Hospital Information Form Template

Just like any organization, a hospital needs to have details about the patients it treats. Having the details is useful for many reasons. Medical facilities keep the data saved in their database, which can be used for research and other purposes.

What is a hospital information form?

It is a form that is given to a patient to fill out. The patient provides his specifics to the hospital through this form. Whether it is going to be a long stay or a short stay for a patient in a hospital, or if the patient has come for a regular checkup, this form will always be filled out.

What are the benefits of the hospital information form?

It is used as a reference

Those healthcare practitioners who are giving treatment to patients often need to access the information form because it helps them while they treat the patient. The form lets them know about the medical history of the patient, and therefore, they come to know what kind of drugs can be prescribed to the patient to make sure that he remains safe and gets cured easily.

It is important for safe care

A person in a medical facility always feels safe because it is a place where every person is given proper care and attention. Those who need to give care have access to the information of the patient, and through the medical record, they come to know what kind of care the patient needs. This way, they make sure that they give the level of care that the health and medical condition of the patient require.

It helps in the maintenance of documentation

Hospitals usually have a huge database in which they keep records of every person who visits them and gets treatment, recommendation, or medical care. So, when the patient comes again for the treatment, they don’t have to collect all the details again. They simply enter the patient number or unique ID, and the entire medical history of the patient comes in front of them.

It is useful for trials and research

When a new drug is being tested on patients, the result of the drugs is seen in the medical condition and thus, recorded in the form. This data is extremely useful for those medical facilities that are conducting research and want to know the ratio of people who have shown positive effects.

How to fill out the patient information form?

Some fields are found in the form that collects data from patients. These details are:

Details of the patient

The basic information of the patient is taken including his name, date of birth, gender, etc.

Emergency contact

The person who has come to get the treatment should also provide information about the person from his circle, particularly his family that can be contacted in case there is an emergency with the patient.

Medical history

The patient cannot talk about the technical or medical terms when he gives his medical history. Some basic questions are asked to know the medical history of the person seeking treatment. It often includes questions about medical conditions the patient has been diagnosed with, names of medicines he has taken, history of surgery the patient got in the past, and much more.

Reason for hospitalization

Here, the patient will have to specify why he has been admitted to the hospital. The basic requirement is to provide the details as to why the doctor has asked the patient to stay under medical care. Most of the time, the reason is the surgery of the patient.

Ward, bed, or room assignment number

A person hospitalized is assigned a bed with a unique number and the patient should mention it in the form. This will show where the patient stayed, from which medical practitioner he got the treatment and much more.


A patient should affix his signature at the end of the form after he has provided all the details. This signature will be proof that a legitimate person signed them and there is no doubt in the details’ correction as the patient is asked to review them before signing the form and submitting it.

Hospital information form template

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