Authorization Form
- Deaf and Hard of Hearing Questionnaire
- Patient Information Change/Verification Form
- FGP Cell Phone Call Agreement
- Non-Par Financial Acknowledgement Form
- MyChart Adolescent Proxy Access
- Proxy Access to the Online Medical Record of a Child Under 12 Years Old
- Proxy to the Online Medical Record of a Child 12 to 17 Years Old
- Proxy Access to the Online Medical Record of an Adult
- Financial Assistance Application
- Patient Consent Form for Interpreter Services
- Authorization for the Use and Disclosure PHI
- Authorization for the Use and Disclosure PHI—Instructions
- Workers Compensation/No Fault Insurance Registration Form
- NYS Assignment of Benefit
- Patient Estimate Form
- Medicaid Non-Par Waiver
- Medicare Opt-Out Waiver