Provider Resources
Home Health
What is Needed for Intake
Hospital
- Demographics
- Signed H & P
- Signed Discharge Summary
- Signed Progress Note by Ordering Provider
- Updated Medication List
- Disciplines
- Diagnoses
- Home Bound Status
- Name & Phone Number of Following Provider
Primary Care Physician
- Demographics
-
Signed Supporting Documents
(done within Last 90 days by ordering provider) - Updated Medication List
- Disciplines
- Diagnoses
- Home Bound Status
- Following Provider: Name
Skilled Nursing Facilities
- Demographics
- Signed Discharge Summary
- Signed Progress Note by Ordering Provider
- Updated Medication List
- Disciplines
- Diagnoses
- Home Bound Status
- Name & Phone Number of Following Provider
Specialty Clinics
- Demographics
-
Signed Supporting Documents
(done within Last 90 days by ordering provider) - Updated Medication List
- Disciplines
- Diagnoses
- Home Bound Status
- Name & Phone Number of Following Provider
Hospice
What is Needed for Intake
Hospital
- We Cannot Accept Emergency Department Referrals
- Demographics
- Signed Discharge Summary
- Updated Medication List
- Primary Care Provider : Name & Phone Number
Primary Care Physicians
- Demographics
- Signed Hospice Certification Form with Supporting Documents (done within Last 90 days by ordering provider)
- Updated Medication List
- Primary Care Provider: Name
Skilled Nursing Facilities
- Demographics
- Signed Progress Note by Ordering Provider
- Updated Medication List
- Following Provider: Name & Phone Number
Specialty Clinics
- Demographics
- Signed Progress Note by Ordering Provider
- Updated Medication List
- Primary Care Provider: Name & Phone Number