Due to HIPPA our online referral cannot accept protected information. Please use our e mail address email@example.com provide supporting documents, such as MA- 51 and PASRR. If you have questions or are not able to complete our online form our Information and Referral Unit can assist you by telephone.
To manage the high volume of referrals as quickly as possible, we are asking hospitals, facilities and other agencies to use our online referral form rather than submitting handwritten referrals.
Instructions for using the online form are available:
The easiest thing to do is enter the referral online, then send us an e-mail containing any documents (i.e. MA-51 or PASRR-ID or other items). Our general e-mail address is firstname.lastname@example.org. We’ll forward the referral, your message and the documents to the correct staff person. Please direct questions about referrals and services to the Information and Referral Unit at717 299- 7979 or email@example.com
Please note that if you need to report concerns about abuse, neglect, or exploitation, please do so by phone at 717-299-7979, 24 hours a day.
Please do not use the online form for reports regarding concerns for safety and risk as a result of abuse, neglect, or financial abuse.