Hospital Staff Referral Portal
Hospital Staff Referral Portal
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Your gift opens the door for families in crisis. Support our Open A Door For A Family campaign!
This portal is exclusively for social workers,
case managers, doctors, and nurses.
This portal is exclusively for social workers,
case managers, doctors, and nurses.
NOTE: Guests cannot refer themselves.
NOTE: Guests cannot refer themselves.
The 4-Step Referral Process
The 4-Step Referral Process
To ensure a smooth transition for your patient's family,
please review our quick checklist before submitting the form below.
To ensure a smooth transition for your patient's family,
please review our quick checklist before submitting the form below.
1. Identify the Need
1. Identify the Need
Clinical Severity: Assess if the patient is currently admitted to a specialized unit (Acute Care, Inpatient Services, ICU, PCU, or NICU).
Geographic Distance: Confirm that the family’s permanent residence is located at least 25 miles away from the hospital facility.
Safety & Stability: Verify that the family environment is stable, non-threatening, and free of active contagious diseases.
2. Educate the Family
2. Educate the Family
Guest Resources: Provide the family with a physical copy of our guest brochure. This helps them understand our house guidelines and available amenities before they arrive.
Cost-Free Lodging: Rest assured that staying at Jacob’s House is completely FREE for eligible families.
Accessible Support: We have a small optional donation of $20 per night to help sustain our mission.
3. Connect with Us
3. Connect with Us
We are here to answer your questions and guide you through the referral process. Reach out to our team at any time for assistance or updates.
Call us directly at
951-452-2627
to let us know you will be referring a family to us.Follow the "Click Here to Submit a Referral" link to our secure form just under these instructions.
4. Application Review
4. Application Review
Response Time: We review all submissions within 4 hours. (Note: Referrals sent after 8:00 PM will be reviewed the following morning at 9:00)
Next Steps: Our staff will conduct a brief phone interview with the primary guest and send them a registration link.
Check-In Hours: Families can be received at the house between 8:00 AM and 8:00 PM.
Complete the referral form below.
Pressing the SUBMIT button will send it to us.
Complete the referral form below.
Pressing the SUBMIT button will send it to us.
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