Dear Healthcare Provider:
RE: PATIENT REQUEST FOR SKILLED NURSING HOME HEALTH CARE - COVID-19 HOME VACCINATION SERVICES
**This is a HIPPA COMPLIANT electronic form.**
ABOUT Childress Nursing Services (CNS)
CNS is a WA state licensed home health agency and mobile clinical laboratory based in Renton, WA that primarily provides fertility and maternal in-home medication injections and support to clients in King, Pierce, and Snohomish counties. Our home health agency is uniquely composed exclusively of licensed nurses. We do focus on serving women from preconception to post-delivery; however, due to the need to have all hands on deck to fight the pandemic, we have decided to join in the efforts to vaccinate Washingtonians against the SARS-CoV-2 virus that causes Covid-19 by providing Covid-19 vaccine home injections.
COVID-19 HOME VACCINATION SUPPORT
Our Covid-19 Vaccine teams will be composed of a 2-person nursing unit and all of our staff are vaccinated. These small units are mobile and highly portable, making it the perfect option to maneuver in and out of small spaces.
This form is specifically for submitting home health orders for your pregnant or fertility patient only. This is separate from the registration form that your patient and any other member(s) in the the household who are eligible but have not been vaccinated should submit. We will evaluate referrals for up to 1 homebound individual living alone; however, households with 5 or more people that can be vaccinated will be prioritized.
Clients are not billed directly for services and we will not balance bill for our Covid-19 home vaccination service. We seek reimbursement from private insurance or federal government programs.
HOME HEALTH ORDER
We have attached a copy of our Home Health Physician/Ordering Provider Order Form template that can be used, or please feel free to use your own template. Only physicians, NPs and PAs are currently allowed to write a home health order. Additionally, please submit a copy of your face-to-face encounter notes where you spoke with your fertility or pregnant patient about receiving the Covid-19 vaccine, along with your home health order. As time is of the essence and to minimize vaccine wastage, please submit your order as soon as possible, so we coordinate multiple home visits per day.
If you have any questions, then please feel free to contact our office at (206) 310 - 5101 or fax any documents to (206) 407-3301. You can also securely email us at Vaccine@ChildressNursing.com
Childress Nursing Services