Get Home Care Fax Referral Form - Sutter Care At Home - Suttercareathome

Filling out the Home Care Fax Referral Form is a crucial step in ensuring that the necessary home care services are provided. This comprehensive guide will help you navigate each section of the form with ease, ensuring accuracy and completeness.

Follow the steps to complete the referral form effectively.

1. Press the ‘Get Form’ button to access the Home Care Fax Referral Form, allowing you to open it in your preferred document editor.
2. Begin by filling out the patient information section. Include the patient's full name, date of birth, sex, and phone number. Ensure that the information is accurate to avoid any delays in processing.
3. Provide the patient's address, including city, state, and zip code. Include the social security number and insurance information. Indicate if the patient has Medicare or MediCal coverage, as well as any other insurance details.
4. In the Ordering Physician section, enter the names and contact numbers of the referring physician and the following MD if applicable. This ensures coordination in care.
5. Specify the emergency contact information. This is important in case there are urgent questions or updates about the patient's care.
6. Detail the diagnosis and surgery date if applicable. This information is vital for the healthcare team to understand the patient’s medical background.
7. Check the disciplines requested for home health services. Note that to receive certain therapies, skilled nursing or other services must also be included.
8. For skilled assessment instructions, check all applicable categories such as medication management, wound care, and more, based on the patient's needs.
9. The physician's information section requires the printed name, phone number, and fax number of the referring physician. Ensure everything is legible and accurate.
10. Finally, review all sections for completeness and accuracy. Once confirmed, you may save changes, download the form, print it, or share it as needed.

Take the next step in providing quality care by completing the Home Care Fax Referral Form online today.