Patient Registration

This document is required to be completed in its entirety and returned in person along with all the original documents listed below. Patient registration will review the application and the original documents, make copies and return original documents to applicant: (Check list is part of the document)  

• Birth Certificate
• Social Security Card
• Certificate of Indian Blood/Tribal ID
• Proof of residency (Utility bill, rental agreement)

                 ▪ Non-Isleta tribal members residing on Isleta Pueblo submit Permission to Reside on 

                   Pueblo Letter issued by Isleta Governor’s office.

                 ▪ Letter stating Community Ties to Isleta Pueblo.

• Valid Identification card or Driver’s license

Once the application is reviewed for completion and received by patient registration the application is logged and forwarded to administration for determination. Any application missing needed documentation will be returned to the applicant. Please allow administration some time to complete the determination process. If after a month you have not heard anything regarding the submitted application please call billing supervisor (505)869-4888 for status update.

• This document is required to be completed in its entirety and returned in person along with all the original document listed below. New born applications will be accepted within 60 days from birth. New born applications are expedited and the new born will be able to schedule a same day appointment once the application is processed. Would be advised to print out the new born application, fill it out and gather all the needed documents then call and schedule the same day appointment with the medical clinic and then calling patient registration to inform them of the appointment, and arrive 30 minutes prior to appointment time to allow time for new born account to be created. Patient registration will review the application and the original documents, make copies and return original documents to applicant’s parent/legal guardian. Below is the list of needed documents: (Check list is part of the document)
•  Proof of Birth
•  Discharge Forms
•  Insurance cards
•  Mother’s valid Driver license/ valid government issued photo ID

                     Mother’s valid tribal ID/or CIB

•  Father’s valid Driver license/valid government issued photo ID

                     Father’s Valid tribal ID/ or CIB

               (unwed parents) notarized Declaration of Paternity

This document allows us to see you, treat you and bill your insurance. It contains our privacy notice (Health Insurance Portability and Accountability Act) and Patient Rights and Responsibilities.

This is our privacy notice (Health Insurance Portability and Accountability Act). This pamphlet explains how we may and may not utilize your protected health information.

This document explains both your rights and your responsibilities as a patient at Isleta Health Center.