Referral from a Skilled Nursing Facility

The preferred method for submitting referrals is to submit them electronically using the online form below. Please include all required forms and information in the referral.

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Required Referral Documents

ULTC 100.2 Initial Screening and Intake Form

Professional Medical Information Page (PMIP)

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Optional Referral Documents

Release of Information

Pre-Admission and Resident Review Program (PASRR)

You can also submit referrals via email, SEPreferrals@rmhumanservices.org