For Healthcare Professionals

Healthcare Referrals Portal

Submit a secure referral for your patient. We confirm receipt within 2 hours and initiate contact within 24 hours.

Designed for Healthcare Partners

Trusted by discharge planners and care teams across Kentucky

Hospitals

Physicians

Case Managers

Social Workers

Assisted Living

Rehab Centers

Referral Tracking Dashboard

Real-Time Status Updates

Secure Document Upload

Auto Confirmation

How Referrals Work

A simple, fast, and secure process from referral to care

Step 1

Submit Referral

Complete the secure form with patient details.

Step 2

Auto-Confirmation

Immediate receipt confirmation within 2 hours.

Step 3

Coordinator Outreach

A care coordinator contacts the patient within 24 hours.

Step 4

Care Begins

Personalized care plan & caregiver match started.

Submit a Referral

All information is transmitted securely and kept confidential.

Referring Facility / Contact

Referring Organization Type *

Facility / Organization Name

Contact Name *

Title / Role

Phone *

Email *

Client Information

Client First Name *

Client Last Name *

Client Phone

Date of Birth

Client Address

City

State

ZIP

Diagnosis (Optional)

Service Request

Requested Services *

Insurance / Payer

Preferred Start Date

Urgency Level *

Additional Notes

Attach Documents (Optional)

Medical records, discharge papers, insurance info (max 10MB each)

I acknowledge that this referral contains protected health information (PHI) and confirm I am authorized to share it for the purpose of coordinating care. I consent to Reliant Home Care contacting the client to initiate services.

You will receive an auto-confirmation immediately. A care coordinator will follow up within 2 hours.