Patient Referral

 Alfouz Care Services is a Home Care Agency that partners with Medicaid Waiver programs to provide care in the home.  

Our referral program provides fast, compassionate and reliable home care transition process. Our referral program is designed to efficiently and quickly address your needs 

To make a referral please fill this form and email info@alfouzcs.com or

 call us at 267-412-8376  and have the following information 

• Demographic information (such as patient name, address, and telephone number)
• Patient’s emergency contact information
• Diagnosis
• Name of the ordering physician
• Name of the physician who will sign orders (if different from ordering physician)
• Insurance information 
• Desired start of care date

Physicians, please have the following information ready when referring a patient 

• Required non-skilled services 
• medical diagnosis
• medical orders (please fax orders to  +1 484-930-0631).