Instructions:
1. Complete the form for your patient.
2. The form can be used for all seniors being discharged from your hospital requiring in-home care or senior living arrangements.
3. Please indicate in the comments section any relevant information you want to provide, but include the name of the Case Manager and their contact information (phone number, email address) for follow up by our representative in the area.
4. During business hours, you’ll receive a follow up within an hour of form receipt.
5. After hours, you’ll receive follow up the following day, Monday thru Saturday.
Our national network of local experts are in your community and ready to help you. To get connected to the right local advisor, please fill out the form below.