DAILY COVID HOSPITALIZATIONS Registration & Forms Thank you for choosing Monroe Hospital for your healthcare needs. Save time! Pre-register. When you arrive at the hospital for your procedure, you will be greeted and brought to the Registration Office by one of our friendly registration staff. During the registration process, you will be asked several questions, including but not limited to the following: Name Address Social Security Number Date of Birth Phone Number Emergency Contact Name Emergency Contact Phone Number Name of Primary Care Physician Employer Information Please also be sure to bring the following items with you to your appointment: Photo ID (MUST HAVE) Insurance Cards (MUST HAVE) Handwritten order from physician’s office (if available) A list of all current medications Pre-Registration: To save time and pre-register for your procedure, you can download a copy of the registration form and fax it to the phone number listed below. If you wish to pre-register, you must do so at least 48 hours prior to your scheduled appointment. *Please note: Even if you pre-register, you will be asked to verify much of the information upon your arrival at the hospital for your procedure. You will also need to present your insurance cards and a photo ID at this time. ** You do not need to pre-register for any walk-in procedures such as lab work or X-Rays. For any questions, or to fax your pre-registration information please call Phone: 812-825-1111 Fax: 812-825-0760 Contact Us Medical Records Registration & Forms Community Partners Phone Numbers Information Center COVID-19 Patient & Visitor Information Monroe Medical Group - MyChart - Patient Portal Monroe Hospital - MyChart - Patient Portal Request Medical Records Monroe Experiences Internships Physician Portal ABOUT US ABOUT PRIME HEALTHCARE OUR SERVICES PATIENTS & GUESTS FIND A PROVIDER CAREERS OUR LOCATIONS CONTACT US NEWS INTERNSHIPS Monroe Hospital 4011 S. Monroe Medical Park Blvd Bloomington, IN 47403 812-825-1111 Get Directions Copyright © 2021 Privacy Policy Site Map Website Accessibility A member of Prime Healthcare www.primehealthcare.com

DAILY COVID HOSPITALIZATIONS Awards Monroe Hospital Achieves Healthgrades 2019, 2020 and 2021 Patient Safety Excellence AwardTM Monroe Hospital in the top 10% in the Nation for Patient Safety Monroe Hospital Nationally Recognized with an ‘A’ Grade in the Fall 2019 Leapfrog Hospital Safety Grades About Us About Prime Healthcare Mission Patient Experiences Meet Our Team Health Tips Fact Sheet Locations Information Center COVID-19 Patient & Visitor Information Monroe Medical Group - MyChart - Patient Portal Monroe Hospital - MyChart - Patient Portal Request Medical Records Monroe Experiences Internships Physician Portal ABOUT US ABOUT PRIME HEALTHCARE OUR SERVICES PATIENTS & GUESTS FIND A PROVIDER CAREERS OUR LOCATIONS CONTACT US NEWS INTERNSHIPS Monroe Hospital 4011 S. Monroe Medical Park Blvd Bloomington, IN 47403 812-825-1111 Get Directions Copyright © 2021 Privacy Policy Site Map Website Accessibility A member of Prime Healthcare www.primehealthcare.com