Patient Registration Form Template

The hospital management system is based upon a number of very important things that aim to ensure quality health care. A proper record system forms the foundation of a good health system. There are many reasons for its importance. A patient’s record makes the foundation for proper diagnosis and treatment. We also want to provide the patient care to the right patient and not to someone who is of the same name but doesn’t require the treatment we accidentally give.

A proper documentation system obviously begins with the patient’s registration form. As soon as a patient enters the premises of the hospital, his information is needed by the hospital management. The hospital also needs it so that this information is shared with the concerned doctor to use it in his treatment and follow up.

What do we need to know about a patient’s registration form?

A patient’s registration form is a data-sheet in which we enter the basic information of the patient to use if for health care purposes.


There are some very important components of the patient registration form. We will discuss them one by one.

  • Name, age, gender

Some hospitals use only the first and last names of the patient while registering. Some hospitals have the policy to use first, middle, and last names as a necessity. The main reason behind this is to maintain the proper identity of the patient. Similarly, the age and gender of the patient are required for identity as well as the probable diagnosis of his problem. We all know that some diseases are gender and age-specific. So, this information helps a lot in reaching the diagnosis.

  • Date of birth, marital and employment status

To establish the identity of the patient, all of this is also used. Apart from that, in the hospital management system, we are also interested in knowing this all to reach the diagnosis especially those that are age and occupation-based. For example, respiratory illnesses are frequently found in the people working in mines or cotton fields.

Employment status also gives information about who will be bearing the expenses and if there is any panel for the patient or not.

  • Address and emergency contacts

This portion of a patient registration form is self-explanatory. Hospitals and all other healthcare facilities always want to follow up with the patient cases for better health services and make sure that the patient is getting the right treatment. It also helps in corresponding in case of emergencies that occur in the hospital or maybe outside.

  • Insurance details

This part of the patient registration form is specific to the hospital management which is always interested in knowing the financial status of the patient. They need to know the status of health insurance for the patient and as well as his family who need health care facility at any point of time.

The closing part of the patient registration form usually consists of the signature making sure that the patient agrees to the terms and conditions of the hospital.

Patient Registration Form Template for Word -1

Simi Karton

Simi Karton is a regular contributor to National Science Quarterly and an enthusiastic Lakers fan. She recently collaborated on a manuscript with friends and colleagues. Dr. Simi Karton, entitled Parkinsons and the Genetic Response to Eastern Medicine, in which she and Dr. Inshal presented research compiled during a summer spent in United States. She currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health related information stuff at an easy approach. The information has been collected from different sources at one place.

You may also like...