The patient registration forms are categorised into three sections and you will need to complete the following sections:
1. Patient registration form
Please complete all the questions on the Patient Registration form, including any insurance or payment details ie. private health insurance, self-insured, ACC or DHB contract details.
If you have private health insurance, please request approval from your health insurance company before your operation/procedure to ensure you are clear on what is and isn't covered under your policy.
Your insurance company will give you a 'Prior Approval Number', which should be included on your Patient Registration form. However do not delay returning your documents if your prior approval has not been processed. This can be advised nearer to your surgery date. Please bring your Prior Approval letter with you to hospital.
2. Patient health questionnaire
Please complete all the questions on the Health Questionnaire form.
3. Informed Consent
Please make sure that you complete the Consent for Operation/Procedure form together with your surgeon.
Completing the Consent form confirms you've received all the information you need to make an informed choice, and that you've agreed to your operation/procedure. It also includes consent for blood sampling, in the event of a MercyAscot employee receiving a needle stick injury or other blood accident during your operation/procedure.
Download the Consent for Operation/Procedure form here (or complete on pages 10 of the booklet)
Send us your forms
Please send the completed forms straight away to Customer Support at the hospital where your surgery is booked, Mercy Hospital or Ascot Hospital, in one of the following ways:
- Scan and email: email@example.com
- In person to Reception: 98 Mountain Road, Epsom (open 6am - 9pm Monday to Friday, 8am-8pm Saturday, 8am-8pm Sunday
- Courier to Reception
- Post using the reply-paid envelope included in your patient information and admission pack given to you by your surgeon's rooms: Mercy Hospital, PO Box 9911, Newmarket, Auckland 1149, only if 14 or more days before surgery date.
- Scan and email: firstname.lastname@example.org
- In person to Reception: 90 Greenlane Road East, Remuera (open 6am-5pm Monday to Friday, 8am - 8pm Saturday, 8am-8pm Sunday
- Courier to Reception
- Post using the reply-paid envelope included in your patient information and admission pack given to you by your surgeon's rooms: Ascot Hospital, Private Bag, Remuera, Auckland 1051, only if 14 or more days before surgery date.
The forms must be received your hospital at least ONE WEEK before your proposed admission date. Please ensure you allow at least TWO WEEKS for postage as this service is slow.
Returning this information in advance means we can better plan for your surgery and confirm all your relevant health details. If you have any questions please feel free to contact us directly by calling Mercy Hospital 09 623 5700 or Ascot Hospital on 09 520 9500 or if emailing, please remember to bring the original forms with you on your admission to hospital.
Your surgeon will have given you a leaflet about anaesthetics. Before admission, your anaesthetist may call you to talk about your current health and any anaesthetic-related questions.
Contact from the hospital
To help you be completely prepared and dependent on your planned surgery and/or your medical history you may receive a phone call from one of our Pre-Admission nurses to clarify the information you provided on your Patient Health Questionnaire.
You will usually receive separate accounts from your surgeon, your anaesthetist and MercyAscot.
MercyAscot hospital charges include accommodation, operating room fees, anaesthetic supplies, medication and medical supplies.
There may also be additional charges for X-rays, physiotherapy or laboratory services.
Personal expenses such as toll calls, beverages from the drinks trolley and visitor meals will be charged to your account.
Your invoice will be posted to you approximately five working days after discharge. All collection or legal costs incurred in recovering any debt will be charged to you.
Patients with insurance
If you had prior approval from your insurer, once you have received all the invoices relating to your surgery, you must complete a claim form and forward all this to your health insurer including all invoices.
After the hospital has received payment from your insurance company, MercyAscot will then forward you a statement showing any amount outstanding that has not have been covered by your insurer.
If you didn't have prior approval from your insurer, you will have paid the total estimated hospital costs on admission.
You will be invoiced for any additional costs approximately seven working days after discharge, or notified of any refund.
Overseas and self-funded patients
Overseas patients and self-funded patients must contact Customer Support (Mercy Hospital 09 623 6833 extn 28460, Ascot Hospital 09 520 9500 extn 69134) prior to admission to obtain an estimate of hospital costs. You are then required to pay the total estimated cost on admission. You will be invoiced for any additional costs approximately five working days after discharge, or notified of any refund.
Your hospital accounts will be paid directly by ACC. You are required to pay any personal expenses incurred such as toll calls, drinks and visitors meals on discharge.
You will also need to pay for any take-home medication when you're discharged.
If you'd like to pay your account with us by Internet banking, please ask for our account details.
MercyAscot also accepts cash, bank cheques, most credit cards and EFTPOS (please check your daily card limits prior to admission).
Personal cheques are accepted by prior arrangement only. Personal cheques must be deposited five working days prior to admission to the hospital to allow for clearance.
Patients without prior approval will be requested to pay the total estimated hospital costs on admission, and pay a balance of payment after your discharge. Please see "Settling your account
" page of this website for more information.
So that you're aware of any payment or possible balance of payment, and so we can give you an estimate of our costs, please call:
Customer Support on 09 623 6833 extn 28460 or email: email@example.com
Customer Support on 09 520 9500 extn 69134 or email: firstname.lastname@example.org
Information about your regular medications
We're committed to providing the safest and highest quality care possible. To make sure this is always the case, we need accurate information about the medications you take at home. Ask your family doctor to give you a list of your current medications to bring with you.
