Human Wellnome

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Our Services

GUIDE – Dementia Care
Brain Health Assessment
Transition of Care

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FOR STAFF

Guide Referral

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From physician leaders in rehabilitation, prevention, & technology, empower your patients to monitor their health. Safe, secure, and fun!

SMARTPHONE ENABLED:

Cardiac rehabilitation
Pulmonary rehabilitation
Diabetes rehabilitation
Cancer rehabilitation
Diabetes prevention
CVD prevention
Cancer prevention
Alzheimer's prevention
Hospitalization prevention
Fall prevention
Pre-surgical prevention
Wellness

Best Referral Contact *

Patient Details *

Best Patient Contact *

Patient Family / Friends

Select Relative

Daughter Friend Husband Other family Son Wife

Note (Optional)

Selfcare Support Service

During the past year, have you experienced changes in thinking, remembering, or decision-making? For example, have you had more difficulty remembering people, places, or things? Have you had more difficulty making decisions? *

Yes No Not sure

Does forgetfulness (such as paying your bills or counting change) cause problems in your daily life? *

Yes No Not sure

Has a doctor or other health care professional ever told you that they have Alzheimer’s disease or another form of dementia? *

Yes No Not sure

Are you enrolled in BOTH Medicare Parts A and B? *

Yes No Not sure

Is Medicare your primary health insurance? *

Yes No Not sure

Are you enrolled in Medicare Advantage or another Medicare health plan (SNP, PACE)? *

Yes No Not sure

Are you participating in a Medicare Hospice service? *

Yes No Not sure

Do you live in a long-term care facility or nursing home? *

Yes No Not sure

Are you currently participating in a Medicare GUIDE program with another medical provider? *

Yes No Not sure

Demonstrating a next generation sub-specialty that transforms physiatry and independent pharmacies as the new self management support team for you.

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