×

Admissions Referral Form

Admissions Referral Form





UniHealthCare accepts client/resident referrals and works to ensure each individual is matched with the most suitable home environment to meet their specific needs. To facilitate the referral process, we ask that you provide the details requested in this online form.

Kindly fill out the following form to the best of your ability:

Current Residential Information

Essential information for prospective clients
Resident's Name
Resident's Name

First

Last





Your Current Housing Information





Our Accepted Payment Method

Residents are not required to make private payments prior to moving in. We accept BI, CADI and Elderly Waivers upon move-in.







Group Residential Housing (GRH) is a state-funded income supplement program that covers room and board expenses for low-income adults residing in licensed or registered facilities, where a county human services agency has established a monthly rate agreement.

Case Management Team

Case Manager's Name
Case Manager's Name

First

Last


Rep Payee's Name
Rep Payee's Name

First

Last


Housing Preferences







Assistance Pets/Animals


Supporting and Assessment Documents Available





Select below assessments and supporting documents available


Interagency Medication Reconciliation

Our team will collaborate with the resident's care team, including the case manager, to simplify the interagency medication reconciliation process. This process involves five key steps: (1) reviewing the current list of medications; (2) compiling a list of any new or prescribed medications; (3) comparing both lists of medications; (4) making informed clinical decisions based on the comparison; and (5) sharing the updated medication list with the resident/client and staff.



Copyright ©2025 all rights reserved