For Case Managers & Discharge Planners

Hospital Discharge & Care Referral

A fast path for hospital case managers, social workers, discharge planners, and care coordinators to arrange non-medical caregiving for patients transitioning home — including urgent and same-day discharges.

Same-day discharges

Urgent referrals triaged as soon as they arrive.

Fax clinicals

Send H&P and face sheet so care can start prepared.

Non-medical only

Companion and custodial caregiving, not skilled nursing.

Urgent referrals are reviewed the same business day.

Referring Professional

So our coordination team knows who to call back.

Full Name *

Hospital or Facility Name *

Professional Role *

Direct Phone Number *

Work Email *

Discharge & Care Request

Enough detail to start coordination — no patient identifiers.

Referral Urgency *

Anticipated Care Start Date

Service Location *

Requested Care Schedule

General Non-Medical Support Needed

Select all that apply. Describe needs only — no diagnoses or clinical details.

Coordination Notes (optional)

0/1500

Please do not include patient names, dates of birth, diagnoses, medical record numbers, or other protected health information in this preliminary form. Clinical information should be sent securely by fax using the instructions alongside this form.

How Referrals Work

From discharge plan to care at home

Submit the referral

Share the professional contact, urgency, schedule, and non-medical support needed. No patient identifiers required.

Fax the clinicals

Send the H&P and face sheet to (888) 721-9665 so the assigned caregiver understands the discharge plan.

We confirm coverage

Our coordination team reviews availability for the service area and calls you back to confirm the start time.

Care begins

A screened, non-medical caregiver arrives at the home and follows the agreed schedule and safety supports.

Hospital Discharge & Care Referral

Referring Professional

Discharge & Care Request

From discharge plan to care at home

Submit the referral

Fax the clinicals

We confirm coverage

Care begins

Before you refer

How quickly can care start after a same-day discharge?

What information should I include in this form?

Why shouldn't I include patient details here?

What should I fax, and to what number?

Do you provide skilled nursing or medical care?

Which areas do you cover?

Can family members coordinate with your team?