• Referral Submission Form

    Referral Submission Form

    Submit your patient referral and documentation securely.
  • Format: (000) 000-0000.
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  • HIPAA Compliance & Confidentiality Notice

    This secure referral portal is intended solely for the authorized transmission of Protected Health Information (PHI) to Rice Home Health for treatment, payment, and healthcare operations purposes in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the HITECH Act.

    All information submitted through this portal is encrypted in transit and stored within a HIPAA-compliant environment protected by administrative, physical, and technical safeguards consistent with the HIPAA Security Rule (45 CFR Part 164, Subpart C). Access to submitted information is restricted to authorized personnel and is subject to monitoring and audit controls.

    By submitting documentation through this portal, you represent and warrant that:

    You are authorized to disclose the information provided for legitimate healthcare referral purposes under 45 CFR §164.506.

    The disclosure complies with applicable federal and state privacy laws.

    The information submitted is accurate to the best of your knowledge.

    Unauthorized access, misuse, or transmission of information through this system is strictly prohibited and may subject the responsible party to civil and criminal penalties under applicable law.

    If you believe information has been submitted in error, please contact our Intake Department immediately at:

    Phone: (918) 609-0109
    Central Fax: (855) 775-8537
    Referral Email: referrals@ricehomehealth.com

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