Request care management

A few questions about the situation, then how to reach you. Each request is reviewed against the person's needs, service fit, and current availability.

A request for Care Management

Care Management can support local families and families coordinating from a distance. Each request is reviewed against the person's needs, service fit, and current availability. Submitting a request does not create or confirm a Care Management engagement.

The situation

Who needs coordination?

Which description fits best?

Where does that person live?

Care Management centers on local advocacy and coordination, so location informs service fit.

Where are they right now?

How soon is coordination needed?

What would you want covered?

Choose everything that applies. Scope is agreed in writing before any engagement begins.

Hospital or short-term rehabilitation advocacy and discharge planningAppointments and coordination between providersMedication questions and daily-routine coordinationBenefits and paperwork organizationScheduled updates back to the familyHousehold and day-to-day arrangementsNot sure yet

What is happening right now?

A few sentences is plenty. Do not include diagnoses, records, account numbers, or policy numbers.

Where to reach you

Name

Phone

Preferred contact method

Best time to reach you (optional)

I understand care management is a private-pay service, billed for Stacie's time, and is not covered by Medicare or health insurance.

I agree that Ruskin Senior Services may contact me about this service request. I have read the privacy notice.