Referrals

At Access Hospital Dayton, we strive to make the referral process as simple as 1-2-3!

Step 1: Determine Clinical Eligibility

• Does the patient require inpatient detox, substance abuse, mental health, or dual-diagnosis services?
• Is the patient 18 years or older?

Step 2: Determine Financial Eligibility

• Does the patient have Medicare bed days available, Managed Care, private insurance, or the ability to self-pay?

Step 3: Submit Patient Information for Review

If you answered “Yes” to all of the above questions, fax the following patient information to 937.965.4950 for immediate review:

• Demographic information
• Insurance information
• Patient’s photo ID
• Guardian or healthcare power of attorney contact information (if applicable)
• An assessment that includes presenting problems and behaviors/symptoms describing how the individual meets criteria for acute inpatient care
• Diagnosis sheet for medical and psychiatric evaluation
• Complete medication list
• Last doctor’s note
• Most recent lab work
• Pink slip (if applicable)
• Contact information for a nurse-to-nurse report
• Completed Voluntary Admission Form

Upon receipt, an Admissions Specialist will confirm clinical and financial eligibility and then follow-up directly with an admission decision!

If you have any questions about or during the referral process, please do not hesitate to call us at 937.256.7801.