Make a Referral
Parents, physicians, discharge planners and case managers can ask our team to contact them about home nursing services for children.
Who Can Refer
Parents, physicians and discharge planners can ask our team to contact them about services and next steps.
- Parents and caregivers
- Physicians and pediatric specialists
- Hospital discharge planners
- Case managers and care coordinators
General Referral Process
Request a callback
Send the general callback form below or call our office.
We contact you
Our team follows up to understand what you are looking for.
Review and next steps
We explain services, general eligibility and the information needed through our secure intake process.
Care coordination
When services are appropriate, we coordinate with the family and the child's healthcare providers.
Services Families Ask About
Request Skilled Nursing Care
Parents, physicians and discharge planners can ask our team to contact them about services and next steps.
In case of emergency, call 911. This form is not monitored for emergencies.
What Happens Next
- You receive a reference number right away.
- Our team reviews your request and contacts you by your preferred method.
- Clinical details are collected later through an appropriate, secure process.
- Phone(214) 550-1661
- Fax(214) 206-8521
- Referral coordinationreferrals@assuredpediatrichha.com
Frequently Asked Questions
Do I need a physician's order?
Home health services generally require orders from the child's physician. Our team can explain what is needed for your situation.
Can parents make a referral?
Yes. Parents and caregivers can request a callback, and we can help coordinate with the child's physician.
Should I include medical records in this form?
No. This form is for general callback information only. Please do not include diagnoses or medical records.
Does submitting the form guarantee services?
No. Services depend on the child's needs, physician orders, coverage and our service area. Our team will follow up as appropriate.
Which insurance and payment options do you accept?
We work with Superior HealthPlan of Texas, Aetna, Medicaid and private pay (out-of-pocket). Coverage and eligibility vary by plan and individual circumstances, so our team will help verify your benefits.
What if it is an emergency?
This form is not monitored for emergencies. In case of emergency, call 911.