Helpful Tips for Home Health Referral and Orders
□ Demographic sheet to include:
o Patient’s first and last name
o Address and phone number of where patient will receive homecare services
o Email address, if available
o Patient’s primary language
o Patient-selected representative or power of attorney o Insurance information
o Emergency contact information
□ For patients with primary or secondary Medicare or Medical Assistance, a completed Face-to-Face encounter document must be signed by a physician (PA or NP signature not acceptable)
□ Physician’s home care referrals should include:
□ Referring physician’s name and phone number
□ Name and phone number of the physician who will be following the patient for home care services
□ Medication profile
□ Hospital transfer/discharge summary (if applicable)
□ History and physical
□ Home Health orders for the following disciplines should include as indicated by provider:
□ Registered Nurse:
▪ RN Evaluation
▪ To administer IV antibiotics or specify drug to be administered
▪ Provide wound care
▪ Vital signs monitoring
▪ Medication management
□ Home Health Aide:
To assist with activities of daily living (ADLs) – like showering, dressing, making the bed, making simple meal, and/or light housekeeping
□ Physical Therapy:
▪ For evaluation and treatment
□ Occupational Therapy:
▪ For evaluation and treatment
□ Social Worker:
▪ Identify biopsychosocial needs and resources to meet patient needs
▪ Home risk assessment
Additional items needed for referrals:
□ Signed physician’s order with medication, dose, frequency and duration
□ PICC line X-ray showing tip placement, length of PICC line and date of placement
□ Lab/blood work orders (if applicable) and the physician who should receive the results
□ Home health care for RN evaluation and wound care
o Specific wound care orders must be provided – either by the attending MD, surgeon or wound care specialist – or else the arrangements will not be complete and/or the nurse at home won’t know how to care for the patient’s wound which will result in infection and readmission of patient to the hospital. Patient’s nurse must be made aware this needed.
o Specific wound care orders state what medication must be applied (if any) how the wound must be cleaned or care for and how often in a day or week.
o Patient’s nurse must be made aware this is needed.
□ Home health care for RN Evaluation and administration of IV meds
o Specific IV medication orders must be provided.
o If IV med orders are not provided arrangements cannot be completed.
o Patient’s nurse must be made aware this is needed.
□ Specific IV medication orders should include the following:
o Name of medication
o Dosage
o Route
o Frequency
o Duration
Example for IV: Cefepime 2 gram IV every 12 hours for 7 days OR Cefepime 2 gram IV q 12 hours for 7 days If applicable also include: Remove PICC line (or midline) after IV antibiotics are completed
Example for SC: Lovenox 50mg Subcutaneous q 12 hours for 7 days OR Lovenox 50mg SC every 12 hours, for 7 days
Example for Wound Care: Clean right lower leg daily with saline solution and change dressing.
o Instruction to include do what? Clean? Apply?
o Location of wound care – example: right lower leg
o Frequency – daily or every other day
o Supplies required – gauze (include size) and cleaning solution (i.e., saline)
Important Notes for Home Health Care (HHC) Arrangements:
HHC arrangements involving the following services need to be completed before patient is discharged:
• IV antibiotic information
• Wound care
• Drainage care – how much to drain and how often
• Foley care
• Peg tube care/feedings (for a patient with a new peg tube) – need to provide specific formula and if patient on a pump need to provide order for IV pump and bags.
• Total Parenteral Nutrition (TPN) -order has to specify TPN formula
• Ostomy care, urostomy care, ileostomy care, colostomy care – specific order for supplies are needed whichincludes serial numbers for supplies
