Referral Form

Patient Protection Affordable Care Act provision dictates that physicians wishing to order home health care services for patients covered by Medicare must schedule a face-to-face encounter. 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. It is a required form by Medicare when physicians order home health care for Medicare patients. This form affirms 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. You may use the Face-to-Face Encounter.