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Block Party/Recuperative Care Grand Opening
Housing Referral
About Us
Our Mission
Message from Our CEO
Leadership
Board of Directors
Recuperative Care
Housing Is Health
What We Offer
Referrals
Success Stories
Frequently Asked Questions
Locations
Programs
Food
Housing
Built Environment
Education
Donate
NHF Tribute Dinner
Contact
News & Events
Blog
Newsletter
In The News
Videos
Block Party/Recuperative Care Grand Opening
Housing Referral
Thank you for making a referral to National Health Foundation's Recuperative Care Program.
Fill out the form below or if you prefer to make a referral over the phone you can call
888-NHF BEDS (888-643-2337)
- 24 hours a day, 7 days a week. To send us more patient information you can fax us at
877-551-5580
.
Referring Organization Information
Referring Organization Source Type
Health Plan
Hospital
Independent Physician Association
Referral Source
*
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Referral Source Contact
*
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Referral Source Phone #
*
*
Add New
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Location
*
LA County
Ventura County
Referral
First Name
*
*
Middle Name
*
Last Name
*
*
DOB (MM/DD/YYYY)
*
*
Gender
Male
Female
Trans Man
Trans Woman
Doesn't identify with a gender
Other
Bed Gender Preference
Male
Female
Primary Language
English
Spanish
Korean
Tagalog
Armenian
Other, please specify
Other Primary Language
*
Other Race/ Ethnic Bacground
*
Medical Reason for Admission
*
Abdominal Pain
Abscesses (sp I and D)
Alcohol Withdrawal Symptoms
ALOC
Amputation
Broken Limb
Burns
Cancer
Cellulitis
Chest Pain/Shortness of Breath
COPD
Diabetes Complications
Dizziness/Ataxia
Fractures
GI Bleeding
Hernia
Hypoglycemia
Mental Illness
Motor Vehicle Accident
Osteomyelitis
Pain
Paracentesis
Seizure
Sepsis
Surgery
Traumatic Wounds
Ulcer
Urinary Tract Infection
Viral Infection
Weakness
Other, please specify
Anticipated Hospital Discharge Date
*
*
Approved Length of stay at Recuperative Care Center (days minimum 15)
*
*
*
Notes (Optional)
*
Criteria
Is the patient ambulatory & able to transfer independently? (Walker, cane, or wheelchair is considered ambulatory)
*
Yes
No
Is patient continent of bowel and bladder? (OR are they able to independently manage using an adult diaper? No assistance available.)
*
Yes
No
Is the patient currently medically and psychiatrically stable? (cleared from any transmission based precautions, etc.)
*
Yes
No
You can upload H&P notes, Face Sheet and Covid-19 test here or you can send them through fax at 877-551-5580.
Choose one or more files to upload, files must all be added at the same time or previous selections will be overridden.
To upload multiple files:
Make sure all of the files are in the same folder
Select "Choose Files"
Hold the "CTRL" key and click each file or Click and drag the mouse to select
Click "Open"
If multiple files are selected, the number of files will appear next to the "Choose Files" button.