san-antonio-logo
  • My Health Records
  • Pay Your Bill
  • Icon-awesome-heartGift Giving
  • Icon-awesome-phone909.985.2811
  • icon-awesome-search
  • icon-awesome-search
When autocomplete results are available use up and down arrows to review and enter to select.
close-icon
  • Services
    • Centers of Excellence
      • Urgent Care
      • Heart Center
      • Stroke Center
      • Cancer Center
      • Emergency Services
      • Women's Breast and Imaging Center
      • Orthopedic Institute
      • Healthy Beginnings Maternity
      • All Services
      • Care4U Clinic
      • Make an Appointment
  • Programs
    • Programs
      • Classes & Support Groups
      • Education & Events
      • Blood Donation
      • Community Health Improvement (CHIP)
      • Healthy Communities Institute (HCI)
      • Generations Ahead
      • Volunteers
      • Women Caring for Women
  • Patients & Visitors
    • Patient Guide
      • Your Hospital Stay
      • Before You Arrive
      • During Your Stay
      • Going Home
      • Surgery & Recovery
      • Safety & Security
    • Visiting Information
      • Location & Maps
      • Hospital Directory
      • Hospital Charges
      • Patient Resources
      • Medical Records
      • Patient Stories
  • Find a Physician
  • Careers
      • Careers
      • Search & Apply
      • Nursing
      • Allied Health
      • About San Antonio
      • Working At San Antonio
      • Career FAQ
  • About Us
    • About Us
      • Locations
      • Quality/Patient Experience
      • Mission & Vision
      • Leadership
      • Latest News
      • History
      • Awards & Accolades
      • Accreditures & Licensures
      • DAISY, LEAF & PROVIDER Award
      • Physician Portal
icon-awesome-search
icon-awesome-search
  1. Home
  2. Patients and Visitors
  3. Patient Rights and Responsibilities
  4. Patient Forms
When autocomplete results are available use up and down arrows to review and enter to select.
In this section

Patient & Visitors

  • Your Hospital Stay
  • Before You Arrive
    • Registration
    • Advance Beneficiary Notice
    • Advance Directive Forms
  • During Your Stay
    • Parking
    • Meals
    • Patient Healthcare Decisions
    • Patient Satisfaction
    • Pain Management
    • Spiritual Care
    • Television
    • Telephone
    • Smoking
  • Going Home
    • Preparing for Discharge
    • Don't Leave Until
  • Surgery & Recovery
    • Before Surgery
    • The Day of Surgery
    • Following Surgery
    • Second Opinion Before Surgery
  • Safety & Security
    • Parking Security Escort
    • Speak Up
    • Stay Safe
  • Visiting Information
  • Medical Records
  • Privacy Practices
  • Location & Maps
  • Hospital Directory
  • Hospital Charges
  • Insurance
  • Help Paying Your Bill
  • Good Faith Estimate
  • Balance Billing
  • Patient Resources
    • Support Groups
    • Healthcare Services Defined
    • Healthcare Staff Defined
    • Caregiver Information
    • Patient Healthcare Decisions
  • Patient Services
  • Covid-19
  • Seasonal Flu & H1N1
  • Gift Shop
  • Patient Records
  • Patient Rights & Responsibilities
    • Patient Forms
  • Giving Back
    • Patient-Family Advisor
    • Volunteers

Patient Forms:

My Health Record Brochure (English)

My Health Record Brochure (Spanish)

Your Right to Make Decisions About Medial Treatment (English)

Your Right to Make Decisions About Medical Treatment (Spanish)

Patient Rights (English)

Patient Rights (Spanish)

Notice of Privacy Practices (English)

Notice of Privacy Practices (Spanish)

No Surprise Act Notice - English (For Commercial Insurance Only)

No Surprise Act Notice - Spanish (For Commercial Insurance Only)

Financial Assistance Policy Summary (English)

Financial Assistance Policy Summary (Spanish)

Good Faith Estimate Notice - English/Spanish (For Self Pay Only)

Your health records belong to you.

Log in to securely view lab results and more online.

Access Records
san-antonio-logo
Here for Life

Important Links Toggle

  • Services
  • Programs
  • Patients & Visitors
  •  
  • Give to San Antonio

Locations Toggle

  • San Antonio Regional Hospital
  • The Scheu Family Building
  • Rancho San Antonio Medical Plaza
  • Sierra San Antonio Medical Plaza
  • Eastvale San Antonio Medical Plaza
  • San Antonio Urgent Care Ontario

Access Toggle

  • Care4U Family Health Center
  • Patient Portal
  • Physician Portal

Contact Toggle

  • 999 San Bernardino Rd., Upland, California 91786
  • General Inquiries
  • 909.985.2811  [email protected]

  • Billing Inquiries
  • 909.980.9511   [email protected]
  • Icon-map-doctorFind a Physician
  • Icon-awesome-hospitalAbout Us
  • Icon-ionic-md-briefcasCareers
  • Icon-material-paymentPay Your Bill
  • Help Paying Your Bill
  • icon-awesome-help-payingPrice Transparency
  • Twitter
Copyright © 2024,  San Antonio Regional Hospital
Privacy Policy Patient Privacy SARH Materials Mgmt. Standard Supply T&C’s