Wherever You Are In Hawai'i, You're Never Far from Quality Healthcare
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Pre-Admission/Registration Form
You and your physician can use this form to provide Hilo Medical Center with the information we will need to prepare for your visit. Completing this form fully will help streamline the process of your admission or registration. Fax it to (808) 974-6869 and bring a copy with you on the day of your procedure.
Forms for the physician and physician's office.
Diagnostic Imaging Requisition
Physician Orders
These forms are provided for reference only. Please use the Standard Register forms for inclusion in the medical record.
322-0002 ANESTHESIA RECORD rev 08-07
322-0007 CODE STATUS rev 08-05
322-0263 RESTRAINT ORDER FORM rev 08-07
322-0296 IN-HOUSE TRANSFERS rev 11-05
322-0411 CONGESTIVE HEART FAILURE rev 02-06
322-0543 EMERGENCY DEPARTMENT RECORD rev 09-05
322-0561 HYSTERECTOMY MD ORDERS rev 09-04
322-0566 VACCINE CONSENT-DOCUMENTATION TOOL rev 03-06
322-0567 COMMUNITY ACQUIRED PNEUMONIA (CAP) SEVERITY SCORE TOOL rev 10-05
322-0568 PNEUMONIA ORDERS rev 02-07
322-0578 PHYSICIAN AND NURSING DISCHARGE INSTRUCTION DOCUMENTATION rev 07-07
322-0597 ISCHEMIC STROKE MD ORDERS rev 11-05
322-0599 RESPIRATORY THERAPY ORDERS rev 08-05
322-0604 HALE HO’OLA STANDING ADMISSION rev 04-05
322-0607 CERTIFICATE OF TRANSFER rev 06-05
322-0631 ALCOHOL DETOX PROTOCOL rev 03-06
322-0635 CCU PRIMARY ADMIT ORDERS rev 12-05
322-0636 CCU SECONDARY ADMIT ORDERS rev 12-05
322-0646 ELECTROENCEPHALOGRAM AND EVOKED POTENTIAL SERVICE rev 08-05
322-0659 ISCHEMIC STROKE THROMBOLYTIC ORDERS rev 09-05
322-0669 MRI PATIENT SCREENING FORM rev 11-05
322-0687 DEEP VENOUS THROMBOSIS ver 04-06