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Patients

Before Your Visit

Pre-Registration

Our hospital offers online Pre-Registration for your upcoming, scheduled visit. Please submit your information at least two business days before your arrival. If you are experiencing a life threatening emergency, go directly to the ER or dial 9-1-1. This form is NOT intended for Emergency Room use.

Pre-Registration Secure Form

Insurance & Financial Assistance

Pikes Peak Regional Hospital currently accepts the following health plans. If your managed healthcare plan is not listed, please contact your insurance provider. Some affiliates may not be listed.

  • Aetna/Aetna Medicare
  • Anthem Blue Cross/Blue Shield
  • Bankers Life
  • BlueCross/BlueShield HMO
  • BlueCross/BlueShield PPO
  • BlueCross/Blue Shield of Colorado
  • BlueCross Federal
  • BlueCard
  • BlueCross/BlueShield Smart Value/Medicare Advantage/Indemnity Plan
  • CICP
  • CHP+
  • CTSI (Anglo Gold Ashanti Mine) Workers’ Compensation
  • Cigna/Great West
  • Cirsa Workers’ Compensation
  • Government Employees Health Association (GEHA)
  • Humana/Humana Gold
  • Kaiser Permanente Health Plans
  • Medicare
  • Medicaid
  • Multiplan/Private Health Care Systems (PHCS)/Assurant Health
  • Pinnacol Assurance Workers’ Compensation
  • Rocky Mountain Healthplans PPO, HMO Medicare (includes CNIC Health Solutions)
  • Secure Horizons (includes AARP, Medicare Complete & Medicare Direct)
  • Self-pay – a 25% discount is offered for uninsured patients if paid in full at time of service
  • Sloans Lake/MMA (Mountain Medical Affiliates) Ameribend/Cofinity
  • Today’s Option (Pyramid Life)
  • Tricare (all plans)
  • Walmart Workers’ Compensation
  • United Healthcare

Financial assistance for patients who are unable to pay the full cost of care:

Colorado Indigent Care Program (CICP) Sliding Scale

Uninsured/self pay applicants will be assigned a “rating” based on their total income and resources. The rating determines the co-payment amount that will be charged to the applicant for medical services for a twelve month calendar year.

To be eligible, you must:

  • Be a Colorado resident, migrant farm worker and a United States citizen or legal immigrant;
  • Have income and resources combined at or below 250% of the Federal Poverty Level (FPL); and
  • Cannot be eligible for the Medicaid program or CHP+.

Financial counseling services are available by appointment Monday-Friday 7:00 am – 4:00 pm by calling 719.686.5708

Medical Records

Pikes Peak Regional Hospital maintains medical records for each patient treated at the hospital. To request your medical records, please visit our Health Information Management department between the hours of 8:00 a.m. – 5:00 p.m., Monday through Friday, or call 719-686-5721.

Prior to receiving copies of records or authorizing records to be disclosed, you will be asked to complete the appropriate form and provide proof of your identification with a valid, government issued photo ID.

The appropriate form, along with a copy of your proof of identification, may be faxed to 719-686-5823.

Requests for medical records generally take up to 72 hours to process.

The following form should be used for requests to inspect or obtain a copy of one’s own records or those of a patient for whom you are the legal representative.

Request a Copy of PHI (English)

Request a Copy of PHI (Español)

The following form should be used for requests to disclose medical records to a third party.

Authorization to Release Records (English)

Authorization to Release Records (Español)

NOTE: Records needed for continuing care purposes do not require the completion of any of the above referenced forms, but rather will be sent directly to your provider.

Advance Medical Directive

An advance medical directive is a form that lets you plan ahead for the care you’d want if you could no longer express your wishes. This statement outlines the medical treatment you’d want or names the person you’d wish to make health care decisions for you. Be aware that laws vary from state to state, and it may be worthwhile to talk with an attorney.

Writing Down Your Wishes

  • An advance directive is important whether you’re young or old. Injury or illness can strike at any age.
  • Decide what is important to you and the kind of treatment you’d want, or not want to have.
  • Some states allow only one kind of advance directive. Some states put both kinds on the same form.

Durable Power of Attorney for Health Care

  • This form lets you name someone else to be your agent.
  • This person can decide on treatment for you only when you can’t speak for yourself.
  • You do not need to be at the end of your life. He or she could speak for you if you were in a coma but were likely to recover.

A Living Will

  • This form lets you list the care you want at the end of your life.
  • A living will applies only if you won’t live without medical treatment. It would apply if you had advanced cancer, a massive stroke, or other serious illness from which you will not recover.
  • It takes effect only when you can no longer express your wishes yourself.

Explore more about Advance Medical Directives

Click here for information and Advance Directive Forms

Patient Safety

At Pikes Peak Regional Hospital, our goal is to help patients have a safe and positive hospital experience. We’ve put many safety measures in place to reduce falls, allergic reactions, infections, equipment malfunctions and medication errors. Still, there are some risks possible with any visit to a hospital. We believe that when patients and hospitals work together, we can lower the risk of accidents and improve the safety for all involved.

Research shows that patients who are more involved with their care tend to get better results. Communication with your health care providers is extremely important. Make sure you understand all aspects of your care, including tests, procedures, medications and other instructions regarding your medical condition. Speak up if you have questions and expect answers you can understand. You have the right to be well informed about the care you are receiving.

Here are some topics you should discuss with your health care providers to help make your hospital stay as safe as possible:

  • If you have allergies to certain medications, be sure to tell your doctors and nurses and ask for that information to be documented in your medical records.
  • Inform your health care providers of any medications you are currently taking, including prescription medications, over-the-counter medications, vitamins, minerals, dietary/herbal supplements, laxatives, pain relievers, sleeping aids, etc.
  • Ask all questions you have pertaining to medications that are prescribed for you. Make sure you understand what the medication is for, the dosage, directions for use, refills, storage, expiration, and what to do about missed dosages. Discuss any side effects or warnings associated with the use of the medication and what to do if you experience side effects.
  • If your doctor orders treatment or tests during your hospital stay, a member of your healthcare team will describe what you should expect during the procedure. You should discuss questions or any concerns you might have and ask for any information that makes you feel the most comfortable and confident about the care you are receiving.
  • Make sure you are clear about any instructions you are given when leaving for home, including recommended or limited activities, scheduling follow-up appointments and what medications you need to take.

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16420 West Highway 24 • Woodland Park, CO 80863
(719) 687-9999

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