The paperwork you encounter while at the hospital may seem overwhelming. Certainly, the paperwork involved in hospital care is immense! But the paperwork is an important part of care -- it is essential for our staff in every area to document accurate information that will help us provide the best service to you.
To help you prepare for your visit, we are presenting certain forms on-line. Feel free to print these forms, read them carefully, complete them and bring them with you when you come to the hospital.
All of the forms below are saved as Adobe Acrobat files to retain the format of the form. If you do not have Acrobat Reader, you can obtain a free copy of it from the Adobe Web site.
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Advance Healthcare Directives
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You may obtain an Advance Directive form here to prepare and bring with you to the hospital and to provide to your physician and family. If you need assistance with this form, you can attend one of our free Advance Directive classes or call our Social Work Services Department at (510) 728-1614
California Advance Health Care Directive Form - English Version
Directiva Por Anticipado De La Salud - Spanish Version
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Your Medical Records
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You have a right to access your medical records, and to have your records (or a portion of your records) released to another party. The forms below begin the process.
Request for Release of Health Information
This is known as the "General Authorization for Use or Disclosure of Protected Health Information." Please print this form, complete it and deliver it in person to Medical Records Department located on the first floor of the hospital. Please be sure to bring a valid photo ID.
Request for Access to Medical Records.
Please print this form, complete it, and mail it to Medical Records Department, 20103 Lake Chabot Road, Castro Valley CA 94546, or fax it to (510) 888-9198.
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Maternity
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You can access a pre-registration form in English or Spanish, or you can >use our secure, on-line registration process.
forms will be uploaded soon!
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Radiology/Imaging
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The forms below are for use by your physician for assessing your renal status and for ordering premedication that may be needed to reduce the risk of renal or allergic side effects prior to receiving intravenous iodinated contrast.
Prevention of Contrast-Induced Nephropathy - Physician Assessment Form
Prevention of Contrast-Induced Nephropathy - Physician Order Form
Prevention of Contrast-Induced Allergic Reaction - Premedication Recommendations
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Notice of Privacy Practices
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This notice describes how medical information about you may be used and disclosed by Eden Medical Center and how you access this information.
Notice of Privacy Practices
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Service Excellence
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Eden Medical Center employees and physicians strive to provide the best possible care and service at all times. This is Service Excellence. If you would like to recognize a staff member, physician or volunteer who has gone above and beyond, please take the time to let us know! You can contact us by e-mail or print out the form below and mail it to:
Eden Medical Center
Administration
20103 Lake Chabot Road
Castro Valley, CA 94546
Service Excellence Recognition
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Personal Medication Record
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Keeping track of your medications and supplements is essential to your good health. This Personal Medication Record helps you monitor your medications, vitamins and supplements -- as well as your allergies -- so that you can share this with your physician, pharmacist and caregivers and the hospital. Our pharmacists track this information to prevent any adverse drug reactions and help keep you safe.
Personal Medication Record
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