Document Library

Telehomecare Referral Form

ELIGIBILITY FOR TELEHOMECARE SERVICES

• Patient has an established diagnosis of Heart Failure or COPD (with or without co-morbid conditions).
• Health care provider feels the patient will benefit from Telehomecare. (This would require the patient or caregiver being able to operate simple equipment.)
• Patient lives in a residential setting with an active land line (internet or analog phone line).
• Patient or family caregiver is able to provide informed consent to participate.