DOWNLOAD A REFERRAL FORM HERE

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UPLOAD A REFERRAL FORM HERE

100% Secure and HIPAA Compliant

We will check the benefits, get the admission paperwork handled and get right back to you on the scheduling of your patient. In order to get the process started we need the following form or your offices Patient Demographics & Insurance Information.

To get an admission completed and the patient on service, please send the following.

REFERRAL CHECKLIST

  1. Referral’s Demographic Information 

  2. Doctor’s Order 

  3. Clinicals 

  4. Face Sheet 

  5. Medication List 

LET'S GET YOU THE CARE YOU NEED

GET IN TOUCH WITH US IF YOU NEED HELP FOR A LOVE ONE

THANK YOU FOR CHOOSING US

Our online referral process has been designed to provide you with another easy option for making home health care referrals. All of the information that you provide is safe and secure. Once we receive your information we will follow up with you directly. You may contact us 24-hours-a-day, seven-days-a-week. 

 

If you are covered under Medicare A benefits, our services may be available at no cost to you. We also accept many private payers. To find out more, just call us, we’ll be glad to discuss your situation with you. 

 

Contact an Altruist agency location, or contact our national call center at:  (844) 258-7847

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DALLAS

5409 N. Jim Miller Rd., Suite 205

Dallas, TX 75227

 

Phone: (214) 328-8600

Fax:      (214) 594-2192

GREENVILLE

5402 Wesley Street, Suite B

Greenville, TX 75402

 

Phone: (903) 453-8082

Fax:      (214) 594-2192

MONDAY -FRIDAY

8:30 AM - 5:00 PM

ACCREDITED HOME HEALTH CARE, HOSPICE & PRIMARY CARE

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