Referral Forms

Please note that these visits must occur 90 days prior to, or within 30 days of the start of a Medicare home health care episode, and that each visit must also be documented using the Face-to-Face Encounter Form.

A Face-to-Face Encounter form is required by Medicare when ordering home health care for your Medicare patients. 

This form supports the assertion that an encounter with the patient occurred, that the encounter was related to the primary reason the patient needs home care and that the patient’s medical status qualifies him or her as homebound. A helpful guide for completing the Face-to-Face Encounter form is included.