REHAB PRE-ADMISSION FORM Elective Hip and Knee Surgery 2026

1. Click ‘Get Form’ to open the REHAB PRE-ADMISSION FORM in our editor.
2. Begin by entering your personal information in the 'Patient' section. Fill in your last name, first name, health card number, version, gender, height, address, home phone number, and date of birth.
3. Indicate your weight status by selecting from the options provided (>250lb/113 kg) and choose your accommodation preference (Standard, Semi-Private, Private).
4. Complete the insurance details by entering the insurance company name and policy certificate/group number.
5. Fill out the 'Next of Kin/Emergency Contact' section with the contact's name and telephone number.
6. Specify your current surgical intervention by checking the appropriate boxes for hip or knee replacements and any revisions.
7. Provide your primary diagnosis and any secondary diagnoses that apply. If necessary, indicate if an interpreter is required.
8. Discuss living settings and discharge plans before finalizing your form. Ensure all relevant medical history is documented.
9. Finally, enter dates related to surgery and referrals as applicable. Review all entries for accuracy before submission.

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