Patient Registration
Patient Registration Documents
When you come to Anderson Healthcare for care, you will sign several forms that allow us to best assist you. These forms are available on our website, but you can request a copy of the forms to review before signing.
Consent to Treat
Anderson Healthcare obtains permission to diagnose and treat you through the Consent to Treat document. When signing the Consent to Treat form, you agree to:
- Request for Treatment
- Assignment of Insurance Benefits
- Release of Medical Information
- Payment Guarantee
- Personal Property Release
Consent to Treat for:
- Anderson Hospital (English)
- Anderson Hospital (Spanish)
- Anderson Medical Group (English)
- Anderson Medical Group (Spanish)
- Community Hospital of Staunton (English)
- Community Hospital of Staunton (Spanish)
- Anderson Surgery Center (English)
- Anderson Surgery Center (Spanish)
- Maryville-Goshen Imaging (English)
- Maryville-Goshen Imaging (Spanish)
Notice of Contracted Services
Anderson Healthcare contracts with physicians and allied health professionals to provide care for you during your visit. The Notice of Contracted Services advises you that you may receive a bill from one or more of the following groups for care provided.
Patient Rights and Responsibilities
Anderson Healthcare believes that every patient should be treated with dignity, respect, and compassion. The Rights and Responsibilities form outlines the patient’s basic rights and how we are committed to honoring these rights.
Notice of Privacy Practices
Anderson Healthcare complies with the Health Insurance Portability and Accountability Act (HIPAA). The Notice of Privacy tells you what and who we share your data with and your rights under HIPAA.
Notice of Nondiscrimination and Availability of Language Assistance and Auxiliary Aids
Anderson Healthcare complies with the Affordable Care Act Under Section 1557.