Referral Process
If you have a patient you believe meets criteria for inpatient hospitalization and who you would like to refer to us for treatment, please follow the guidelines below to assure that each of the admissions criteria have been met.
If you have a loved one that you think might need our help, please consult the individual’s primary care physician so that the potential for a referral can be explored. Only medical professionals can refer into our program.
ADMISSION CRITERIA:
The patient is an imminent threat or danger to self or others, or property due to symptoms of psychiatric disorder; significant impairment of judgement or logical thinking that affects safety; patient's condition is expected to deteriorate in current setting.
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55 or older
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Behaviors the are documented prior to admission
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Medically stable with NO serious medical conditions such as:
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Chemo
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Hemodialysis
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Central lines or femoral lines
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Continuous IV therapies
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Blood transfusions
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Continuous tube feedings
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Critical lab results without medical explanations
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Post-op patients
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Cervical fractures
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End-stage COPD with acute respiratory distress
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End-stage renal disease with critical BUN and creatinine
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Reverse isolation
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Active MRSA only if private rooms are available
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Acute delirium
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UTI at discretion of admitting staff criteria.
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Additionally, we will require the following labs and information for our medical director to review.
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Urinalysis within 72 hours
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Urine drug screen within 72 hours
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Comprehensive Metabolic Panel within 72 hours
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Complete Blood Count within 72 hours
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Chest x-ray (from the last 30 days)
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An updated Medication List
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Weight
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Current history of symptoms and behaviors
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A negative Covid test will be required prior to admission
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Safe discharge plan in progress.
Along with medical clearance, please include the patient's history of symptoms and behaviors from either the history and physical or nurse's notes.
Fax: 865-630-9203
Phone: 865-630-9205
Email: Case.Management@summitviewhm.com
Providers can complete and send the following Referral Form to our Case Manager: