Get Ronald Mcdonald House Referral Form

Filling out the RONALD MCDONALD HOUSE REFERRAL FORM online can be a straightforward process with a clear understanding of each section. This guide will walk you through the necessary steps to complete the form accurately and efficiently.

Follow the steps to complete the referral form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient’s name in the designated field. Ensure the name is spelled correctly for the records.
3. Provide the home address of the patient, including the city, state, and zip code. This information is crucial for correspondence.
4. Fill out the primary and secondary phone numbers. This helps facilitate communication regarding the patient's needs.
5. Select the parish or county related to the patient's residence and provide the patient's date of birth.
6. Indicate the hospital where the patient is receiving care, along with the specific campus.
7. Circle the applicable diagnoses from the options provided, including cancer, heart, eye, kidney, neurology, preemie, inpatient, or outpatient. Include any other relevant surgical or non-surgical diagnosis in the space provided.
8. List the names and relationships of guests accompanying the patient. Include the date of birth for each guest.
9. Provide a primary contact email address for future communications.
10. Enter the date of the patient’s first appointment along with the expected arrival date and length of stay. Also, indicate the total number of individuals in the party, separated into adults and children.
11. Note the suggested daily donation amount and provide the referral information, including the full name, title, contact phone number, cell number, and email of the person making the referral.
12. Address any special instructions or needs for the family, ensuring to clarify any specific requirements.
13. Indicate if transportation is needed and specify the proper hospital campus for pickup and drop-off, communicating this information to the family.
14. Review and acknowledge the important information regarding family acceptance, reservation policy, and check-in time.
15. Finally, complete the section for RMHC staff, which includes who took the referral and the date of completion. Confirm if the family has checked in on the due date.
16. After completing all sections, save changes, download, print, or share the form as needed.

Complete the RONALD MCDONALD HOUSE REFERRAL FORM online today to support families in need.