Referral


Referral

Dear Prospective Member:

Thank you for your interest in services provided by Vista Health Services. Please complete the enclosed application and forward, along with the following listed below, to Vita Health Services Administrator.

  • Complete Social History
  • Current Physical (within 30 days)
  • Clear two-step Manatoux test or Chest X-ray (within 90 days)
  • Signed Required Level of Care by a physician
  • Current Diet Order
  • List of current medications and hard (written) scripts on day of admission . Notice of Decision for Habilitation or Intellectual Disability funding

Upon receipt of the above items, our leadership team will review your application and contact you.

Please consider the regulations pertaining to a Residential Care Facility, contained in Chapter 57 of the Iowa Code:

135c.23 Express requirements/or admission or residence.

A health care facility shall not knowingly admit or retain a resident:

  • Who is dangerous to the resident or other residents.
  • Who is an acute stage of alcoholism, drug addiction, or mental illness.
  • Whose condition or conduct is such that the resident would be unduly disturbing to other residents.
  • Who is in need of medical procedure, as determined II)’ a physician or services which cannot be or are not being carried out in the facility.

Again, thank you for your interest in services with Vita Health Services.

Referral Forms:

VHS Application Form [78KB]

Level of Care Form [35KB]

Online Application:

VHS Online Application

Providing Opportunities to Individuals in Need


At Vita Health Services, we believe that the person should remain the center of the entire service planning and delivery process, and that process should incorporate his/her future plans. The plan should be designed with the individual’s specific desires and support requirements as the priority.