Pre-Admission Information for Labor and Delivery

We ask that you provide your pre-admission information before you come to Lucile Packard Children's Hospital to have your baby. If you send this information to us before your baby arrives, you can go straight to Labor and Delivery when you come to the hospital. Labor and Delivery will have all of the information you provided.
 
We offer two ways of pre-registering:

1. Online This will take 5-10 minutes of your time. Please have the following information available when you complete the online form: Mother's information, including employment Father's information, including employment Pregnancy information, including due date and desired method of delivery Emergency contact information Insurance information, including copies of the front and back of your insurance card and prescription card(s).  A copy of your advanced directive, if you have one. We will also ask you to print out, sign and fax some pre-admission forms that require your legal signature.   Begin the online pre-admission process(English or Español).   We will contact you if we have any questions and to verify your registration. If you have any questions, please call (650) 497-8229.

 

2. Download and Fax/Mail Forms

1. Download the pre-admission forms (PDF) and print out all eight (8) pages.
   
   
2. Complete the forms:
   • Page 1 - Patient Registration Form for Labor and Delivery
     • Please fill out the form as completely as possible.
       
       
   • Pages 2-3 - Terms and Conditions of Service - Consent to Treatment
     Please read and sign this form as the patient who will be delivering her baby at the hospital.
     
     • Please sign and date the Patient or Responsible Person Signature field and check the Patient Authorized to Consent box.
     • Please have an adult watch you complete the form and sign in the Witness field.
     • Complete the Financial Responsibility Agreement at the bottom of the page, if applicable.
       
       
   • Page 4 - Release of Information, Child Safety Seats, Financial Assistance Available
     This page is for your information. You do not need to fax or mail it back to us.
     
     
   • Pages 5-6 - Terms and Conditions of Service - Consent to Treatment
     This is the same form you completed for pages 2-3. However, you should read and sign this form as the parent/legal guardian of your baby who will become a Packard Children's Hospital patient at birth.
     
     If you are expecting multiples, please print out, read and sign pages 5-6 for each baby.
     
     
     • Please sign and date the Patient or Responsible Person Signature field and check the Parent with Legal Custody box.
     • Please have an adult watch you complete the form and sign in the Witness field.
     • Complete the Financial Responsibility Agreement at the bottom of the page, if applicable.
       
       
   • Page 7 - Release of Information, Child Safety Seats, Financial Assistance Available 
     This page is a duplicate of page 4 that we are legally required to provide for your information. You do not need to fax or mail it back to us.
     
     
   • Page 8 - Advance Directive Information Form
     • Please check the box that best describes your Advance Directive status and/or wishes.
     • Please sign the Patient (or representative) signature field toward the bottom of the page.
     • Please also read the Your Right to Make Decisions about Your Medical Treatment (PDF) document.
       
       
3. Make a copy of the front and back of your insurance card.
   
   
4. Make a copy of the front and back of your prescription card.
   
   
5. Fax the completed pre-registration forms, copy of your insurance card, and copy of your prescription card to us at (650) 725-3574. Please make sure the hospital receives this information 4-6 weeks before your due date.

Please call the Patient Admitting department at (650) 497-8229 if you have any questions. 
 

Photo Identification

In compliance with Federal Trade Commission Red Flag Rules, Lucile Packard Children’s Hospital has established an Identity Theft Prevention Program to detect, prevent and mitigate risks associated with identity theft. Effective August 1, 2009, Packard Children’s Hospital requests that patients arriving for an inpatient stay, clinic visit or outpatient procedure present:

1. A valid form of photo identification and
2. The patient’s insurance card (if applicable)

The hospital will request this identification at each hospital visit. Learn more about this requirement and valid forms of identification.
 

Additional Information

• Labor and Delivery is on the second floor of the hospital
• Directions to the hospital
• Parking
• Financial and insurance information
• Resource Guide for Families (English / Español PDF) - The essential hospital places, specific amenities and services for patients and families.

 

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