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Admitting Forms

This webpage has been recently revised to improve ease of use and navigation. We would appreciate feedback concerning the new design. If there are questions, please contact the Admitting Office at 212-979-4306.

All forms must be submitted to the New York Eye and Ear Infirmary of Mount Sinai (NYEE) Admitting Office at least four business days prior to your patient's scheduled admission date. Please fax forms to 866-333-0174.

Directions: Please read carefully and complete all steps!

  1. Read the following information prior to Scheduling:
    1. Surgical Time Guidelines: Arrival to Hospital
    2. Guidelines for Pre-Surgical Testing and Standard Pre-Operative Orders
    3. NPO Guidelines
    4. Pre-Operative Patient Medication Guidelines
    5. Pre-Operative Instructions for Outpatient Surgery
      1. English
      2. Spanish
      3. Russian
      4. Chinese
  2. Consult the Adult and Pediatric grids below to find all patient-specific forms that must be completed and submitted at least four business days prior to your patient’s scheduled admission date. Please include the CPT / ICD 10 code associated with all diagnoses. Fax all forms to 866-333-0174.
  3. Special Instructions for the required Pre-Admission Registration Form:
    1. All areas pertaining to the physician’s specific surgical procedure must be completed.
    2. Please include all insurance information, including precertification form and/or authorization for NYEE services to be provided.

ADULT

Ophthalmology

ENT

Plastic Surgery

Required Forms

Required Forms

Required Forms

Optional Forms (as needed only)

Optional Forms (as needed only)

Optional Forms (as needed only)

PEDIATRICS

Ophthalmology

ENT

Plastic Surgery

Required Forms

Required Forms

Required Forms

Optional Forms (as needed only)

Optional Forms (as needed only)

Optional Forms (as needed only)