CareLink

CareLink by HCP

Partner Referral Portal
Submit a referral for Home Care, Senior Living Placement, CalAIM, or Disabilities Services

Our Operations team will follow up within 1 business days. All submissions are confidential
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Your relationship to the individual needing care
- Client Name
  
  First NameLast Name
- Phone Number
  Format: (000) 000-0000.
- Best Time to Contact
- City of Residence
- Region / Territory
- Type of Care Needed
- Estimated Start of Care Date
- Estimated hours of care needed per week
- Point of Contact Name
- Point of Contact phone number
  Please enter a valid phone number.Format: (000) 000-0000.
- Care Needs / Additional Notes
  Describe the client's care needs, conditions, and special requirements
- Partner Organization (If Applicable)
  Submitting on behalf of a referring organization?
- Privacy Notice
- Home Care Placement is a licensed non-medical home care organization, not a medical provider. This is not a HIPAA Notice of Privacy Practices. We collect the information on this form to evaluate care needs and coordinate services, whether you're a family member inquiring about care or a professional referral source.
  
  In some cases, this may include protected health information (PHI) shared by a health care partner, such as a hospital, skilled nursing facility, home health, or hospice provider. We use this information only to coordinate care and communicate with you and any referral partners involved, we don't sell it, and we limit access to staff involved in care coordination.
  
  If you are submitting this form on behalf of someone else, please confirm they have been informed their information is being shared with us for this purpose.
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CareLink by HCP

Submit a referral for Home Care, Senior Living Placement, CalAIM, or Disabilities Services

Privacy Notice