Admitting Forms
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 read the following instructions carefully and complete all necessary steps.
1. Prior to scheduling, please review the following information:
- Premium IOL/FEMTO Fee Schedule
- Surgical Time Guidelines: Arrival to Hospital
- BMI Calculator
- ASA Guidance
- Guidelines for Pre-Surgical Testing and Standard Pre-Operative Orders
- NPO Guidelines
- Pre-Operative Patient Medication Guidelines
- Pre-Operative Instructions for Outpatient Surgery
2. Consult the Adult and Pediatric sections 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.
3. Please review these special instructions for the required Pre-Admission Registration Form:
- All areas pertaining to the physician’s specific surgical procedure must be completed.
- Please include all insurance information, including precertification form and/or authorization for NYEE services to be provided.
- Financial Clearance Form
4. One Medical Passport Downtime Resources:
5. One Medical Passport Training Resources
- One Medical Passport Training Video
- One Medical Passport Booking Guide
- One Medical Passport Booking Quick Guide
- One Medical Passport Documents Guide
Adult Forms
Please find the following required and optional forms for adult ophthalmology, ENT, and plastic surgery patients.
Ophthalmology Forms: Required
Bilingual Informed Consents must be completed on the preferred language side of the form. Procedures must be written in English.
- Procedure/Surgery Consent:
- Ophthalmology Adult - Admitting Note and Pre-Surgical Order Form
- Ambulatory Surgery (Adult) Pre-Operative Medical Evaluation Form
Ophthalmology Forms: Optional
The following forms are to be used as needed only.
- Notice of Exclusion Form
- Pre-Admission Certification Form
- Cardiac Rhythm Management Devices
- Intraocular Request Form
- Intraocular Lens Verification Form
- Medical Photography and Imaging Orders Form
- Outpatient Laser Center Form
- Self Pay Cosmetic Form
- Consultation Request and Report
- Physician’s Orders
- Patient Self-Assessment Questionnaire
- My Medication List
- Pre-Operative Medical Assessment (Adult)
ENT Forms: Required
Bilingual Informed Consents must be completed on the preferred language side of the form. Procedures must be written in English.
- Procedure/Surgery Consent:
- ENT and Plastic Surgery Adult - Admitting Note and Pre-Surgical Order Form
- Ambulatory Surgery (Adult) Pre-Operative Medical Evaluation Form
ENT Forms: Optional
The following forms are to be used as needed only.
- Pre-Admission Certification Form
- Cardiac Rhythm Management Devices
- Cochlear Implant Device
- Self Pay Cosmetic Form
- Consultation Request and Report
- Physician’s Orders
- Patient Self-Assessment Questionnaire
- My Medication List
- Pre-Operative Medical Assessment (Adult)
Plastic Surgery Forms: Required
Bilingual Informed Consents must be completed on the preferred language side of the form. Procedures must be written in English.
- Procedure/Surgery Consent:
- ENT and Plastic Surgery Adult - Admitting Note and Pre-Surgical Order Form
- Ambulatory Surgery (Adult) Pre-Operative Medical Evaluation Form
Plastic Surgery Forms: Optional
The following forms are to be used as needed only.
Pediatric Forms
Please find the following required and optional forms for pediatric ophthalmology, ENT, and plastic surgery patients.
Ophthalmology Forms: Required
Bilingual Informed Consents must be completed on the preferred language side of the form. Procedures must be written in English.
- Procedure/Surgery Consent:
- Ophthalmology Pediatric - Admitting Note and Pre-Surgical Order Form
- Pediatric History and Physical Form
Ophthalmology Forms: Optional
The following forms are to be used as needed only.
- Intraocular Lens Verification Form
- Medical Photography and Imaging Orders Form
- Outpatient Laser Center Form
- Consultation Request and Report
- Physician’s Orders
- My Medication List
ENT Forms: Required
Bilingual Informed Consents must be completed on the preferred language side of the form. Procedures must be written in English.
- Procedure/Surgery Consent:
- ENT and Plastic Surgery Pediatric - Admitting Note and Pre-Surgical Order Form
- Pediatric History and Physical Form
ENT Forms: Optional
The following forms are to be used as needed only.
Plastic Surgery Forms: Required
Bilingual Informed Consents must be completed on the preferred language side of the form. Procedures must be written in English.
- Procedure/Surgery Consent:
- ENT and Plastic Surgery Pediatric - Admitting Note and Pre-Surgical Order Form
- Pediatric History and Physical Form
Plastic Surgery Forms: Optional
The following forms are to be used as needed only.