Fort Bayard Medical Center Admission Team
Adrian Duran
Admissions Director
(575) 537-8636
(575) 537-8871 FAX
email: Adrian Duran
Admission Information
Required Information
Click here to download a printable copy of the "Required Information for Admission"
To ensure that the admission of a referred individual is processed smoothly and efficiently, please see that the following information is obtained from the referring hospital, nursing home or attending physician and provided to Fort Bayard Medical Center BEFORE the arrival or admission of an individual.
- Transfer Form or Discharge Summary
- History and Physical Examination Documentation(within 6 months prior to admission)
- Abstract(the most current one)
- Any other assessments
- Most recent lab work include HIV, X-Rays, MRI, CT Scan(within 1 year), Mammogram, Dexa and Colonoscopy.
- Progress Notes(nursing, social services and physician)
- Incident Reports (identifying behavioral issues, combativeness, sexual inappropriateness, striking out, accidents, etc…)
- Medical History (operations, allergies, fractures, etc…)
- Psychological/Psychiatric Evaluations(if applicable), history of Psychiatric Hospitalizations(if known) and Diagnoses.
- List of Present Medications( Please bring Medications to Admission for Review)
- Consultation Reports
- Emergency Room Reports(if applicable)
- Guardianship papers if referred individual is incompetent or statement of competency (We do not accept Treatment Guardians), copies of Power of Attorney/Durable Power of Attorney, Conservatorship, etc...
- PASSR approval i.e., level I or Level II or documentation from PASSR office suggesting otherwise.
- Copies of Advance Directives (if applicable, i.e., Burial Plan, Life Insurance, Living Will, etc...)
- Copy of Social Security Card, Picture ID and Medicaid/Medicare Card(s)
- All Financial Information/attached documents
- PT/OT/Speech Evaluations and Progress Notes
- Vaccination records
- Dietary assessment including most recent height, weight, usual body weight, significant weight change for 1,3 & 6 months (if known), and current diet (including supplements and allergies) or tube feeding orders.
- If the Patient is on any Psych Meds, please download these consents HERE
If we do not receive all required information, the admission process will be delayed until received.
The admission team will make every effort to assure that the entire process is as convenient and quick as possible.
Admission Packet and Forms (Please Download and Fill all Forms)
Advance Directives Form Treatment Choices
Ancillary Services Consent Form
Influenza Immunization Informed Consent