Registration & Forms

Registration Process

The registration process at WMMC is necessary to ensure your healthcare records are kept up-to-date. This includes demographic information, insurance information and personal contacts. WMMC strives to ensure accurate patient information.

Part of the registration process is a signature from you, our patient, on forms that are intended to inform you of your rights, the use of medical information and your consent for health care services.

Consent for Treatment and Patient Agreement

  1. Consent to Treatment: general consent to medical treatment at WMMC and our care partners.
  2. A Release of Information: consent to release health information in accordance with HIPAA for the purposes of treatment, payment or healthcare operations.
  3. Assignment of Benefits, Medicare & Tricare Benefits: consent to bill the patient’s insurance on behalf of the patient and receive payment directly.
  4. Agreement to Pay: an acknowledgment that the patient is responsible for payment of services, and understanding of the expectation of collection of that payment.
  5. Personal Valuables: an acknowledgment that WMMC is not responsible for loss or damage to personal items.
  6. Patient Bill of Rights: an acknowledgment that a copy of the Patient Bill of Rights is available to each patient.
  7. Consent to Telephone Calls, Email, or Text Usage for Healthcare Calls consent for WMMC and our care partners to contact the patient using HIPAA approved means of communication.
  8. Complaints: acknowledgment of the ways in which complaints can be made regarding services at WMMC.

Important Message from Medicare and Tricare

Forms are required by certain payers to be presented and acknowledged by patients that are covered by these plans. If a patient is admitted to stay as an inpatient at WMMC these forms will be provided for the patient’s signature. These forms explain benefits and expectations specific to the service being provided.

Medicare Observation Notice

A notice is provided to Medicare patients that are admitted in an outpatient observation status. There are several exceptions and rights a Medicare observation patient needs to be informed of when receiving services in this admission status.

Notice of Privacy Practices

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Each patient will be asked to sign an acknowledgment of this notice during their initial registration with WMMC.