Public Health accepts referrals from professionals or individuals by phone, fax or mail. Email is accepted if sent by a secure, encrypted service to email@example.com.
Due to the COVID-19 outbreak, in-person home visits will not be available at this time. Public Health Nurses are able to complete assessments, and provide health education and connections to resources by phone. If a client needs direct clinical services, we recommend they work with their health care provider to receive this care.
If your browser opens the PDF in a new window, you must download the form to your computer. After completing and saving, email the PDF to firstname.lastname@example.org.
Include detailed information about the reason for the telephonic nurse visit. A more complete form will help us better meet an individual’s needs.
Include a discharge summary or other relevant medical information as appropriate, along with the completed referral form. (Bloomington Public Health does not have access to Epic or any other external electronic medical records.)