A practical assisted-living referral checklist.

Complete referral information helps Evergreen determine service capability, payer pathway, timing and whether a resident may be a good fit for the home.

Clinical and medication information

• Current diagnoses and recent clinical summaries
• Current medication list and administration needs
• Recent hospital, emergency or specialty-care information when relevant
• Ordered monitoring, treatments or therapies

Functional support needs

• Bathing, grooming, dressing and toileting needs
• Continence support
• Eating assistance or modified diet needs
• Walking, wheelchair, transfer and bed-mobility needs
• Adaptive equipment or durable medical equipment

Cognitive, behavioral and safety information

• Memory or orientation concerns
• Exit-seeking, wandering or elopement risk
• Verbal or physical behaviors
• Psychiatric diagnoses or behavioral-health supports
• Fall, seizure, aspiration or other relevant safety risks

Payer and placement information

• Private Pay, Long-Term Care Insurance, or Medicaid waiver program
• Waiver type, including CADI, BI or EW when applicable
• County, case manager and authorization contacts
• Desired move date and current setting

Send the referral

Use Evergreen’s secure online referral form or secure fax. Evergreen reviews the referral for fit and follows up directly with the referral source.