Send a Patient Referral

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Submit a Referral

Send a Patient Referral

Refer a patient for in-home medical care in Metro Atlanta. Our intake team responds within one business day.

Who Can Submit a Referral?

Our referral form is open to anyone who knows a patient who could benefit from in-home medical care. You do not need to be a healthcare provider to refer someone.

Hospital Discharge Planners and Case Managers

If you are coordinating post-discharge care for a patient transitioning from an inpatient facility back into the community, our Transitional Care Management program provides contact within 48 hours, medication reconciliation, and a follow-up home visit. Submit the referral below and our intake team will begin coordination immediately.

Physicians and Primary Care Providers

If you have a patient who is homebound, managing multiple chronic conditions, or struggling to maintain regular office visits, our in-home medical visit and Chronic Care Management programs can extend your care into the patient’s home. We coordinate with your office to keep you informed at every step.

Family Members and Caregivers

If you have a loved one who needs medical care at home — whether they are recovering from surgery, managing a chronic illness, or simply unable to travel safely to a clinic — you can submit a referral on their behalf. Our team will contact the patient or the family to confirm interest and begin the intake process.

Self-Referral

Patients can also refer themselves. If you believe you could benefit from in-home medical care, fill out the form below with your own information and our team will reach out to discuss your options.

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Referral Form

Please complete the form below to refer a patient for in-home medical services. All required fields are
marked with an asterisk. If you have the patient’s medication list, medical history, or recent test results
available, you can upload them at the end of the form to expedite the intake process.

Contact Form
After You Submit

What Happens After You Submit a Referral?

Understanding the process upfront builds confidence in both referring providers and family members.
Here is exactly what to expect after you hit “Submit.”

Step 1 — We Review Your Referral

Our intake team reviews every submission within one business day. We confirm the patient’s basic information, insurance eligibility, and the reason for referral.

Step 2 — We Contact the Patient or Referring Party

Based on your preference (selected in the form below), our staff will call either the referring organization or the patient directly to confirm interest in our services and gather any additional information needed to complete intake.

Step 3 — We Request Medical Records

Before a patient is seen, we need a complete medication list, medical history, and any current test results. If you upload these documents with your referral, we can move faster. If not, we will request them on your behalf from the physicians and facilities you list in the form.

Step 4 — We Schedule the First Visit

Once intake is complete and insurance is verified, we schedule the patient’s first in-home visit with a licensed nurse practitioner. For Transitional Care Management referrals, we aim to complete this within the post-discharge window to reduce readmission risk.

Privacy and Security

1st Care Management transmits all information submitted through this form via secure, encrypted emailvto ensure the confidentiality, integrity, and availability of all electronic protected health information (ePHI) in accordance with HIPAA Security Rule requirements under 45 CFR 164.306(a)(1).
We regularly review and update our security measures to maintain reasonable and appropriate protection of all patient data received through this website.
If you have questions about how your information is handled, please contact us at (833) 633-4778 or
email intake@1stcaremanagement.com.