Please include all names you know of that the patient may use. This can be very helpful to our Eastminster Hospital Visitation Team, especially if the patient goes by a name other than what is listed in the hospital records.
Your answer
Room Number
If you don't know the patient's room number, simply leave this blank, because this can be added or updated later.
Your answer
Relation to Eastminster
Staff can go through and update this after checking the church database, so it's ok if you don't know and leave this blank.
Clear selection
Comments
Feel free to include any comments that might be helpful to the Eastminster Hospital Visitation Team.