Referral Form

Please complete the referral patient form below.

This form is encrypted and stored securely in accordance with HIPAA regulations. Please do not submit emergency requests. If this is a medical emergency, call 911.

How Home Health Referrals Work?

Home health referrals connect patients with licensed home health agencies after a hospital stay or physician order. The process ensures patients receive appropriate care at home based on medical needs, insurance, and location.

How the Home Health Referral Process Works

  1. Referral Initiation
    A physician, hospital discharge planner, or case manager determines that home health services are needed.

  2. Patient Information Review
    Care needs, insurance coverage, location, and physician orders are reviewed.

  3. Agency Matching
    Patients are matched with licensed and CMS-certified home health agencies that can meet their care requirements.

  4. Secure Referral Transmission
    Referral details are shared through a HIPAA-conscious workflow to protect patient information.

  5. Agency Acceptance & Start of Care
    The selected agency accepts the referral and coordinates the start of home health services.

Why Home Health Referrals Matter

  • Support safe transitions from hospital to home

  • Reduce readmissions

  • Ensure continuity of care

  • Connect patients with verified providers