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Telehomecare Referral Form
ELIGIBILITY FOR TELEHOMECARE SERVICES
- Patient has an established diagnosis of Heart Failure or COPD (with or without co-morbid conditions).
- Health care provider feels the patient will benefit from Telehomecare. (This would require the patient or caregiver being able to operate simple equipment.)
- Patient lives in a residential setting with an active land line (internet or analog phone line).
- Patient or family caregiver is able to provide informed consent to participate.
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