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DHCC- HUP Service Request Form

This interpreter request form is ONLY for Hospital of Pennsylvania (HUP) customer use.

Type of Service

Services description:


ASL (American Sign Language): Appropriate for individuals who are Deaf or Hard of Hearing and/or use ASL as their primary language. Available modalities:

  1. Remote (VRI): An interpreter joins via video for virtual or hybrid events. Must be scheduled (not on-demand)

    Recommended: Brief interactions, confirmations, or consultations; check-ins/check-outs

  2. In-Person: An interpreter is physically present at a HUP location.

    Recommended: Goals of care meetings, consenting, multi-hour surgical procedures, when demonstration is critical to understanding, mental health encounters, and if an individual is experiencing an altered mental status (neuro assessments), and individuals who are language deprived.


CART (Communication Access Realtime Translation): Appropriate for individuals who are Deaf or Hard of Hearing and/or individuals who do not use ASL but benefit from visual access — live captioning—  to spoken language.


Lip reading services may be requested when communication is needed but speech or writing is not possible due to a medical condition or medical intervention. Examples of such can range from traumatic injury to vocal cords, to intubation, to end of life care. A deaf interpreter reads the patient’s lips, while a hearing interpreter voices the message. The patient confirms accuracy through nonverbal cues like nodding. This method has proven effective in critical care settings in limited situation

Requester Contact Information

Hospital of Pennsylvania (HUP) Employee Name

The interpreting service may need to follow up with a person who will be available to answer questions about the care the patient may require before the request can be fulfilled.

Request Location Information

Location Address

Please select a location.If the location is not listed, please choose “Other” and provide the full location details.

Parking information has already been provided to DHCC.

Please only include any specific desk locations or check-in procedures that interpreters should be aware of.

Assignment Details

Requested Time for Interpreter Arrival
Time
HoursMinutes
Actual Time of Appointment
Time
HoursMinutes
Requested End Time
Time
HoursMinutes

Thank you for providing all the necessary information!


Please click Submit to complete your request. Our team will review it and respond by the next business day.


If this request is for today or tomorrow, please contact IRD directly at

(610) 604-0452 after submitting this form to ensure timely coordination.


Please let the patient know a request for an interpreter has been submitted


We appreciate your attention to time-sensitive requests!

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