Helpful Tips for Home Health Referral and Orders

Fax number: 786-558-5192

Demographic sheet to include

• Patient’s first and last name
• Address and phone number of where patient will receive homecare services
• Email address, if available
• Patient’s primary language
• Patient-selected representative or power of attorney
• Insurance information
• Emergency contact information

Face-to-Face encounter

For patients with primary or secondary Medicare or Medical Assistance, a completed Face-to-Face encounter document must be signed by the certifying physician, nurse practitioner or physician assistant.

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
  • 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.
  • Specific wound care orders state what medication must be applied (if any), how the wound must be cleaned or cared for and how often in a day or week.
  • Patient’s nurse must be made aware this is needed.
• Home health care for RN Evaluation and administration of IV meds
  • Specific IV medication orders must be provided.
  • If IV med orders are not provided arrangements cannot be completed.
  • Patient’s nurse must be made aware this is needed.
• Specific IV medication orders should include the following:
  • Name of medication
  • Dosage
  • Route
  • Frequency
  • Duration

Examples

• Instruction to include: do what? Clean? Apply?
• Location of wound care – example: right lower leg
• Frequency – daily or every other day
• 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 which includes serial numbers for supplies