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How to make a referral: Nursing or Rehab Services (PT/OT/ST)

  1. Be able to answer questions to establish homebound status and skilled need for insurance coverage:
    • Is there a “considerable and taxing” effort to go to out of the home / AL facility?
    • Are any non-medical visits "short and infrequent" in nature?
    • Does the patient have a skilled medical need that requires a licensed nurse, physical therapist or speech therapist to perform?
    • Are the skilled needs "part time and intermittent" in nature?
  2. Please have the following information available before you call:
    • Patient's name and DOB
    • Patient's current address and phone number
    • Emergency contact name and phone number
    • Desired service start date
    • Type of insurance (Medicare, Medicaid, private insurance, charity)
    • Purpose of the visit (Why are we seeing the patient/patient goals?)
    • Type of services needed (PT, OT, Nursing, ST)
    • Ordering/Attending Physician name and phone (Who will sign the plan of care?)
  3. It is important to start the process with a phone call. Call 608-241-6900 or 800-900-8040 and ask for the Admissions department.
  4. After giving the information to the admission staff by phone, please fax the following information at 866-553-0869:
    • A face sheet (includes patient's name, current address and phone number, DOB, marital status, emergency contact/caregiver name with phone number)
    • Insurance information (including ins numbers, primary/secondary insurances)
    • HCPOA (if activated), a copy of the form, name of POA and phone # to coordinate admission.
    • Initial signed physician orders.
    • Current medication list and current labs (if available)
    • History & Physical/Medical summary/Discharge summary statement (if available)
  5. For PT/OT/ST, please fax the last 2 PT/OT/ST progress notes or summary /discharge note.
  6. For wound care patients, it is important to know specifics about the wound and initial orders/wound dressings. It is important to note that wounds with long term daily or BID dressing changes may not be accepted unless a caregiver can be taught to do the dressing change.
  7. Patients that need supplies ordered and sent prior to the visit, please verify the type of products used and change frequency.

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