To Send A Referral
Questions? Call our Admissions Coordinator at 805-569-8957.
Comprehensive inpatient rehabilitation program serving patients with brain injury, spinal cord injury, multiple trauma, orthopedic injuries, and other diagnoses.
New referrals from acute care hospitals, skilled nursing facilities, long term care facilities and home are reviewed by our Medical Director and Admissions Team.
Referrals may be faxed or emailed to our Admissions Coordinator, and a Clinical Liaison will follow up with the referring provider.
- Physician referral
- Admissions Team reviews case per referral checklist
- Acceptance or denial is communicated with referring physician and care team
- Face Sheet
- History & Physical
- Operative Notes & Consults
- Therapy notes: Physical, Occupational, Speech
- Vital Signs & Labs
- Medication list
- Current Diet
- Status of: 1) Restraints, 2) Drains, 3) Isolation
To Send A Referral
Questions? Call our Outpatient Business Coordinator at 805-569-8900 ext. 82403.
Referrals may be dropped off or faxed to CRH Keck Center for Outpatient Services. Keck Center referrals are coordinated by the Keck Center Business Coordinator.
- Referrals for outpatient services are accepted, per Medicare guidelines, from physicians, physician’s assistants, dentists, podiatrists, osteopaths, nurse practitioners, optometrists, certified clinical nurse specialists, clinical psychologists, certified nurse midwives and clinical social workers. Referring parties must have a California license to practice.
- Each referral is reviewed to verify completeness, including rehabilitation or mental health diagnosis, specific therapy service requested, and a date within 60 days of initial outpatient visit.
- Referrals are screened for the following criteria:
a. Patient minimum age requirement of 4 years old for PT, OT, SLP; and 16 years for Neuropsychology and Psychology.
b. Primary diagnosis is acquired, not congenital, and appropriate for breadth and scope of the hospital-based medical rehabilitation outpatient setting.
- Insurance benefits are verified and authorizations obtained if indicated.
- Referrals are screened for diagnoses that are best suited to this facility. If the referral indicates that a patient may be better served at our Goleta Valley Campus, information will be provided to the patient.
- Prior to your initial evaluation visit:
a. Admissions paperwork is completed by the patient.
i. Therapy Questionnaire
ii. Cuestionario de terapia (Español)
b. Patient will review the attendance standards.
- Your initial evaluation visit:
a. What to bring:
i. Your list of current medications
ii. Your completed admission paperwork. This may be faxed or dropped off prior if able.
- Arrive 15 minutes ahead of time for registration.
- Please wear appropriate attire for active participation in your initial evaluation.
- You and your therapist will determine your plan of care based on the initial evaluations findings.
- You are encouraged to schedule out your entire plan of care at that time.
Pelvic Symptom Forms and Questionnaires
Please follow the guidelines below and fill out the form(s) that best describe the symptoms you are experiencing.
|Forms & Questionnaires
||Who Should Fill It Out
|Pelvic Symptom Questionnaire
||All pelvic floor patients
|NIH CPSI for Males
||Men with pelvic pain
||Incontinence of bowel or bladder, Prolapse, urinary urgency, frequency, constipation
||Incontinencia de intestino o vejiga, Prolapso, urgencia urinaria, frecuencia, estreñimiento
||If urinary incontinence is the only problem
|Female Genitourinary Pain Index
||Interstitial cystitis, bladder pain, female pelvic pain, dyspareunia, vaginismus
|Pediatric Screening and Symptom Questionnaire