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Referral Upload Portal


For any problems please contact 509-758-2568 or fax referral to 509-758-3413


Home Health Referral:

Send the following for a complete referral:

  1. ORDER (Click here for a blank order form)

    • (NP can sign, but MD must follow)

  2. DEMOGRAPHIC "FACE" SHEET

  3. MEDICATION LIST

  4. H&P

  5. MOST RECENT VISIT NOTES RELATED TO HOME HEALTH NEED (within 90 days)

    • Specific to Diagnosis

 

Please consider HOMEBOUND status when placing this referral. For more info about homebound, please click here.



 

Hospice Referral:

Send the following for a complete referral:

  1. ORDER (Click here for a blank order form)

    • (MD or NP can sign)

  2. DEMOGRAPHIC "FACE" SHEET

  3. SUPPORTING DIAGNOSIS DOCUMENTATION, such as:

    • Office visit notes

    • Lab Tests

    • Radiological Reports

    • Echo

  4. MEDICATION LIST

  5. ANY OFFICE VISIT NOTES RELATED TO DIAGNOSIS

 

Please consider Medicare hospice diagnosis requirements for this referral. For diagnosis assistance to match with Medicare requirements, please click here.