Name, Address, Phone Number, Date of Birth, Directions to Patient’s Home, Homebound Status, List of Current Medications, List of Allergies, Pertinent Medical History/Surgeries, Local Physician Name, Medicare Number, Insurance Company, and Policy Number. The individual making the referral must also give their name and telephone number.
Be prepared to discuss why you feel the patient needs homecare. For example:
Needs help with medications (confused about what medications are for). New diabetic on insulin - needs diabetes education. Had recent surgery and requires nursing assessment or Needs assessment of appropriate home care needs.