How to make a referral: Nursing or Rehab Services (PT/OT/ST)
- Be able to answer questions to establish homebound status and skilled need for
- 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?
- 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?)
- 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.
- 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)
- For PT/OT/ST, please fax the last 2 PT/OT/ST progress notes or summary /discharge note.
- 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
- Patients that need supplies ordered and sent prior to the visit, please verify the type
of products used and change frequency.