Phone: (518) 489-2681
Intake fax: (518) 489-2532
8:00 am – 5:00 pm Monday – Friday
7:30 am – 4:00 pm Saturday
7:30 am – 12 noon Sunday
To initiate a referral please fax the following patient information to VNA Home Health Intake:
Completed VNA referral form (signed by MD or DO)
Patient demographic information including:
- insurance information
- current address/phone number
Current diagnosis list (this must have a physician signature on it)
Most recent visit notes to summarize patient’s current status
Current medication list
List of services you are requesting with orders outlining the purpose for each service
Face to Face form for ALL MEDICARE PATIENTS (may serve as an order form for home health care orders)
Name and contact information of person sending referral
If diabetic – include parameters
If wound care – include orders and wound measurements
If you have any questions or need for assistance in completing a referral, please contact our Intake Department, they will be happy to assist you.
- Upon receipt of referral, VNA will contact the patient to set up the first appointment.
- After the first appointment, VNA will fax Form 485(Plan of Care) to your office. It is necessary that this form be signed by the physician and faxed back to VNA Home Health at: (518) 489-2532 to commence care and meet New York State regulations.