Would you like to make a referral to Hope Harbor?
Referrals can be made by a family member, friend, psychiatrist, doctor, nursing home, hospital or community agency. An older adult may also make a self-referral.
The following four items need to be completed and faxed to 712.213.4034 for consideration of admission. Additional information will be requested upon provider approval.
If you submit a referral during business hours and have not heard from us within two hours, please call us at 712-213-8656. You may also email the referral paperwork to Hope.Harbor@bvrmc.org.
- Copy of complete History and Physical within the past 6 months.
- Recent lab work: CBC, BMP and UA within two weeks of admission.
- Complete the Hope Harbor Admission Form below, including attempted medical and non-medical interventions used with dates and outcomes for the past few days.
- Copy of front and back of Medicare and other insurance cards.
Please call 712.213.8656 or email Hope.Harbor@bvrmc.org if you have questions. We want to make this process as easy as possible for you.