Vantage HouseRecuperative CareCOMMUNITY WELL CALIFORNIA
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PATIENT REFERRALS / COMMUNITY WELL CALIFORNIA

Vantage House
Recuperative Care

Prepare the information our team needs to review a patient for Vantage House Recuperative Care.

Our six-bed home supports recovery for up to 180 days, subject to individual review, availability, and applicable authorization. Submitting a referral does not confirm admission or reserve a bed.

WHAT TO HAVE READY

One patient.
Nine brief questions.

Patient details and a brief description are required. The agency name and agency contact details are optional.

  1. Patient’s full nameUse the patient’s full name.
    Required
  2. Medical number / patient IDThe patient’s medical or member identification number.
    Required
  3. Patient’s date of birthMonth, day, and year.
    Required
  4. Patient’s health planInclude the health plan name, such as CenCal Health Medi-Cal.
    Required
  5. Patient’s phone numberThe best number for contacting the patient.
    Required
  6. Agency submitting the referralThe hospital, organization, or agency making the referral.
    Optional
  7. Submitting agency’s phone numberA number our team can use for follow-up.
    Optional
  8. Submitting agency’s email addressA valid agency email address, if provided.
    Optional
  9. What should we know about the patient?In 2–3 sentences, summarize the reason for referral, recovery needs, and support considerations.
    Required

This page is a preparation guide. Enter patient details only in the referral form. Send additional records only through the secure process confirmed by the team.