Basin Home Health & Hospice Referral Guide

We work closely with our referring offices to streamline the referral process, allowing us to collectively prioritize and deliver compassionate care to our patients.

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Ensuring Compassionate Care

Referring a patient to home health or hospice is more than paperwork—it’s about ensuring comfort, dignity, and essential medical support.

This guide simplifies the process so you can focus on your patients’ well-being.

The image shows a professional, possibly a doctor or medical professional, talking on a landline phone while writing on a form or document. The individual is wearing a white coat and has a pen in hand, indicating they might be handling paperwork related to patient care, referrals, or medical records. The setting appears to be an office or clinic with a keyboard and other office supplies visible.

Home Health Referral Process

Home health allows patients to heal comfortably at home while receiving the skilled care they need.

To ensure the best possible care, please provide:

1. Order for Home Health Services (specify required skills)

2. Provider visit/progress note including:

• Reason for home health services (nursing, PT, OT, ST)

• Clinical evidence of homebound status

• Specific diagnosis (no unspecified diagnoses or symptoms)

3. Demographic information, including physical address, phone number,
Medicare Beneficiary ID, and SSN

4. Alternate contact information and phone number

5. Medication list

6. History and physical

7. Lab, diagnostic, and other reports

8. Has the patient been in an in-patient facility in the last 14 days?
If so, provide documentation.

Homebound Status Requirement

For a patient to receive home health care, they must meet Medicare’s homebound status criteria, ensuring that care is truly needed.

This means they:

Are unable to leave home without assistance

Experience significant difficulty or exhaustion when leaving home

May only leave for essential medical visits, personal outings, or religious services

Hospice Referral Process

Referring a patient to hospice means providing them with dignity, comfort, and compassionate care in their final months.

To ensure they receive the support they need as quickly as possible, please provide:

Patient Information

Name, date of birth, and address

Primary Contact

Name and working phone number to schedule consultation

Insurance

Payor information and SSN

Referral Order
  • Must be signed by doctor
  • Patient must have a terminal diagnosis with a prognosis of six months or less
  • List any co-morbidities
  • Include medication list, medical history, and physical
  • Two most recent progress notes from physician, showing evidence of patient’s decline

Contact

Questions? We’re here to help.

For questions, contact us by calling (505) 325-8231 or by filling out the contact form.