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Referrals & Medicaid Home Health

Is your patient a candidate for Home Health Care? Use our assessment checklist below to help determine if she/he is a candidate:

VNS Patient Referral Form
Medicaid Home Health Referral Form
Face to Face Form

Does your patient require one or more of the following assessments?

  • Wounds
  • Pain
  • Social Surroundings
  • Environmental Home Safety
  • Self-care Skills
  • Response to new treatments/medicines

Does your patient require one or more of the following treatments?

  • Wound Care
  • Catheter/tube care (insertion, removal or maintenance)
  • Drainage Tubes
  • Trach care
  • Infusion

Does your patient require one or more of the following education?

  • Medication administration
  • Disease management
  • Self care
  • Special diets
  • Assistive device, DME

Does your patient require one or more of the following rehabilitation therapies: Physical Therapy, Occupational Therapy, Speech Language Pathology, and Medical Social Work?

  • Difficulty with ambulation
  • Difficulty with stairs
  • Fall risk or history of falls
  • Issues with bed mobility
  • Difficulty with transfers
  • Weakness or deconditioning
  • Patient lives alone – safety concerns
  • Dyspnea/difficulty breathing at any level
  • Difficulty dressing/grooming
  • Difficulty bathing
  • Difficulty with feeding/meal preparation
  • Confusion at any level, including memory problems
  • Difficulty swallowing
  • Difficulty speaking clearly
  • Anxiety
  • Depression

If you answered yes to any of these questions, then Visiting Nurse Service of Ithaca and Tompkins County can be there, helping with a wide range of home health care services, to make sure your patient follows your plan of care.

Visiting Nurse Service of Ithaca and Tompkins County can help your patients!

  • Provide Therapy Services including PT, OT, SPT, MSW
  • Provide Skilled Nursing including Wound and IV therapy
  • Provide certified Home Health Aide Service
  • Provide Tele-Health Monitoring
  • Provide education on self-management techniques
  • Provide education on oxygen use and safety
  • Provide support to patient and their care partners
  • Most patients can receive care in as little as 24 hours of your referral!