OB Pre-Admission

Pre-Admission
When you come to the hospital for your test or tour please come to the registration desk, located in the front lobby of Trios Women's and Children's Hospital, 900 S. Auburn, Kennewick.

The registration representative will have you complete the following:

1. Registration form for your future delivery. At this time, you will sign for your consent to be treated and complete any other payer required paper work that is needed for your stay.
2. The registrar will assist you with financial arrangements for your stay, if needed, by contacting one of our financial counselors.

To download a copy of our Pre-Admission Registration form, click here.

Admission
OB Patients: If you believe you are in labor please go to Trios Women's and Children's Hospital located at 900 S. Auburn St. (See map.) There are no obstetric services at Trios Southridge Hospital.

Please come to the front lobby of the Women's and Children's Hospital to the registration area located just inside the facility entrance. We are open 24 hours a day. The registration staff will check you in and direct you to the Family Birthing Center for services.

Financial Responsibility
The OB Pre-Admission Registration form asks for financial information so that we may help you with any arrangements necessary to cover your services and stay with us.

If you are covered by insurance, please provide your insurance cards and identification when you check in or pre-register. If your insurance does not provide 100% coverage, you will need to discuss financial arrangements with a financial counselor.

If your service is not covered by insurance, the financial counselor will guide you on your payment options.

The following methods of payment are available:

1. Payment of the account in full within 30 days of the first statement with a 10% discount.
2. If your financial situation does not allow you to pay within 30 days of the first statement, you will need to speak to a financial counselor for payment options and to set up payment arrangements. Call 509-221-5748.
3. Financial assistance applications are available. Please contact a financial counselor at 509-221-5748 for an application or questions.

 

OB Pre-Admission Registration

Last Name

First Name

Middle Initial

Date of Birth

Birthplace

Social Security Number

Marital Status MarriedSingleWidowedDivorcedSeparated

Religious Preference

Are you a smoker?YesNo

Address

City

State

Zip

Home Phone

Other Phone

Employer

Employer Phone

Employer Address

City

State

Zip

Occupation

Have you ever been a patient at Trios Health before?YesNo

If yes, when?

Expected due date

Date of last menstrul period

Allergies

Emergency Contact (relative/friend not living with you)

Relationship

Address, City, State, Zip

Primary Insurance – Name of Subscriber

Policy #

Group #

Secondary Insurance - Name of Subscriber

Policy #

Group #

Medicaid – Name of Subscriber

Policy #

Group #

Other Insurance – Name of Subscriber

Policy #

Group #

OB Physician's Name

Baby care provider at time of delivery

Patient Signature (Typing your full name in this box serves as your signature)

Email Address

Date Signed

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