Forms

In order to see any patient for home healthcare RCS must obtain the following forms:

  • Patient Demographic
  • History and Physical Examination (H&P)
  • Doctor's Order
  • Face-to-Face

To make life easier, you can download the Doctor's Order and Face-to-Face form below:

Doctor's Order
Face-to-Face

You may email the completed forms to us at This email address is being protected from spambots. You need JavaScript enabled to view it. or fax them to us at (219)736-5720.

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Listen to the RCS staff on the 3rd Wednesday of every month at 5:00 P.M. CST discussing current issues in home health care!