Herbal medications and dietary supplements
Herbal medications and dietary supplements can interact with the drugs we may prescribe you. We recommend that wherever possible you stop taking them at least one week before your operation.
Planning for your discharge
Your surgeon will let you know if he/she thinks you'll need extra support when you leave hospital. This might be a home nursing or rehabilitation service - especially if you live alone. These services need to be arranged through the surgeon's rooms before your admission.
For your safety and wellbeing you will not be allowed to drive for 24 hours after your operation/procedure, and someone should be at home with you when you leave hospital. Please discuss this with your surgeon or family doctor prior to surgery.
We're here to help. If you have any questions at all about the admission process, forms or costs, our Customer Support staff will be happy to assist you on Mercy Hospital 09 623 6833 extn 28460, or Ascot Hospital 09 520 9500 extn. 69134.
Before your Admission Checklist
On the Day of your Admission
Your surgeon's instructions
It's important to follow any pre-surgery instructions from your surgeon, especially any around medication or fasting (no eating, drinking or chewing).
Please also have a bath or shower, and wear loose, comfortable clothing.
What to bring with you:
- Your Patient Information folder and booklet
- If you emailed your forms, bring the original forms with you
- Any Prior Approval letter from your health insurer
- All the medications that you're currently taking including tablets, liquids, creams, eye drops, inhalers, patches and any medications you have bought from a pharmacy, supermarket or health food store eg. herbal and dietary supplements. This helps guarantee your medications are available when you need them, and your operation/procedure isn't interrupted. It also helps your specialist review your regular medications accurately from your drug chart and prescribe any new medications, and the clinical pharmacist can make sure any new medications don't interact negatively with your current medications:
Please bring the medications in their original packs with the pharmacy label on them. Do not bring loose strips of medication or medications that have been transferred into another container.
If you use a tablet organiser/box, please bring in the original packs that contained the medications.
If you have a list of your medication from your family doctor, bring this with you too.
- A current form of ID. This can be passport; birth certificate; drivers license.
- Any relevant X-rays, CT or MRI scans (including CDs) and reports, test results, pathology reports, or any letters or reports from your surgeon, family doctor or another hospital
- Prescription Subsidy Card
- Any mobility aids/crutches/equipment (ie. CPAP machine) that you are currently using, reading glasses, hearing aids, and their cases
- Reading material, or something to do while you're in the waiting area or resting in recovery
If you're staying with us overnight or longer, you should also bring:
- Something suitable to wear to bed, eg. a comfortable nightie or pyjamas
- A dressing gown
- Comfortable daywear
- Personal toiletries
Please DO NOT:
- Smoke or drink alcohol 24 hours prior to admission
- Wear make-up, nail polish, jewellery or body piercing (you can wear your wedding ring)
- Bring any valuables, jewellery or large amounts of luggage as we do not accept liability for any items brought to hospital
Mercy Hospital is located at 98 Mountain Road, Epsom, about six kilometers from Auckland city center. The shopping area of Newmarket is just five minutes' drive from the hospital.
A ten-minute patient pick-up and drop-off zone are situated outside the main entrance of the hospital, accessed through Gate 1. Longer term free parking is available in the adjacent, clearly-signed area, accessed through Gate 3. Entrances around the hospital are open from 7.00am-8.00pm.
After that time visitors should use the main entrance, which is open until 8.15pm. Entrance to the hospital outside these hours is available through the buzzer near the main entrance.
Ascot Hospital is located at 90 Greenlane Road East, Remuera, just off the Greenlane Motorway interchange in Auckland.
There is a patient pick-up and drop-off zone outside the main entrance to the hospital. 90-minute parking is available at the front of the building and there is a large car park at the rear of the hospital, where the first 30 minutes of parking is free.
The rear entrance of the Hospital is open from 6.00am - 5.00pm Monday to Friday, after that time, visitors should use the front entrance which is open 24 hours.
MercyAscot is committed to delivering care within the Code of Health & Disability Service Consumers' Rights.
We encourage you to:
- Be actively involved in decisions about your care
- Respect the rights of other patients
- Comply with our no smoking policy.
MercyAscot complies with the Health Information Privacy Code. All personal information is protected by the Privacy Act 1993.
By law, we must retain your health information for ten years. You have the right at any time to access and correct any health information about you held by MercyAscot.
If you have any questions or concerns about the way in which your health information is managed by MercyAscot, please contact our privacy officer, or discuss with your clinical charge nurse, or the duty manager.
Our objective is to provide excellent service and care, and we value feedback from patients. Please pass on any comments or compliments you may have to the clinical charge nurse. You do not need to wait until you are discharged if you feel dissatisfied.
Receiving information from patients can alert the team to problems that may not previously have been identified. If you are not satisfied with the response you receive or you wish to inform us of your concern in writing please address your concern to the chief operating officer who can:
- Discuss a problem with you confidentially
- Help with any concerns you may have about the care you receive, and with your permission talk to appropriate employees
- Give you more information about your rights as a patient.
We will you to complete a Patient Satisfaction Survey after you have been discharged. We would appreciate you completing the survey and returning it to us so we can understand and measure the service we provide.
Access to the Health and Disability Consumer Advocacy Service, a free confidential service, is available by calling 0800 555 050, faxing 0800 2787 7678 or emailing email@example.com.