Referral
Our goal at The Children's Center Rehabilitation Hospital is to make the admission process smooth for the patient, the patient's family, clinician and hospital.
Forms and Brochures
Please have the following information available when referring a patient to help staff better assist you.
Your contact information:
- Name
- Address
- Phone Number
- Fax Number
- Email Address
Information about the patient:
- Name
- Birth date
- Address
- Phone Number
- Social Security Number
- Insurance Information
The patient’s Medical History and Records:
- Medical History
- Surgeries/Procedures
- Devices: type/settings
- Most recent notes from hospital or primary care provider
- Community pharmacy
Description of the patient’s current medications:
- Type(s)
- Dosages
- Allergies
- Frequency