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How to use or fill out the application - Holy Cross Hospital with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the Patient Information section. Enter your full name, medical record number, current address, city, state, zip code, email, and phone number.
- In the Release Information From section, check all applicable boxes and provide your date of birth.
- For Release Information To, specify the name of the recipient (Holy Cross Hospital) and their address. Include the facility details if necessary.
- Indicate whether you prefer paper or secure electronic delivery for your records. If choosing electronic delivery, provide the recipient's email address.
- Clearly state the purpose for disclosure and fill in the dates of service you wish to release.
- Review the authorization statement carefully. Sign and date at the bottom of the form. If someone other than yourself is signing, ensure legal documentation is attached.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2017 | 4.3 Satisfied (30 Votes) |
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What level hospital is Holy Cross?
As a Level II trauma center, our Center provides surgeons, surgical specialists, emergency physicians, nurses, and other healthcare professionals trained to give immediate care to the trauma patient.
What is the #1 ranked hospital in Los Angeles?
Cedars-Sinai has been named to the Honor Roll for the 10th consecutive year in U.S. News World Reports Best Hospitals 2025-26 rankings. The medical center also tied for #1 in California and Los Angeles.
How to get a hospital admission?
If you plan to go into hospital, it usually involves a doctor or specialist giving you a referral. Urgent (unplanned) admission to hospital involves a sudden health issue that needs you to go to an emergency department or call an ambulance.
Can I go to Holy Cross Hospital without insurance?
Holy Cross Hospital extends discounts to all uninsured patients who receive medically necessary services. Uninsured discount amounts are based on Federal Poverty Level (FPL) guidelines. Patient statements will show the discount amount and the adjusted balance owed.
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