Here you will find information about the forms we require prior to your admission. These will be sent to you by post and must be completed and returned by post or email no later than one week before admission. If your admission is scheduled at short notice, please bring the completed forms with you on the day of admission.
Standard Forms:
- Admission Form
- Form “Your Inpatient Admission”
- Electronic Patient Dossier (EPD)
- General Consent Form
Additional Forms (if included with your documents)
- SIRIS
- SWISS NOSO
- Room Upgrade Application (if desired)
General Data Protection Regulation (GDPR) Form
Standard Forms
Admission Form
The admission form is a three-page document containing personal details as well as general information regarding admission and your stay. It serves as the treatment and hospital admission agreement and must therefore be signed once on page 3.
Form “Your Inpatient Admission”
The form “Your Inpatient Admission” is a document in which you are asked to list your current medications, including dosage. In addition to ensuring completeness, please remember to bring your current medications with you to the clinic in their original packaging on the day of admission.
General Consent Form
The general consent form provides information about the further use of personal data and biological material for research purposes. Please read the information sheet carefully and then indicate “yes” or “no.” Your signature is also required on page 2.
Electronic Patient Dossier (EPD)
The Electronic Patient Dossier (EPD) is an electronic collection of personal documents containing information about your health. Thanks to the EPD, these documents are available online at any time and can be accessed by you or by individuals to whom you grant authorization.
Please indicate whether you have such an EPD (Yes / No). The second question asks whether documents related to your current course of treatment should be excluded from the EPD or not (Yes = documents will not be uploaded; No = documents will be uploaded). Please make sure to sign this form as well.
Additional Forms
SIRIS - Swiss Implant Registry
The SIRIS form is relevant if an implant is being placed. It is a patient consent form for registration in the implant registry and serves the purpose of quality assurance in implant medicine. The data collected is used for comparative, anonymized analyses.
Consent is voluntary and may be withdrawn at any time without affecting your treatment contract. Please read the document carefully, indicate your choice (Yes = registration in SIRIS, No = no registration), and sign the form.
SWISS NOSO
SWISS NOSO is dedicated to reducing infections that occur as a result of hospitalization or treatment in a hospital or care facility. By completing the enclosed form, you confirm your participation in SWISS NOSO’s anonymized monitoring program. If you do not wish to participate, you must explicitly indicate this on the form.
General Data Protection Regulation (GDPR) Form
The form for data processing related to non-medical services regulates the handling of personal data and contact via telephone, email, and postal mail. In addition, if eligible, you may receive the Hirslanden Privé membership and participate in customer satisfaction surveys. Please indicate for each item whether we may contact you.
You may, of course, withdraw your consent at any time by phone, post, or email.
Room Upgrade Application (if desired)
You can find information about room upgrades here. If you are interested in an upgrade, please complete the upgrade form and return it by post or email to our Patient Services team.
Anaesthesia Questionnaire
Please complete the two-page patient questionnaire in full if you have received it. Information regarding anesthesia can be found in the enclosed document.