Refer a Patient
Refer a patient for home infusion therapy, or for home health care: skilled nursing, wound care, and physical and occupational therapy. Choose the type of care, then complete its form.
Submit a Referral Online
Each type of care has its own form, with the details our intake team needs for it.
Choose the type of care to see its referral form.
How It Works
Our simple 4-step process gets your patients started quickly.
Submit Referral
Complete the referral form with patient information, therapy details, and prescriber information.
Confirmation Call
Our intake team will contact you within 24 hours to confirm receipt and gather any additional details.
Nurse Assignment
We match the patient with a qualified infusion nurse based on location, therapy type, and scheduling needs.
Care Delivery
Our nurse coordinates with the pharmacy and patient to schedule and deliver home infusion therapy.
Downloadable Referral Forms
Prefer to submit via fax? Download our referral forms below.
Refer a Patient
For immunoglobulin therapy referrals including IVIG and SCIG.
Download PDFHydration Therapy Referral Form
For IV hydration and vitamin infusion therapy referrals.
Download PDFPhysical & Occupational Therapy Referral Form
Mobility, balance, fall prevention and daily living skills at home.
Download PDFWound Care Referral Form
Surgical wounds, pressure injuries, ulcers and NPWT at home.
Download PDFSkilled Nursing Referral Form
Medications, injections, chronic disease and catheter care at home.
Download PDFFax completed forms to (206) 737-3118
Information Needed
To ensure a smooth referral process, please have the following information ready:
- Patient demographics and contact information
- Insurance information and authorization details
- Prescriber name and contact information
- Medication name, dose, and frequency
- Diagnosis and ICD-10 codes
- Therapy start date and duration
- Any special considerations or patient needs
Quick Turnaround
We aim to confirm all referrals within 24 hours and schedule the first visit within 48-72 hours of receiving complete information.
Ways to Refer
Physicians, specialty pharmacies, and case managers can submit referrals through any of these channels.
Online Form
Submit referrals instantly using our secure online form. No account required.
Submit OnlinePhone
Call our intake team directly to submit a referral or ask questions about our services.
(206) 737-0669Fax
Download our referral forms and fax completed documents to our intake team.
(206) 737-3118Ready to Refer a Patient?
Our team is ready to help your patients receive expert home infusion care. Submit a referral today or contact us with any questions.