Emergent admissions 2026

1. Click ‘Get Form’ to open the emergent admissions document in the editor.
2. Begin by entering the facility name at the top of the form. This identifies where the admission is taking place.
3. Fill in the participant information, including the date of admission, participant ID number, date of birth, and participant’s name. Ensure accuracy as this information is crucial for processing.
4. Select the type of admission by checking one of the boxes: Inpatient, Medical observation, Short procedure, or Obstetric observation.
5. Provide a diagnosis or reason for admission and enter the attending physician's name along with their Keystone First CHC provider ID number.
6. If applicable, complete the procedures performed section for SPU admissions and indicate if the participant is pregnant by selecting 'Yes' or 'No'.
7. Finally, review all entered information for accuracy before submitting. You can return it via fax or phone as indicated at the bottom of the form.

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