UT Southwestern University Hospitals would like to make it as easy as possible for you to pre-register for your admission. A Preregistration Form is available for you to fill in the appropriate information and it will be sent to the Admissions Department.

Important Instruction:
The following forms are required to be reviewed and signed for each visit/admission to the hospital:

• Consent for Admission
• Notice of Privacy Practices ( In English)
• Notice of Privacy Practices ( In Spanish)

In addition:
If you are a Medicare recipient, the following information is available for your review:

• Medicare Secondary Payor questionnaire
• An Important Message from Medicare

The following additional information is available for your review:

• Patient Bill of Rights
• Charity Care
• Medicare Benefits 2004
• Payment Policy Statement
• Advance Directives

To view and print copies of these forms, a free copy of Adobe Acrobat Readeris provided.

When you report to the hospital, please bring a picture ID, all of your insurance cards, and any paperwork given to you by your physician, including any primary care physician referrals. If you provide copies of an advanced directive, living will and power of attorney, they will be placed in your medical record.

All information obtained during this process will be held in strict confidence. We at UT Southwestern University Hospitals want to make your stay as comfortable as possible. If you have any questions, please call 214-590-3135.