Referral Forms

Health worker and client

SSM Health at Home provides a variety of services to meet your needs. Our services can be arranged quickly and efficiently by a single phone call. Referrals can be made by physicians, case managers, social workers, family and friends, or by request from the patient.

What are the requirements for receiving home health services?

  • You must be homebound at least temporarily.
  • You require care that is considered skilled, according to Medicare/Medicaid.
  • You require care that is reasonable and necessary.
  • A physician must order and certify that you are homebound.
  • If nursing is needed, it must be "intermittent." (more than one visit and less than daily.)

    What are the requirements for receiving hospice services?
    To be eligible for hospice services, a patient's physician and SSM Health at Home Hospice's medical director must certify that a patient is in the advanced stages of a life-threatening illness with a life expectancy of six months or less.

    Referral forms

    SSM Health at Home Referral Form

    SSM Health at Home Hospice Referral Form