Recuperative Care Referral Form

REFER A PATIENT

For Los Angeles County and Orange County hospitals seeking to refer homeless patients to Horizon Recuperative Care, we invite you to download our Admissions Criteria and Referral Process Form.
Simply fill it out and email it to us at admissions@horizoncenters.org.
You may also submit your referral using our digital form by clicking on our online referral form below.
Horizon response times are just a few hours, seven days a week. We’ll be in touch with you as soon as possible.

  • CHECK ALL THAT APPLY

    (Referring entity to arrange all DMEs prior to admission)
  • ADMISSION CRITERIA:

    1. Must have a primary medical problem
    2. Must be physically and psychiatrically stable to receive care in a medical respite setting
    3. Must be in need of short term recuperative care
    4. Must be able to participate in ADLs
    5. If on Methadone must be in a Methadone Program
    6. Must be mentally competent
  • EXCLUSION CRITERIA:

    1. Incomplete treatment of Scabies
    2. Unable to transfer or perform ADLs
    3. C. diff / MRSA / TB
    4. Dementia/Memory Loss
    5. Combative/Violent behavior
    6. Hallucination/Delusion
    7. Psychiatrically Unstable
    8. Unable to self-represent
    9. Unable to perform ADL and transfer with assistance
  • Drop files here or
    Face Sheet CXR or PPD (within last year) Covid Test (within 1 week) H&P Med List S.W. Notes Recent PT/OT notes Surgical Notes (if any) Wound Care Notes (if any)