Refer A Patient

PLEASE NOTE: The information on this page is intended for use by healthcare providers referring a patient for our services. General inquiries from the public about our services should be directed to our Customer Service staff at 202-7882 (greater Little Rock area) or 1-800-850-6789 (outside greater Little Rock).

Our service area covers a large part of Arkansas. The map below is an approximate representation of our service area, but we accept referrals based on the ZIP code of the patient's residence. You may call our Customer Service Center at 202-7882  (greater Little Rock area) or toll-free at 1-800-850-6789 to quickly determine if the patient you wish to refer is within our service area.

If you would like to refer a patient to our agency, please use one of the following options:

A. Refer by Phone
Please contact our Customer Service Center at 202-7882 (greater Little Rock area) or toll-free at 1-800-850-6789. We will also need a physician's order, patient demographics, a history and physical and medication list faxed to 501-202-7706 or 1-800-992-6448.

B. Refer by Fax
To save time and avoid a phone call, use our Website Referral Form. When completed, fax the form and requested attachments to 501-202-7706 or 1-800-992-6448. We will contact you if necessary for any addtional information required to initiate care for your patient.

Please note: We are unable to accept referrals by email at this time due to HIPAA regulations. DO NOT use this website's email address ( to refer a patient or send patient information!

HOME HEALTH REFERRALS ONLY: Free Face-to-Face Resources Available!
If the patient being referred for Home Health has Medicare or Medicare Advantage, a completed Face-to-Face encounter form signed by the physician is required. Click on the links below to download blank forms for either an inpatient or community physician. You may also request as many Tip Cards as you need, and download example guides which illustrate Medicare's documentation requirements to assist you in completing the form accurately. Please be sure to include the completed Face-to-Face form when you fax the referral information to us!

Blank Forms
Face-to-Face Form for Inpatient Physician
Face-to-Face Form for Community Physician

Free Laminated Face-to-Face Tip Cards
We have free laminated tip cards you may request by clicking here or by calling our Customer Service Center. You may request as many as you need at no charge.

Example Guides for the Inpatient Physician
Heart Failure Example - Inpatient MD.pdf
Heart Failure with LVAD Example - Inpatient MD.pdf
Pneumonia Example - Inpatient MD.pdf
Stroke Example - Inpatient MD.pdf
Total Hip Example - Inpatient MD.pdf
Total Knee Example - Inpatient MD.pdf
Wound Example - Inpatient MD.pdf

Example Guides for the Community Physician
Heart Failure Example - Community MD
Heart Failure with LVAD Example - Community MD
Pneumonia Example - Community MD
Stroke Example - Community MD
Total Hip Example - Community MD
Total Knee Example - Community MD
Wound Example - Community MD


If you have any questions about completing the Face-to-Face form, please call our Customer Service Center at 202-7882 (greater Little Rock area) or 1-800-850-6789 for assistance. While we cannot assist you in completing the form on a specific patient, we can answer general questions about this requirement.