Verification Lookup Portal
Providers for Holy Redeemer Health System
Holy Redeemer Ambulatory Surgery Center
Holy Redeemer Hospital
Holy Redeemer Lafayette
Holy Redeemer Physician Services
Holy Redeemer St. Joseph Manor
Holy Redeemer Transitional Care Unit
Provider Last Name
Last name is required.
Provider First Name
First name is required.
Provider Birthdate
Birthdate is required.
Provider Full SSN
Full SSN is required.
Provider NPI
NPI is required.
Required Information
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Requester Name
Name is required.
Requester Title
Title is required.
Requester Organization
Organization is required.
Requester Address
Address is required.
Requester City, State, Zip
City, State, Zip is required.
Requester Phone
Phone is required.
Requester Fax
Fax is required.
Requester Email
Email is required.
I agree and acknowledge that I possess a signed release and immunity statement signed by the practitioner for which I am obtaining hospital verification informaton. Such signed release and immunity holds harmless and indemnifies ***Echo Sample Hospital*** and individuals providing information pursuant to this request, its medical staff, board of directors and each of their respective members and designees, the administration of such ***Echo Sample Hospital*** and its directors, officers, employees, representatives and agents, and each of them from any and all claims, demands or actions with respect to all acts, including without limitation, communications, reports, recommendations, or disclosures performed or made in connection with the request for the release of information pertaining to the practitioner's hospital affiliation with ***Echo Sample Hospital***.
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Facility
Provider Last Name
Provider First Name
Provider Birthdate
Provider Full SSN
Provider NPI
Requester Name
Requester Title
Requester Organization
Requester Address
Requester City, State, Zip
Requester Phone
Requester Fax
Requester Email