Pre-Admission into Hospital San José de Hermosillo

The data you provide is confidential and it will be used to registry your entry into the Hospital San José de Hermosillo and to perform the necessary reservations.

You can view our privacy notice here

  • Data requested with an asterisk are mandatory to fill.
  • If you have health insurance, you should mention it as well as the policy number.
  • The day of admission into Hospital San José de Hermosillo, you need to present an ID.

General Data

Gender

Marital status

Residence and family

For minors

Admission

Admission type

Type of patient

Emergencies

Doctor

Diagnosis