contact us

518.382.7932

VNS Services

Physician Referral

Thank you for your interest in our services! To better serve our mutual clients, we require the following information to complete referrals: The highlighted areas are required before we can schedule any homecare visits. Thank you for your cooperation is this
area so we can see your patients in a timely manner.
 

  • Active PCP’s name:
  • Demographic Sheet (incl. next of kin, insurance)
  • History & Physical
  • Active Med Rec/List (including dose, route, frequency)
  • MD Progress Notes
  • Diet (ie. Regular, 1800 ADA diet, NCS, low fat ect.)
  • Allergies
  • Dates of flu and pneumococcal vacines

If applicable:

  • Consults
  • D/C Orders
  • D/C Instructions
  • D/C Summary
  • ER Referral
  • Therapy Notes
  • Any Recent Lab/Test Results
  • List of Consulting MDs (Ex. Cardio, Pulmonary, Renal)

Please feel free to call us with any questions at 518.382.8050, x234 or x285.