Kaiser Permanente Labor and Delivery Preadmission Worksheet

Kaiser Permanente Labor and Delivery Preadmission Worksheet PDF Details

To ensure accurate information, please complete this form in its entirety and return to the Admitting Department.

Payment in advance: If you would prefer to make a payment in advance of your admission, please call or visit the Admitting Department.

Advance directive: Do you have an Advance Health Care Directive? If yes, please provide a copy to the Admitting Department.

Coverage: Medicare Part A and Part B effective dates, Medi-Cal issue date, insurance ID and effective date of insurance coverage.

Contacts: Primary Contact and Secondary Contact, each with name and relationship to patient.