How to Make a Home Health Referral

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 out of the home / AL facility?
  • 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?

NOTE: Per new Medicare regulations, there needs to be a face to face visit with the patient by the physician (or NP/hospitalist/PA) either 90 days prior or 30 days after the start of homecare to qualify. For more information, call our admissions office.

2. Please have the following information available before you call:

  • Patient name and DOB
  • Patient current address and phone number
  • Emergency contact name and phone number
  • Types of insurances (Medicare/Medicaid/private insurance/charity)
  • Purpose of the visit (Why are we seeing the patient? Patient goals?)
  • Type of service(s) needed (Nursing/PT/OT/ST)
  • Ordering/attending physician name, phone and date of last clinic or hospital visit

3. It is important to start the process with a phone call. Call 1.844.TARLANI and ask for the admissions department.

4. After giving the information to the admission staff by phone, please fax the following information to 1.909.777.0099:

  • Face sheet including: patient name, current address and phone number, DOB, marital status, emergency contact/caregiver name and phone number. Please ensure all information is accurate and up-to-date.
  • Insurance information including: Medicare and other insurance numbers, primary/secondary insurances
  • HCPOA (if activated), copy of form, name and phone number of POA to coordinate admission
  • Initial signed physician orders
  • Current medication list and current labs (if available)
  • History and physical/medical summary and discharge summary statement (if available)

5. For wound care patients, it is important to know specifics about the wound and initial orders/wound dressings. Please 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.

6. For patients needing supplies ordered and sent prior to the visit, please verify the type of products used and change frequency.

7. For patients needing IV infusion, please supply specifics of infusion therapy including:

  • drug
  • date patient received first dose
  • type of access line (e.g., central, PICC, peripheral, etc.) and insertion date
  • who will be taught the administration
  • pharmacy providing drug

We will coordinate with the pharmacy to obtain dosing times, pump, labs, and time of first dose at home

For more information or to make a referral, please call 1.844.TARLANI.

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