Get Los Angeles Recuperative Care Program: Preliminary Referral Form

Filling out the Los Angeles Recuperative Care Program: Preliminary Referral Form online can streamline the referral process for patients transitioning from hospital care to recuperative care. This guide will provide step-by-step instructions to help you complete the form efficiently and accurately.

Follow the steps to fill out the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the Referring Hospital information, including the name of the hospital, attending physician, discharge planner, case manager, and their respective phone numbers.
3. In the Patient Information section, enter the patient's name, medical record number (MRN), date of birth, date admitted to the hospital, and anticipated discharge date.
4. Explain the medical reason for the patient's hospital admission in the provided space. Be as clear and detailed as possible to ensure accurate processing.
5. Describe any surgical procedures or patient limitations, providing relevant details for the recuperative care team.
6. Indicate whether wound care or home health services are needed by checking 'Yes' or 'No' and providing additional details if applicable.
7. Provide information on any mental health or substance abuse issues the patient may have, selecting relevant options as needed.
8. Continue to complete the sections regarding the patient's need for oxygen, ability to self-administer medicine, bowel and bladder control, and other essential health information.
9. Indicate whether the patient is ambulatory and if they require assistive devices, detailing any specific aids they use.
10. Provide the estimated length of stay in the recuperative care program.
11. Once all information is filled out accurately, review the form for completeness. You can then save changes, download, print, or share the form as needed.

Start completing your form online today to facilitate a smooth referral process.