BridgeCare Health Network · by The Comfort Homes, LLC
Patient Demographics
Primary Care Doctor
Insurance
Medications & Supplies
⚠ Patient will bring a minimum 5-day supply of ALL medications upon arrival. BridgeCare does not provide, nor pay for any medications.
Physical Information & Bed Size
Facility Policies
🚧 Alcohol and recreational drug use are PROHIBITED during your stay.
🚧 Smoking and vaping are PROHIBITED. This is a 100% non-smoking facility and campus. No accommodations will be made. Nicotine patch/gum may be discussed with your provider.
Respiratory Support
Skilled Home Care Agency Preference
For RN, PT, OT, SLP, HHA and MSW — if ordered by your doctor. Not guaranteed.
Your BridgeCare Stay
Forms & Billing
DocuSign forms (Release of Information, Admission Agreement, Home Care Contracts) will be emailed for completion prior to admission/arrival.
Please describe your next steps once you are ready to leave. Include where you will go, transportation, additional support, and any anticipated barriers.
🔒 By submitting this form you consent to BridgeCare Health Network contacting you. DocuSign agreements will be sent separately for official signatures before admission.
