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Patient Referral Form

Referring a Patient to City Choice Home Health Care

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Referring a Patient to City Choice Home Health Care

For physicians, discharge planners, social workers, and care managers across South Florida, City Choice Home Health Care is a trusted partner for transitioning patients safely from hospital or clinic to home. We are Medicare-certified, AHCA-licensed, and committed to responding to every referral within one business day.

This referral form is designed to give our intake team everything they need to get care started quickly and correctly. It covers six sections: referring provider contact information and NPI number, patient demographics and emergency contact, clinical information including ICD-10 diagnosis codes and requested services, insurance details and authorization numbers, urgency of the referral (routine, soon, or urgent), and a signed authorization from the referring provider.

Completed forms can be faxed to 305.363.7756 or emailed to info@citychoiceflorida.com. A City Choice coordinator will contact you within one business day to confirm receipt and discuss next steps. For urgent referrals, please call us directly at 305.363.7755.

City Choice accepts Medicare, Medicaid, most private insurance plans, and private pay. We serve Boca Raton and the surrounding South Florida communities.

Who This Is For

  • You are a physician, hospitalist, or specialist with a patient who needs home health services after discharge
  • You are a hospital discharge planner or case manager coordinating a patient's transition to home
  • You are a social worker or care manager who has identified a patient in need of skilled home health support
  • You want to establish a referral relationship with a Medicare-certified home health agency in South Florida

Need Home Health Care in South Florida?

City Choice Home Health Care is Medicare-certified, AHCA-licensed, and serves Boca Raton and the surrounding South Florida communities. Speak with a care coordinator today.

Contact City Choice

Contact us today for a free consultation!

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